Musculoskeletal Symptom

Back pain (upper)

Upper back pain affects the thoracic spine, shoulders, and surrounding muscles and is often linked to posture, desk work, and muscle tension. Physiotherapy, osteopathy, massage, and the Alexander Technique are highly effective. Addressing the postural and lifestyle factors that contribute is key to lasting relief.

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What is Back pain (upper)?

The upper back (thoracic spine) is less commonly affected by disc problems than the lower back, but is a common site of muscular tension, postural pain, and myofascial issues — particularly in people who work at desks or spend long hours at computers.

Poor posture, forward head carriage, rounded shoulders, and prolonged sitting all load the thoracic spine and surrounding muscles. Stress and tension are also significant contributors, with many people physically holding tension in the upper back and shoulders.

Signs and symptoms

Symptoms of upper back pain include:

Aching, stiffness, or sharp pain in the upper and mid back
Shoulder blade pain or pain between the shoulder blades
Muscle knots and tightness
Pain that worsens with sitting, computer work, or looking down
Associated neck or shoulder pain
Thoracic nerve irritation causing referred pain around the ribcage

Any chest pain should be medically assessed to rule out cardiac causes before attributing it to the upper back.

How therapy can help

A range of approaches effectively address upper back pain:

Physiotherapy and sports therapy — assessment, manual therapy, exercise prescription, and postural correction
Osteopathy and chiropractic — address spinal alignment and joint mobility
Massage therapy and myofascial release — target muscle tension and trigger points
Alexander Technique — strong evidence for spinal pain via postural re-education
Clinical Pilates and yoga therapy — build the core and postural muscles that support the thoracic spine
Bowen technique and acupuncture — commonly used for upper back pain

Seeking help

Upper back pain that is severe, persistent, associated with neurological symptoms (numbness, weakness, bladder or bowel changes), or accompanied by chest pain warrants medical assessment.

Most uncomplicated upper back pain responds well to physiotherapy and manual therapy, particularly when postural and lifestyle factors are also addressed.

Therapies that may help with Back pain (upper)

Therapy	Evidence	Notes
Massage Therapist	strong	Core use for upper back pain.
Osteopath	strong	Core use for upper back pain.
Physiotherapist	strong	Core use for upper back pain.
Sports Therapist	strong	Core use for upper back pain.
Acupuncturist	moderate	Commonly used for upper back pain.
Alexander Technique Practitioner	strong	Strong use for upper back pain.
Bowen Technique Practitioner	moderate	Bowen commonly used for upper back pain.
Chiropractor	strong	Core use for upper back pain.
Clinical Pilates Practitioner	strong	Core use for upper back pain.
Myofascial Release Practitioner	strong	Core use for upper back pain.
Pilates Practitioner	strong	Core use for upper back pain.
Yoga Therapist	moderate	Yoga for upper back pain and posture.
Acupressurist	limited	Used for upper back muscle tension.
Biofeedback Practitioner	moderate	Biofeedback for upper back pain.
Cognitive Behavioural Therapist	moderate	CBT for chronic upper back pain distress.
Emmet Technique Practitioner	moderate	Emmett technique for upper back pain.
Fascial Stretch Therapist	moderate	Fascial stretch therapy for upper back pain.
Hydrotherapist	moderate	Hydrotherapy for upper back pain.
Hydroterm Masseuse	moderate	Hydrotherm massage for upper back pain.
Indian Head Masseuse	moderate	Used for upper back and neck tension.
Mindfulness Practitioner	moderate	Mindfulness for upper back pain.
Rolfing Practitioner	moderate	Rolfing for upper back pain.
Scar Tissue Release Therapist	moderate	Scar tissue release for upper back pain.
Shiatsu Practitioner	moderate	Used for upper back pain.
Structural Integration Practitioner	moderate	Used for upper back pain.
Thai Masseuse	moderate	Thai massage for upper back pain.
Body Stress Release Practitioner	limited	Used for upper back pain.
Chiropodist	limited	Foot/gait biomechanics can contribute to upper back pain.
Craniosacral Therapist	limited	Used for upper back pain.
Zero Balancing Practitioner	limited	Zero balancing for upper back pain.

Frequently asked questions

Is upper back pain caused by poor posture?

Posture is a major contributor, particularly for desk workers. However, building strength and variability of movement is as important as correcting static posture.

Can stress cause upper back pain?

Yes. Emotional tension is frequently held in the upper back and shoulders. Addressing both the physical and stress dimensions often produces better outcomes.

Should I rest or keep moving with upper back pain?

Generally, keeping gently mobile is more beneficial than rest for most upper back pain. A physiotherapist can advise on appropriate activity for your specific presentation.

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Also known as

Back pain