Upper Back Pain: Where It Usually Comes From

Upper back pain is frequently not an upper back problem. The mid and lower cervical segments refer pain down between the shoulder blades, and the joints where the ribs meet the spine refer it around the side of the chest. That referral is why pressing or rubbing the sore spot produces only brief relief before the ache returns.

Long periods at a desk and on a phone form the usual background, because both hold the shoulder blades forward for extended stretches. Changing position every half hour does more than any single stretch.

For more information about upper back pain, contact the Bukit Damansara (KL) main center: WhatsApp+60 17 269 1873 Call+603 2093 1000

Key Points About Upper Back Pain

Upper back pain is commonly felt between the shoulder blades, around the thoracic spine, or near the rib joints.
Pain in the shoulder blade area is often referred from the lower neck, especially the C5–C6 and C6–C7 segments.
Common triggers include long periods of desk work, driving, lifting and phone use.
The thoracic spinal joints, rib joints, and the trapezius and rhomboid muscles are frequent contributors.
Assessment checks whether the source is in the upper back itself or referred from the neck.
Care may include low-force chiropractic joint mobilization, physiotherapy, soft-tissue work and guided exercise.

Common Signs & Causes of Upper Back Pain

Upper back pain is often noticed as symptoms around the shoulder blades, upper thoracic spine, or where the ribs meet the back. Common signs and causes may include:

stiffness or tightness between the shoulder blades
pain that builds up after desk work, driving, or prolonged sitting
soreness after lifting, exercise, or sleeping in one position
symptoms linked to lower neck stiffness or shoulder blade muscle strain
irritation of the thoracic spinal joints or rib joints
pain that spreads from the neck into the upper back
disc-related changes in the lower neck that refer symptoms into the shoulder blade area
posture-related strain from prolonged screen use or phone use

For desk workers, the Desk Posture Mistakes video shows how the chair, screen, keyboard and mouse are set up, and why Yama Zafer, D.C., recommends standing up every 15 minutes for people with neck or back issues.

Arranging an Upper Back Assessment at CSC

To arrange an assessment at our Kuala Lumpur centers, see the Bukit Damansara contact page and the Bandar Sri Damansara contact page, or call either center directly:

Bukit Damansara (KL, main center): Call +603 2093 1000 or WhatsApp +60 17 269 1873 to see the Bukit Damansara / KL center.
Bandar Sri Damansara (KL): Call +603 6262 5777 or WhatsApp +60 12 455 6939 to see the Bandar Sri Damansara center.

Upper Back Concerns

While lower back issues are often discussed more frequently, pain in the neck and upper back is also common, particularly around the shoulder blades and upper thoracic spine. There are numerous causes of upper back pain, with the most common ones being shoulder-related issues, lower neck complications, spinal disc concerns (such as those cared for with our non-invasive slipped disc methods), arthritis, osteoporosis, spondylosis, degenerative joint issues, muscle spasms, irritated rib joints, sprains/strains, fractures, and even malignancies.

The Function of the Thoracic Spine

The upper back, or thoracic spine, runs from the base of the neck to the bottom of the rib cage. It is made up of 12 vertebrae, each joined to a pair of ribs. While the neck and lower back are built mainly for movement, the thoracic spine is built more for stability. Its two main roles are:

Anchoring the rib cage: the ribs attach to the thoracic spine and protect the heart and lungs.
Protecting the spinal cord: the vertebrae form a bony canal around the spinal cord, which carries signals between the brain and the body.

About Your Back

Upper back pain can come from the soft tissues, joints and bones of the upper back, shoulders or neck. The spine is made up of 24 movable vertebrae (7 in the neck, 12 in the upper back and 5 in the lower back), sitting on the sacrum and coccyx at the base.

Between the vertebrae are the spinal discs, which absorb load and allow movement. The spinal canal, formed by the vertebrae, carries the spinal cord from the brain to the upper lower back, where it continues as a bundle of nerve roots called the cauda equina. Upper back pain arises when the joints, muscles, ligaments, discs or nerves of the spine or rib cage are irritated or injured.

Why the Upper Back Is Prone to Strain and Structural Changes

The upper back is made up of the thoracic spine, rib joints, shoulder blade muscles, and the soft tissues that help stabilize posture throughout the day. Because several structures work together in this region, symptoms may sometimes begin in one area but be felt more broadly across the shoulder blades, upper ribs, or lower neck.

