Upper Back and Chest Pain: 8 Possible Causes

There are many different causes of upper back and chest pain. However, there are several physical causes of upper back and chest pain, including injuries to the muscles, joints, bones and ligaments. Although, the pain could also be related to internal issues, such as heart, lung and stomach issues.

While it can be concerning, many physiotherapists often see patients with physical causes of upper back and chest pain. However, there are situations where more severe conditions warrant a visit to the doctor or even the emergency department.

Below are various conditions and injuries that can cause chest and upper back pain. Additionally, symptoms, treatments and which medical professional you need to see will also be noted.

1. Muscle Injury

There are many muscles that surround the chest and upper back, such as the pectorals, rhomboids, trapeze and erector spinae. Like all the other muscles in the body, they can be injured. These injuries can range from spasms to strains (overstretching or tearing).

Muscle injuries can occur over time through poor posture or certain movements (e.g. lifting, twisting, carrying). Typically, most injuries will occur either on the upper back or chest. There are circumstances, such as poor posture or additional nerve injury that can cause pain in both regions.

Other symptoms related to muscle injuries, include:

• Stiffness

• Pain when moving (i.e. especially twisting, carrying)

• Muscle spasms and tightness

• Inflexibility

• Tender and swollen muscles (also known as knots).

Under most circumstances, muscle injuries will resolve over time. A physiotherapist can help ease pain and recommend strategies (e.g. exercise, posture) to speed recovery. However, large muscle injuries, such as ruptures may need specialist support (e.g. surgery).

2. Costovertebral Dysfunction

The costovertebral joint is the location the rib meets the thoracic spine (mid-back). They are located on either side of the middle part of the spine. Injury to the connective or joint stiffness in this area can cause upper back pain. However, people can sometimes experience ‘referred pain’ to the chest. If the nerve is compressed around the costovertebral joint, the pain can travel to the front of the body.

Costovertebral dysfunction is not a formal diagnosis, but a common condition seen by physiotherapists who see patients with upper back and chest pain. It typically occurs over time, particularly with those who are inactive and have poor posture.

Other symptoms, include:

• Mid-back pain and stiffness

• Difficulty twisting and turning

• Pain that travels from the back to the front of the body

• Chest tightness

• Pain when breathing, coughing, etc.

Under most circumstances, costovertebral dysfunction resolves over time. However, a physiotherapist can prescribe exercises and provide treatment (e.g. dry needling, mobilisations) to speed up recovery.

3. Collarbone Fracture

The collarbone (clavicle) is a flat bone which connects the acromion (tip of the shoulder blade) to the sternum (chest bone). A fracture occurs when the bone cracks or separates from each other. According to the Australian Royal Children’s Hospital, most injuries occur in children under the age of seven through direct impact of landing on an outstretched arm.[1]

Most of the pain will typically occur around the upper chest region over the collarbone. Sometimes, the fracture can be felt or visually observed. Upper back pain can occur overtime due to altered postures and inactivity. Other symptoms, include:

• Limited and painful shoulder movement

• Bruising

• Crunching and grinding sounds during movement

• Swelling around the collarbone

• Pain when breathing.

If a collarbone fracture is suspected, it is advised to visit the emergency department. Usually, a sling needs to be worn for several weeks to allow the fracture to heal. Rarely, would surgery be required. Although it may be required if other structures are at risk, such as the lungs and/or nerves. Physiotherapy is recommended after a fracture to help with rehabilitation and recovery.

4. Spinal Conditions

Spinal conditions, such as fractured vertebrae (bones of the spine) and herniated discs along the thoracic spine (i.e. mid-back) can cause upper back pain. Although not typical, these types of spinal injuries can lead to chest pain.[2] Spinal conditions can gradually develop overtime or suddenly through trauma/impact.

Other possible symptoms, include:

• Pain on movement (e.g. standing, twisting, carrying)

• Muscle spasms along the spine

• Swelling

• Referred or shooting pain

• Loss of height.

Mild to moderate spinal conditions can usually be managed by seeing a physiotherapist. More severe spinal injuries, such as fractured vertebrae may need rest and bracing to encourage recovery.

