When Should I Worry About Upper Back Pain?

Upper back pain is very common and in most cases, it is not a cause for concern. The upper back refers to the area between your neck and lower back and includes the shoulder blades, spine, and rib cage. Pain in this area has many potential causes such as muscle strain, poor posture, osteoarthritis, and even stress. While upper back pain is rarely an emergency, there are some signs and symptoms that indicate you should seek medical attention.

Causes of Upper Back Pain

The most common causes of upper back pain are musculoskeletal injuries and conditions. Some examples include:

  • Muscle strain – Overuse, improper lifting, or awkward movements can strain the muscles in the upper back leading to soreness and stiffness. Muscle strains are especially common in people with physically demanding jobs.
  • Herniated disc – Discs act as cushions between the vertebrae. A herniated or slipped disc occurs when the soft inner gel pushes out through a tear in the tougher exterior. This can irritate nearby nerves and cause pain.
  • Arthritis – Osteoarthritis breaks down the cartilage in joints over time leading to upper back pain, especially near the shoulders. Rheumatoid arthritis, an autoimmune disease, can also affect the upper back joints.
  • Poor posture – Slouching, hunching over, or constantly looking down at phones and devices pulls the upper back out of alignment. This extra strain on the muscles leads to fatigue and pain.
  • Whiplash – Sudden movements like those experienced in a car accident can sprain the neck and upper back muscles and ligaments.

Seeking Medical Care

For run-of-the-mill upper back pain from overuse or minor injuries, home treatment may be sufficient. Try an over-the-counter anti-inflammatory medication like ibuprofen and apply ice packs to relieve pain and swelling. Getting regular gentle exercise, using proper lifting mechanics, and working on posture can help prevent and treat uncomplicated upper back pain.

Make an appointment with your doctor if your pain:

  • Is severe or gets worse with rest
  • Radiates down one or both arms
  • Causes muscle spasms or cramping
  • Is accompanied by numbness or tingling
  • Follows an injury or accident
  • Persists beyond a few days of self-care

Seeking prompt medical attention is crucial if you experience:

  • Loss of bowel or bladder control
  • Fever without other illness
  • Unexplained weight loss
  • Osteoporosis with long-term steroid use
  • History of cancer

These red flag symptoms can indicate a serious underlying condition requiring further evaluation beyond strains or pulls.

When to Visit the Emergency Room

Head straight to the ER if you have upper back pain along with:

  • Trouble breathing
  • Coughing up blood
  • Abdominal pain
  • Chest pain
  • Loss of consciousness
  • Signs of shock like excessive sweating, confusion, and rapid breathing

These symptoms suggest a potentially life-threatening problem like a lung infection, blood clot, heart attack, or aneurysm. Prompt emergency medical care may be needed to stabilize your condition.

Diagnosing Upper Back Pain

To properly diagnose the cause of persistent or worsening upper back pain, the doctor will perform:

  • Medical history – They will ask about any prior injuries, chronic conditions, lifestyle, occupation, and symptoms.
  • Physical exam – The doctor will assess range of motion, check reflexes, and examine your posture, spine, and shoulders. They will note any areas of tenderness or pain.
  • Imaging tests – An x-ray, MRI, or CT scan can help identify spinal abnormalities, injuries, or conditions like arthritis contributing to your pain.
  • Specialist referral – You may need to visit an orthopedist, rheumatologist, or neurologist for further assessment if initial testing is inconclusive or if certain underlying conditions are suspected.

Treatment Options

How upper back pain is treated depends on the diagnosis. Some examples of common treatments include:

  • Medications – Over-the-counter NSAIDs (ibuprofen, naproxen), prescription opioids, muscle relaxants, or antidepressants in some cases.
  • Physical therapy – Stretches, exercises, manual therapy, and modalities like heat or ultrasound can improve mobility and strengthen the upper back.
  • Chiropractic care – Spinal manipulation and mobilization are hands-on techniques to improve joint functioning.
  • Postural correction – This involves awareness and correction of poor sitting and standing posture.
  • Surgery – If conservative treatments fail, surgery like spinal fusion or discectomy may be an option for severe or progressive upper back problems.

When to Worry

Most upper back pain resolves with a few days of self-care. Call your doctor if pain persists over one week or causes disruptions to your daily activities. Severe, progressively worsening pain warrants prompt medical evaluation. Seek emergency care for upper back pain accompanied by symptoms like breathing difficulties, weakness, or loss of bladder control that could indicate a serious medical issue. While frustrating, run-of-the-mill upper back aches generally are not a major cause for concern. Pay attention to your symptoms and seek medical advice if pain is severe or accompanied by other red flag signs.