Repeated desk work, prolonged sitting, lifting, sports activity, carrying bags, and posture-related strain can place ongoing stress on these tissues. Over time, this may contribute to muscle tightness, joint stiffness, ligament strain, or changes involving the surrounding spinal discs and joints, particularly when the area is not given enough recovery time.

Upper back injuries are relatively common due to the complexity of the anatomical structures within the associated spinal segments. Soft tissues, including muscles, tendons, ligaments, and spinal discs, are particularly vulnerable to injury. Various factors can contribute to upper back pain, including muscle tears, damaged ligaments, nerve impingement, facet joint arthritis, vertebral fractures, and slipped discs (protruded, herniated, or prolapsed spinal discs).

Spinal Joints & Upper Back Pain

Facet joints, the small paired joints at the back of each spinal segment, are a common source of upper back pain. In a study of people with chronic thoracic pain, controlled diagnostic blocks identified the facet joints as the source in about 48% (Manchikanti et al., 2002), and a later study of chronic spinal pain found a prevalence of 42% for the thoracic region (Manchikanti et al., 2004).

Facet joint pain is often associated with facet hypertrophy (arthritis or bone spurs) and thickening of the ligamentum flavum. Conservative care is the usual first approach, and it is reasonable to exhaust non-invasive options before considering spine surgery.

Why Is the Pain Between My Shoulder Blades?

Pain between the shoulder blades is often linked to muscle strain, posture-related stress, and stiffness in the thoracic spinal joints. Prolonged desk work, driving, phone use, lifting, and sleeping in one position can place repeated stress on the trapezius, rhomboid, and upper thoracic muscles, which may lead to tightness and soreness in the area between the shoulder blades.

In some cases, the source may not begin in the upper back itself. Reference texts describe how lower cervical segment changes (bulges, protrusions, prolapses & extrusions), particularly around the C5–C6 and C6–C7 levels, may refer symptoms into the peri-scapular region or the area between the shoulder blades, especially when associated with nerve root irritation, lower neck stiffness, arm symptoms, or tingling.

Because this symptom pattern may arise from the upper thoracic spine, rib joints, shoulder blade muscles, or lower cervical segments, a detailed assessment helps determine whether the source is local to the upper back or referred from the neck. Detailed guides are available for the C5-C6, C6-C7, and C7-T1 pages.

Reference: Margetis K, Dowling TJ. Cervical Degenerative Disc Disease. StatPearls Publishing; updated August 2, 2025

Slipped Disc & Upper Back Pain

The joints of the upper back are not always the sole cause of pain. Neck issues, such as a slipped disc at the C5-C6 level, can often refer pain to the upper back.

Although slipped discs are rare in the upper back, they are a more common cause of pain in the neck, and this pain frequently extends to the upper back, especially around the shoulder blade area.

Therefore, upper back pain is a typical symptom for those experiencing a slipped disc in the neck. For that reason, the neck is examined as part of any upper back assessment.

Another factor to consider is the rib cage. Irritation of the joints where the ribs meet the spine or the breastbone can also cause pain around the upper back and chest wall.

Non-Surgical Care for Upper Back Pain

Upper back pain may begin from the thoracic joints, surrounding muscles, rib attachments, or symptoms referring from the lower neck. Because several structures can contribute to symptoms in this region, care is best guided by a detailed assessment rather than assumptions based on the location alone.

Non-surgical upper back care is typically structured around identifying whether the source is joint-related, muscle-related, posture-related, or referred from the cervical spine. Depending on what is found, care may include gentle chiropractic joint mobilization, physiotherapy, soft tissue work, guided rehabilitation, and postural correction strategies to reduce repeated stress on the upper thoracic and shoulder blade region.

An early assessment may help determine whether symptoms are linked to the thoracic spine, lower neck segments, rib joints, or surrounding soft tissues, allowing care to be matched more specifically to the findings.

Care must be taken when getting neck and upper back care to ensure that the type of care is not through aggressive methods. Learn more about the impact of aggressive neck care by watching this video.

Why Upper Back Tightness May Increase During Pregnancy

As pregnancy progresses, changes in breast weight, rib positioning, and sitting posture may increase strain through the upper back and shoulder blade region. Many individuals notice tightness between the shoulder blades or upper thoracic stiffness during desk work and sleep. Read more about pregnancy chiropractic and physiotherapy .

Readers comparing costs can find the chiropractic fees in Kuala Lumpur and the physiotherapy price in Kuala Lumpur on their own pages.