5. Scoliosis

Scoliosis describes a condition where the spine can curve and rotate. The classic scoliotic spine is when the back is developed in the shape of the letter ‘S’. Scoliosis is most commonly diagnosed before adulthood between the ages of 11-18.[3]

Many people with mild to moderate forms of scoliosis will experience no pain or symptoms. However, those more significant curves can develop chest and upper back pain due to misalignment and deformities of the spine and ribcage.

Other scoliosis symptoms, include:

• Unbalanced posture (e.g. uneven shoulder heights, tilted hips)

• Difficulty breathing

• Stiffness

• Muscle spasms.

Treatment of scoliosis will generally depend on the severity of the curvature and deformity. Specialist scoliosis physiotherapists can help slow down or stop the progression of this condition.

6. Heart Conditions

Heart conditions are amongst the deadliest issues in Australia. According to the Australian Bureau of Statistics, at least 27% of all deaths are related to a condition of the heart.[4] Examples of heart conditions include; heart attacks, coronary heart disease and angina.

Given the location of the heart, chest pain can be a common symptom amongst these conditions. However, the pain can also refer to or travel to the upper back. Other symptoms, include:

• Pain in the jaw, arms and neck

• Breathing difficulties

• Cold sweats

• Weakness

• Nausea.

If a heart attack is suspected, please dial 000 to call an ambulance for emergency treatment.

7. Respiratory and Lung Conditions

Lung conditions are some of the most common health issues in Australia. According to the Australian Institute of Health and Welfare, these conditions affect more than 7 million people.[5] Examples of lung conditions that can lead to upper back and chest pain include asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD) and lung cancer.

Breathing restrictions and changes in the lungs can cause the surrounding muscles to work harder and become tighter. Over time, pain and discomfort can develop in these areas. Other possible symptoms, include:

• Shortness of breath

• Coughing

• Fatigue

• Wheezing

• Producing phlegm.

If a respiratory condition is suspected, please visit your doctor for a formal diagnosis, treatment plan and medication. Some people may need regular medication to prevent flare-ups. Specialist respiratory physiotherapists can help prescribe breathing exercises and provide treatments to preserve lung health and also prevent flare-ups.

8. Gastroesophageal Reflux Disease (Aka acid reflux)

Gastroesophageal reflux disease (GERD) occurs when the acid from the stomach leaks back to the oesophagus (food pipe). As a result, this can damage the lining of the oesophagus which leads to inflammation, chest burn and chest pain. Sometimes, the acid can also affect the surrounding nerves which can lead to upper back pain.

Other related acid reflux symptoms, include:

• Food or acid being coming back up or being regurgitated

• Increased saliva

• Dysphagia (difficulty swallowing)

• Feeling that something is stuck in the throat

• Bloating.

Those with GERD should consult their doctor or GP. Medications can be provided to help ease the symptoms. Referrals to specialists (i.e. gastroenterologists) and dietitians may also be made to help with further testing, treatment and lifestyle changes. Additionally, physiotherapy can also help with pain that is related to sore muscles and stiff joints that can sometimes arise from GERD.

Seeing Your Physiotherapist

Chest pain and upper back pain can be caused by various health issues. Consider consulting your physiotherapist about any suspected physical health issues, such as muscle injuries, costovertebral dysfunction and spinal conditions. They can help treat and diagnose your condition and refer to other health professionals if necessary.

Seeing Your Doctor

Chest pain should be taken seriously. Always consult your doctor about any suspected medical causes, including lung, stomach or heart conditions. They will be able to refer you for appropriate testing and treat you with medication.

More serious conditions, such as collarbone fractures near the chest and heart attacks may require a visit to the emergency services. Dial 000 to call for ambulance services in these cases.

Key takeaways

There are several causes of upper back and chest pain. Some are more milder, while others require more urgent treatment.

Doctors and physiotherapists play important roles, depending on the suspected condition. The conditions described above can either be direct or indirect causes for chest and upper back pain.

Those with internal health problems, such as stomach, lung and heart disorders should consider consulting a GP. While physiotherapists help assist with any physical elements of pain. If you are unsure, it may be worthwhile consulting your GP first for a diagnosis.

Please call 000 if you suspect a heart attack.