Pain in the upper back

Pain in the upper back can occur between the lower neck region and the last rib; they are rather rare compared to neck and lower back pain.

They can be acute or chronic, continuously present or only noticeable during certain movements.
In most cases, upper back pain is caused by muscle or joint problems, but lung cancer can also cause symptoms in this area and therefore they must not be treated with negligence.



Ribs are the flat, rod-shaped bones of the rib cage (there are 12 pairs of ribs in the human body) that surround and protect the vital organs in the rib cage.
They have their origin in the 12 thoracic vertebrae and extend to the sternum.

The chest is formed from ribs, thoracic vertebrae and sternum (sternum) and has the important task of protecting the heart and lungs.

The upper ribs (1 to 7) are called “true” or sternal ribs because they are articulated directly to the sternum via the costal cartilage; in this way, the chest is less rigid.

The ribs 8 to 10 are not connected to the sternum, but to the cartilaginous costal arch.
The 11th and 12th ribs end freely at the front and are called “flesh ribs” (costae fluctuantes).
The costal cartilage increases the elasticity of the rib cage.
The costal cartilage extends progressively from the first to the seventh rib, after which it shortens.
It is important that the ribs have freedom of movement so that the chest can expand when inhaling and contract on exhalation.

Chest spine pain or upper back pain

What does that mean?

It is commonly believed that pain in the thoracic spine and in the intercostal space up to the sternum is caused by exposure to cold or the weather; this is usually a misconception, which becomes clear if the symptoms still persist after a week.

It is essential to be examined by a doctor, because the symptoms in the chest area can also be caused by serious diseases, such as cancer, ulcers, chest or pleurisy, etc.
If the severe pain is caused by muscles, bones or nerves, it must be ruled out on the basis of the patient’s medical history and physical examination that lesions (bone fracturesmuscle tears , distraction of the costal cartilage, etc.) be there.

The pain can theoretically occur on both sides, but is usually only noticeable on the right or left side of the chest.

Chest spine pain occurs in representatives of various professional groups, a high percentage of the population suffers from it, factory workers, office workers, technicians, athletes, etc. come to my practice every day. Lower back pain or low back pain occurs more often than pain in the upper back, but we often treat patients with blockages in the middle back, because the pain here is usually very severe.
Upper back pain can occur at any age, adults are more often affected.
Without proper treatment, the pain can become chronic, some patients suffer from it for 20-30 years.

The pain is scapular i.e. it lies within the two shoulder blades in an area that extends from the middle of the back to the neck, and can occur on the spine or slightly to the side of it.

Those who suffer from pain of the thoracic spine often complain of pain in the lumbar spine (lumbalgia), the cervical spine (cervicalgia) or diffuse factual spine of the spine.
The doctors often see the cause of the pain in a tension of the muscles, which is partly correct, because a tension arises as a result of the pain in the spine and shoulder blades.

Scapular pain at the tip of the shoulder blade is common and is mainly tied to the movements of the shoulder; sufferers are unable to raise their arm and put their hand behind their head or back.

What are the causes?

Almost half of the population has to deal with chest spine pain in the course of life and those affected pursue a wide variety of professional and sporting activities.
It is difficult to determine the cause with certainty, some sufferers wake up in the morning with pain, others initially have mild discomfort that increases over time.

The pain is usually caused by the interaction of various causes, only rarely is a single structure responsible.
Older people can suffer from vertebral arthrosis (spondylosis).
For the thoracic spine (thoracic spine), there are no pain syndromes that could be compared to a stiff neck (cervical spine) or lumbago (lumbar spine).
The weight of the patient cannot be decisive for the symptoms, as even very thin people are affected.

Autoimmune diseases, such as ankylosing spondylitis or rheumatoid arthritis attack the back; in the first case, the spine takes the form of a bamboo cane and becomes straight.

What are the symptoms?

The symptoms of upper back pain don’t just affect the back; one should ask the patient the following question: If the pain between the shoulder blades disappears, would he feel healthy?
Does it feel like your back is trapped in a vice?