The Hidden Risks of Viral Neck Adjustment Trends Video

Online videos showcasing the Ring Dinger®, Y-Strap, and towel-based neck pulls may appear convincing, but these forceful methods can be hazardous to your spinal health. Sudden, high-velocity traction can impact critical structures in the neck, including the vertebral arteries, discs, and brainstem posing significant risks for individuals with disc degeneration, bone spurs, or vascular sensitivity. Even mild wear-and-tear in the cervical spine can increase susceptibility to complications such as vertigo, nerve irritation, or vascular damage.

For the chapter list and the transcript, open the Neck Cracks Are Dangerous video page.

Upper Back Care: Quick Recap

Upper back pain may begin from the thoracic joints, rib attachments, shoulder blade muscles, or symptoms referring from the lower neck. Because several structures can contribute to symptoms in this region, a detailed assessment helps determine whether the source is local to the upper back or related to the cervical spine. An early assessment helps guide more specific non-surgical care.

Upper Back FAQ: Common Questions About Shoulder Blade & Thoracic Symptoms

Upper back pain can come from several areas, including the shoulder blade muscles, thoracic joints, rib attachments, or symptoms referring from the lower neck. The questions below cover the most common concerns people ask about pain between the shoulder blades, thoracic stiffness, and neck-related upper back symptoms.

Why do I feel pain between my shoulder blades?

Pain between the shoulder blades is often linked to posture-related muscle strain, prolonged sitting, desk work, driving, or stiffness in the thoracic spinal joints. In some cases, symptoms may also be referred from the lower neck, especially the C5–C6 and C6–C7 segments.

Can a neck issue cause upper back pain?

Yes. Lower cervical segment changes, especially around C5–C6 and C6–C7, may refer symptoms into the shoulder blade area or upper thoracic region. This may happen even when neck symptoms are mild compared to what is felt in the upper back.

What muscles commonly cause pain in the upper back?

The trapezius, rhomboid, levator scapulae, and surrounding thoracic muscles are common contributors. Tightness or overuse in these muscles often leads to symptoms around the shoulder blades.

Can poor posture cause upper back stiffness?

Yes. Prolonged desk work, repeated phone use, and slouched sitting posture may place repeated stress on the thoracic joints and shoulder blade muscles, which commonly leads to tightness and stiffness.

When should upper back pain be assessed?

Consider an assessment if symptoms continue to affect work, sleep, posture, driving, or daily activity, especially when symptoms spread from the neck into the shoulder blade region or are associated with tingling or arm symptoms.

Can rib joints cause upper back symptoms?

Yes. The joints where the ribs attach to the thoracic spine and sternum may contribute to upper back pain, especially during twisting, deep breathing, lifting, or prolonged sitting.

Can a slipped disc in the neck cause symptoms in the upper back?

Yes. A lower cervical disc bulge, protrusion, prolapse, or extrusion may sometimes refer symptoms into the area between the shoulder blades, especially when the C5–C6 or C6–C7 levels are involved.

How is non-surgical upper back care usually structured?

Care is typically guided by assessment findings and may include chiropractic joint mobilization, physiotherapy, soft tissue work, guided rehabilitation, and posture correction strategies.

Peer-Reviewed Medical References

Manchikanti L, Singh V, Pampati V, et al. Evaluation of the prevalence of facet joint pain in chronic thoracic pain. Pain Physician. 2002;5(4):354-359.
Manchikanti L, Boswell MV, Singh V, et al. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord. 2004;5:15.
Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77.
Cleland JA, Glynn P, Whitman JM, et al. Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther. 2007;87(4):431-440.
Walser RF, Meserve BB, Boucher TR. The effectiveness of thoracic spine manipulation for the management of musculoskeletal conditions: a systematic review and meta-analysis of randomized clinical trials. J Man Manip Ther. 2009;17(4):237-246.
Margetis K, Dowling TJ. Cervical degenerative disc disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. StatPearls (NCBI Bookshelf).

These sources describe thoracic and neck pain in general; none of them evaluates care at Chiropractic Specialty Center.

The Author of Upper Back Pain: Where It Actually Comes From

Upper Back Pain: Where It Actually Comes From was written by Yama Zafer, D.C., who has 30+ years in chiropractic and physiotherapy and founded Chiropractic Specialty Center in Kuala Lumpur in 2006.

Last Updated: Upper Back Pain: Where It Usually Comes From

Upper Back Pain: Where It Usually Comes From was last reviewed and updated on September 25, 2026.

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