10 Upper Back Pain Red Flags (Plus What To Do About Them)

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So you've got upper back pain and you're worried that there's something more serious.

I understand. It's not a comfortable situation to be in.

But it is very common.

Up to 80% of adults will experience upper back pain at some point in their lives ^[1] 

It affects people of all ages, genders, and occupations. In fact, it's estimated that 1 in 5 adults experience this condition regularly ^[2].

So you're definitely not alone.

Continue reading as we explore the red flag signs and symptoms, strategies for managing upper back pain, and tips for prevention and self-care.

Whether you've got upper back pain or you're looking to prevent it in the future, this post will give you the tools you need.

What Makes The Upper Back Different?

So what part of your back is "upper" anyway?

Your back is a complex structure consisting of bones, muscles, ligaments, and nerves.

The vertebral column (that's your spine), is the central structure of your back, extending from the base of the skull to the pelvis. It's made up of 33 individual vertebrae, stacked one on top of the other ^[3].

These vertebrae are divided into five regions, including the cervical, thoracic, lumbar, sacral, and coccygeal. The thoracic region of the spine is the middle portion, located between the cervical and lumbar regions.

This region is made up of 12 vertebrae, which are connected to your ribcage and protect vital organs such as the heart and lungs ^[4]. The upper portion of the thoracic region, specifically the area between the shoulder blades, is considered the upper back ^[1].

The muscles of your upper back are responsible for shoulder and arm movements and help maintain good posture, at your desk and otherwise ^[4].

The trapezius muscle (or "trap") is the large triangular muscle that goes from the neck to the shoulder blades and down to the mid-back ^[1].

The rhomboid muscles, located beneath the trapezius, help to retract the shoulder blades. Also, the levator scapulae muscles, located at the back and sides of your neck, help to elevate your shoulder blades ^[4].

Unlike other regions, the upper back has a limited range of motion due to its connection to the ribcage, making it more stable ^[1].

However, this stability can also make it more prone to pain and stiffness if you don't care for your muscles and joints. Poor posture, muscle strain, and spinal abnormalities can all contribute to upper back pain.

Some activities that engage the upper back include:

• Carrying heavy bags
• Pulling or pushing objects
• Reaching for objects above your head
• Household chores like sweeping, mopping, etc

Also, exercises like rowing, pull-ups, and back extensions can target and strengthen the muscles of the upper back ^[4]. We'll cover more on that later.

What Is a Red Flag & What Do They Mean?

Upper back pain is a common complaint, but in some cases, it could be a red flag for a more serious underlying medical issue.

In the medical field, red flags are symptoms or signs that indicate the possibility of a serious medical condition that requires prompt evaluation and treatment ^[7].

It's important to note that not all cases of upper back pain are indicative of a serious underlying medical issue, and most cases resolve with rest, exercise, physio, chiropractic practices, and proper posture ^[5].

However, if you experience any upper back pain red flags, it's crucial to seek medical attention promptly to rule out any serious conditions ^[7].

What Are The Red Flags For Upper Back Pain?

Here are some common examples of upper back pain red flags to be aware of:

1. Trauma

If you have experienced a fall or injury that caused your upper back pain, seek medical attention right away ^[1].

2. Fever

A fever accompanied by upper back pain may indicate an infection and the back pain might be a sign of a systemic disorder ^[7].

3. Back pain at night

If you experience frequent upper back pain at night, this may be a sign of a serious underlying condition such as cancer or infection ^[5]. You can find a more detailed article dedicated to back pain at night here.

4. Unexplained weight loss

If you've got unexplained weight loss along with upper back pain, it may be a sign of a serious underlying condition attention ^[5].

5. Severe pain

Severe upper back pain that don't respond to over-the-counter medications should be taken seriously ^[5].

6. Loss of bladder or bowel control

This is a medical emergency and requires immediate medical attention as it may indicate a spinal cord injury ^[4].

7. Numbness or tingling

If you experience numbness or tingling in your upper back, it may be a sign of nerve compression, requiring medical management ^[5].

8. History of cancer

If you have a history of cancer and are experiencing upper back pain, it may be a sign of metastasis (spread of cancer) ^[7].

9. Pain that is not relieved with rest

If your pain is not relieved with rest and conservative measures, it may be a sign of a more serious underlying condition ^[5].

10. Pain that lasts longer than six weeks

If your pain lasts longer than six weeks, it may be a sign of a chronic back condition. If that's true, an orthopaedic or neurosurgical review might be a good idea^[5].

While most cases of upper back pain are not serious, it is important to be aware of these red flags as they may indicate a more serious underlying condition. Seek medical attention right away if you experience any of these symptoms.

Lifestyle Factors That Cause Upper Back Pain

Upper back pain can be caused by a range of lifestyle factors, sometimes even caused by heartburn ^[8][9]. Here are some common examples of poor lifestyle choices that can contribute to upper back pain:

1. Poor posture, including slouching over a desk or screen ^[6][9]
2. Carrying heavy backpacks or bags ^[9]
3. Sedentary lifestyle and lack of exercise ^[7]
4. Smoking can lead to the degeneration of spinal discs ^[8]
5. Overuse or repetitive strain injuries from activities like sports, lifting, or manual labor ^[9]
6. Sleeping on a poor-quality mattress or pillow ^[9]
7. Poor nutrition and obesity can put extra strain on the back ^[7][8]
8. Stress and anxiety can cause tension in the upper back muscles ^[6]
9. Prolonged periods of standing or sitting ^[10][11]
10. Underlying medical conditions like arthritis or fibromyalgia ^[11]

By addressing these lifestyle factors, you may be able to alleviate some of the upper back pain you're experiencing.