The answer could be negative because the person concerned feels tiredness in the arms.
Thoracic spine pain is very severe, it usually affects only one side of the back and can also be noticeable during periods of rest.

The pain occurs when turning and bending the upper body or when the head is turned, tilted to the side, bent forward or placed in the neck; in extreme cases, back blockage occurs. The symptoms usually occur in the upper part of the thoracic spine, behind the shoulders and shoulder blades, less often the back lumbar region is affected.

Symptoms may appear in the regression phase of a movement or shortly after reaching the resting position.
Some patients are woken up early in the morning at 4 o’clock by severe pain and therefore have to get up, during the day, however, the back is completely painless.
The pain can also occur when coughing and deep breathing.

The patient does not have to feel silly if he feels unusual symptoms; Pain should not be classified as psychosomatic without evidence.

How is the diagnosis made?

“A friend told me that the pain is caused by the shoes, others blame the mattress, maybe a herniated disc … I think I lifted a heavy object and maybe I tore my muscle…”

These are some assumptions that patients make in this case; Sometimes they are true; the doctor will rule out serious diseases on the basis of an examination and diagnose what form of thoracic spine pain it is based on the patient’s medical history, tests and information.
Imaging examinations include: magnetic resonance and CT if a herniated disc is suspected or X-rays if bone fractures or congenital bone anomalies are suspected.
The patient may suffer from nonspecific back pain without a specific cause; the diagnostic procedures (MRI, CT, etc.) indicate neither lesions nor inflammation.
Symptoms may occur punctually or in vertical lanes that extend downwards or upwards.

What can be done? What is the right therapy?

All patients should improve their posture and avoid positions where a “crooked back” (round back or hyperkyphosis) develops, especially when sitting.
Anti-inflammatory drugs (NSAIDs, cortisone, painkillers, etc.) can provide relief, but the effect is usually temporary, because it does not act on the cause of the problem.

A muscle tear is extremely rare, the therapy is exclusively instrumental: some laser or Tecar® sessions are helpful in closing the tear.

Neuromuscular taping or Kinesio taping can be used to support therapy to loosen the contractures and stimulate the muscles on the healthy side; in this way, a balanced tension is created in the shoulders and intercostal muscles.

In a herniated disc, which rarely occurs in the thoracic spine, the McKenzie method is most useful because it pushes the gelatinous core of the intervertebral disc back into its natural seat and thus no longer presses on the nerve and causes symptoms.

In the case of osteoarthritis or inflammation-related back pain, physical therapy methods of physiotherapy are used, which locally exert an anti-inflammatory effect.
In the case of movement-dependent pain (usually during rotation), joint repositioning techniques bring relief to patients.

In patients with non-specific pain who do not have anatomical problems, I was able to achieve the best treatment results with myofascial manipulation; adhesions of the connective tissue that pinch the nerves are loosened.
If the patient feels the pain mainly at night and in the morning when getting up, it should be checked whether the mattress meets personal needs.

Intercostal pain or intercostal neuralgia, what is it?

Is it possible to feel severely painful stitches in the chest area, ranging from the shoulder blade to the sternum?

Acute intercostal pain (intercostal pain) is very severe pain that originates from the thoracic spine, follows the course of the rib and radiates to the sternum; it is possible that no pain is perceived in the middle of the back, but arises at shoulder blade level; in some cases, the pain does not reach the sternum, but ends in the chest at the level of the ribs.

Rib pain, which begins laterally of the vertebrae and extends to the sternum, is always of nervous origin and can be associated with disorders of muscle and bone structures.
The patient feels a continuous and persistent pain approximately in the middle of the back, which can increase in intensity with certain movements or in certain positions.

medical examination should necessarily be made, because symptoms in the area of the chest can be caused by serious diseases of internal organs; however, it is not always necessary to consult a specialist or carry out elaborate examination procedures.
The complaints can affect anyone, mainly adults, whether they work hard physically or mainly engage in sedentary activities.

What are the causes?

One of the most common causes is a herniated disc or protrusion, although this is rare due to the small disc thickness in this section of the spine. Or the pain arises in the facet joints of the vertebrae.
Reasons for the prolapse of the intervertebral disc or misalignment of the vertebrae are postural errorstrauma and the incorrect lifting of heavy objects.

Cold does not seem to be a reason for intercostal pain, even though it can contribute to a cramping of the muscles and promote the occurrence of pain.

What symptoms are noticeable?

The pain is extremely strong and resembles a lash of the whip, it is intense and unbearable; it can also occur at rest, but is usually tied to movements of the arm or back.

The pain can be felt as a burning sensation and is localized around the chest like half a belt.
With deep breathing, the symptoms may increase, in the more severe cases this is already the case with normal breathing.
The patient suffers if the arm is raised for a long time (e.g. when brushing the teeth), especially if the arm is stretched forward with the hand at shoulder level (as if one wanted to reach a distant object).

The movements of the chest and back are painful, especially turning to a certain side and leaning forward.
If the pain is in the upper back, turning and bending the neck can also cause pain.

Less common symptoms include tingling and loss of sensitivity in the chest region.
The pain increases when a position is maintained for more than 5 – 10 minutes, which can be the case when sitting, standing or in certain lying positions.
In severe cases, the patient always keeps his back bent to one side and is not even aware of it until he is asked to look at himself in the mirror.

How is the diagnosis made?

medical examination in most cases is sufficient to exclude diseases of internal organs.
If necessary, the doctor may order diagnostic imaging procedures.
By means of magnetic resonance or CT, a herniated disc can be visualized, which could be responsible for the symptoms.

On an X-ray, only the bones are shown, so this examination method is suitable for diagnosing fractures, spondylosis (vertebral arthrosis) or scoliosis of the spine.

An ultrasound examination makes little sense because it does not provide any information about the intervertebral disc and the back muscles are not clearly visible, because this consists of four superimposed layers.

A blood test with ANA (antinuclear antibodies) can indicate whether the patient is suffering from rheumatic diseases, such as ankylosing spondylitis; the diagnosis should be confirmed by magnetic resonance, which is a bamboo cane-like, upright spine.

The family doctor may recommend a visit to a specialist (e.g. rheumatologist or orthopaedist).
It is virtually impossible to find muscle lesions on the back, chest and abdominal muscles because the movements of the trunk are not particularly fast and the numerous ligaments and joint capsules prevent the muscles from stretching beyond their natural elasticity.

A brief note on how to evaluate
the results of magnetic resonance, CT, X-ray, etc.: 
Can scoliosis cause intercostal pain?

No – this is true in most cases; if the scoliosis curve is particularly pronounced, it is necessary to check whether a nerve is in distress, but this is extremely rare.

Can osteoarthritis cause upper back and rib pain?
It is practically impossible for an elderly patient to have such severe osteoarthritis that a nerve would be pinched, because this area of the spine is less mobile and the joints are therefore less susceptible to wear.

Can a herniated disc cause pain that radiates from the back to the sternum?
Yes, that is quite possible.

My spine has straightened, can this be the cause of the back and intercostal pain?

Which therapy is suitable?

The form of treatment depends on the cause of the back pain.
As a rule, the pain arising from the spine is caused by postural errors or incorrect movements, so in this case it is necessary to first correct the posture, which will already give the patient great relief.
If there is a suspicion that the symptoms are caused by protrusion, bulging or herniated disc, manual therapy is most suitable, the McKenzie method brings excellent results.

Physical therapies can help reduce the inflammation, but are not always the solution to the problem.
If the gelatinous core of the intervertebral disc has emerged from its natural seat and presses on a nerve, no anti-inflammatory treatment can eliminate the symptoms, because it is not an inflammation, even if the consistency is almost liquid.