How to Relieve Upper Back Pain Relief

Upper back pain can be debilitating and frustrating, but there are plenty of things you can do to alleviate your symptoms. Here are some tips and tricks to help you manage your upper back pain.

Stretching & Exercises 

Staying active can help ease your pain and prevent future flare-ups. Strength training exercises that target your upper back muscles can help improve your posture and reduce tension ^[9].

Stretching can help alleviate tightness and tension in your upper back. Try simple stretches like the doorway stretch or the chest opener stretch to improve your range of motion and relieve discomfort ^[10].

Desk posture adjustments

Poor posture can contribute to upper back pain, especially if you work at a desk. Make sure you sit up straight and avoid slouching, and adjust your workspace to minimise strain on your neck and shoulders ^[9]. I have a guide to proper desk posture here.

Heat and ice therapy

Applying heat or ice to your upper back can help reduce inflammation and relieve pain. Experiment with both to see what works best for you ^[13].

Massage therapy

A professional massage therapist can work out knots and tension in your upper back, providing relief from pain and discomfort ^[10].

Yoga

Yoga can help improve your flexibility, strengthen your muscles, and reduce stress levels, all of which can contribute to upper back pain relief ^[12].

Mindfulness practices

Techniques like meditation and deep breathing can help reduce stress levels, which can alleviate upper back pain caused by tension ^[13].

Good sleep hygiene

Getting adequate sleep and using a supportive mattress and pillow can help alleviate mild to moderate upper back pain.

Maintain a healthy diet

A healthy diet can help manage body weight. And a balanced body is typically easier for the back to manage and less prone to back pain. In some cases, heartburn can actually contribute to back pain too.

Physiotherapy

A physiotherapist can provide exercises and treatments that can help alleviate upper back pain. Physiotherapy may include massage therapy, spinal mobilisation, and postural correction techniques ^[13].

Chiropractic practices

Chiropractors use spinal manipulation and other techniques to align your spine and improve your overall health. This practice has been shown to be effective in reducing upper back pain ^[9].

Swimming

Swimming is a low impact exercise that makes it very good for working all the muscles in your back. But there are a few caveats to be aware of. Check out my article on swimming and how it can help back pain.

When To Speak With Your Own Doctor About Your Back

If you've been getting upper back pain, you may be wondering whether you should seek professional help. Well, some back soreness can definitely be treated at home. 

But the upper back pain red flags covered in this article provide the answer to this question ^[11].

Also, if your back pain is affecting your daily life and activities, it's worth seeing a doctor. That means when your pain is preventing you from doing things you enjoy, or if it's interfering with your ability to work or perform daily tasks ^[12].

Finally, if you've tried self-care techniques such as:

1. Rest
2. Ice
3. Over-the-counter pain medication

...and your upper back pain isn't improving or is getting worse, speak with a doctor ^[10].

References:

Spine Structure and Function. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/articles/10040-spine-structure-and-function

How common is back pain? Brainlab.org. Available at: https://www.brainlab.org/get-educated/spine/investigate-spine-disorder/how-common-is-back-pain

Mahadevan, V., 2018. Anatomy of the vertebral column. Surgery (Oxford), 36(7), pp.327-332. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0263931918300978

Devereaux, M.W., 2007. Anatomy and examination of the spine. Neurologic clinics, 25(2), pp.331-351. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0733861907000163

All About Upper Back Pain. Spine Health. Available at: https://www.spine-health.com/conditions/upper-back-pain/all-about-upper-back-pain Is Poor

Posture Causing Your Back Pain? Spine Health. Available at: https://www.spine-health.com/blog/poor-posture-causing-your-back-pain

Maselli, F., Palladino, M., Barbari, V., Storari, L., Rossettini, G. and Testa, M., 2022. The diagnostic value of Red Flags in thoracolumbar pain: A systematic review. Disability and Rehabilitation, 44(8), pp.1190-1206. Available at: https://www.tandfonline.com/doi/abs/10.1080/09638288.2020.1804626 

Bikbov, M.M., Kazakbaeva, G.M., Zainullin, R.M., Salavatova, V.F., Gilmanshin, T.R., Arslangareeva, I.I., Nikitin, N.A., Mukhamadieva, S.R., Yakupova, D.F., Panda-Jonas, S. and Khikmatullin, R.I., 2020. Prevalence of and factors associated with low Back pain, thoracic spine pain and neck pain in Bashkortostan, Russia: the Ural Eye and Medical Study. BMC Musculoskeletal Disorders, 21(1), pp.1-14. Available at: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-3080-4

10 Most Common Causes of Upper Back Pain. Available at: https://www.chirodenton.com/10-most-common-causes-of-upper-back-pain/

The Muscles of the Back. Good Path. Available at: https://www.goodpath.com/learn/muscles-back

Briggs, A.M., Smith, A.J., Straker, L.M. and Bragge, P., 2009. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents, and adults. A systematic review. BMC Musculoskeletal Disorders, 10(1), pp.1-12. Available at: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-10-77

Ratzlaff, E., 2012. Yoga for back pain: a physiotherapy perspective. RCSI SMJ, 5, pp.84-9. Available at: http://www.rcsismj.com/wp-content/uploads/RCSIsmj-Vol5-Yoga-for-Back-Pain.pdf

Andersson, H.I., 2009. Increased mortality among individuals with chronic widespread pain relates to lifestyle factors: a prospective population-based study. Disability and Rehabilitation, 31(24), pp.1980-1987. Available at: https://www.tandfonline.com/doi/abs/10.3109/09638280902874154