Pain in the thoracic spine and back of the arm

What is it?

Pain that arises in the upper back can also be felt in the arm, but only in the back area.

The symptoms are terrible, lying down the patient is fine, but sitting and standing he can not find a position that gives him relief.
When standing upright, the arms are on the side of the body, the palms point forward, the pain sits in the back of the arm, at the level of the triceps muscle and the wrist and finger extensors.

Überkopfhaltung des Unterarms oder Abstützung durch den gesunden Arm, so kommt der Patient in die Praxis, um die Symptome zu lindern.
Normalerweise treten die Schmerzen zusammen mit Nackenschmerzen auf, der Betroffene kann den Hals in keine Richtung bewegen, ohne Schmerzen zu verspüren.
Dieses Schmerzsyndrom tritt oft in Zusammenhang mit Gelenk- oder Bandscheibenproblemen im Bereich des Nackens auf.

What are the causes?

Like all back pain caused by the musculoskeletal system, pain is caused by postural errors, trauma, incorrect lifting movements, joint wear (spondylosis) or congenital malformations.
The pain is acute and often constant, which can be annoying.

My patients report that the pain occurs because their stool is very high, they adopt a hunched posture at work for a long time or because they have performed certain sports exercises.
The reason for the pain can be an abnormal vertebral position, so that they create friction due to a slight axis deformity during movement, a muscle contracture or a protrusion or bulging of the intervertebral disc.

Some patients hold the result of magnetic resonance in their hands and believe their problem is the presence of compressed vertebrae.
This is usually not true, because the intervertebral discs in the thoracic spine are very narrow and the abrasion of cartilage and intervertebral disc is usually asymptomatic; in addition, young people and adults are affected much more often than older people.

What are the symptoms?

Those affected try to take painless postures, for example, they hold the hand over the head or the arm in an arm sling.
During the day, the patient does not know what position to take, because the pain is constantly present, unbearable and increases in intensity with certain movements.

In this case, the symptoms that arise in the shoulder blade area and extend into the fingers are caused by the compression of the cervical nerve C6, but the affected person often asserts that the neck is symptom-free.
This is possible because pain of a neurological nature often does not occur exactly in accordance with the affected region.

Many patients come to the practice because of complaints of the shoulder or elbow, the origin of which actually lies in the cervical spine.
In contrast to the intercostal or shoulder blade pain, the affected person has no pain when he stretches the arm forward, but may feel discomfort in the chest on the affected side.
Typical symptoms are: constant tingling in the index and middle finger, severe pain under the arm, in addition, the patient feels pain on the back side of the spine near the shoulder blade.

This pain syndrome can involve the neck, as the movements are very limited, but the pain is located in the area of the shoulder blade; the pain increases in intensity when the affected person bends forward, looks up, turns his head to the aching side and bends.
At night, the patient has no discomfort, but during the day he feels the need to lie down to relieve the pain.

In general, it can be said that the pain decreases during movement and increases when remaining in one position, as well as with deep breathing.

Another type of pain occurs under the first thoracic vertebra and continues to the back center of the forearm.
Upper back pain can also affect athletes, especially volleyball players, because this sport consists of continuous jumping and “landing” and leads to trauma during walls and smashing.

Which is the right therapy?

First of all, a posture correction must be made: the office worker can reduce the height of the chair, a mother can put the baby on a pillow when breastfeeding, you can kneel to pick up an object instead of bending your back.
It is important to use a lumbar roller so that the back is held in the correct position when sitting on the chair.
Any form of treatment will have little effect if the patient maintains his poor postural habits.

The best therapy is manual in nature, because there is no inflammationlaserTecar® and massages help to relieve the muscle tension that may have formed due to the great pain in the neck and in the area of the shoulder blades.
For disc and joint problems, the McKenzie method is best suited, along with joint repositioning.

If there is no herniated disc, myofascial manipulation is the ideal form of manual therapy; the “muscle overlaps” that cause the pain because they squeeze the nerves are released.

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