An upper back strain is an overstretched or partly torn muscle in the area between the base of your neck and the bottom of your ribs. It usually causes a local ache or sharp pain that gets worse when you twist, reach, lift or take a deep breath, and the area is often tender to press. Most mild strains ease noticeably within 1 to 2 weeks and settle within 2 to 6 weeks. Moderate strains can take 6 to 8 weeks or longer.
The muscles involved are usually the trapezius across the top and middle of the back, the rhomboids between the shoulder blades, and the long muscles beside the spine (erector spinae). A strain often follows a lift with a twist, a sudden reach, a fall, a hard sneeze or a weekend of unfamiliar work such as painting a ceiling or moving house. Some strains build up over days of long, still hours at a desk.
Strains are graded by how much of the muscle is affected. Grade 1 means overstretched fibers with mild pain. Grade 2 is a partial tear with more pain and some loss of movement. Grade 3, a complete tear, is uncommon in the upper back.
Key takeaways
- What it is: an overstretched or partly torn muscle in the upper or middle back, most often the trapezius, the rhomboids or the muscles beside the spine.
- Typical symptoms: a local ache or sharp pain, tenderness, muscle spasm, and pain with twisting, reaching or deep breaths.
- Typical recovery: mild strains usually settle within 2 to 6 weeks; moderate strains can take 6 to 8 weeks or longer.
- What usually helps: gentle movement within comfort, regular breaks from sitting, and gradual strengthening once the sharp pain eases.
- Other causes: the neck, a rib joint, a fracture, shingles and organs such as the heart and lungs can cause pain in the same area.
Where are you right now?
- It has just started: read the three safety sections near the end first, then the week-by-week section for what the first days usually feel like.
- Weeks in and not settling: go to “If it isn’t going to plan” and “Where else this could be coming from”. Pain referred from the neck or a rib joint is a common reason a strain does not follow the usual course.
- After an injection or surgery: neither is usual for a simple muscle strain. If you have had either, follow the plan from the doctor who gave it, and use this page for general context.
- Getting back to work or sport: the “When can I…” table gives typical ranges for driving, lifting, desk work and sport.
Week by week
This timeline is for a mild to moderate muscle strain, once other causes have been ruled out. Your own course may be quicker or slower.
- Days 1 to 3: pain and muscle spasm are usually at their worst. Turning in bed, getting up from a chair and deep breaths can catch. Gentle movement within comfort usually helps more than lying still. Heat or a cold pack for 15 to 20 minutes at a time may ease the spasm.
- Days 4 to 7: sharp catches usually become less frequent. Short walks and a change of position every 20 to 30 minutes keep the area from stiffening.
- Weeks 2 to 3: with a mild strain, most daily tasks are comfortable again, with an ache after long sitting or carrying. Gentle stretching and light strengthening for the shoulder blade and upper back muscles can usually start.
- Weeks 3 to 6: strength and tolerance for lifting build back gradually. Most mild strains have settled by the end of this period.
- Weeks 6 to 8 and beyond: a moderate strain can still be improving. Pain that has not changed by this point often has another contributor, such as the neck, a rib joint or long, still work hours.
Where else this could be coming from
Upper back pain is often labeled a strain, but several neighboring structures cause pain in the same place. These features tend to set them apart.
- Pain referred from the neck: an ache near the inner edge of the shoulder blade that changes when you turn or tilt your head, sometimes with arm pain, tingling or numbness. A muscle strain usually changes little with neck movement.
- Rib joint irritation: sharp, pinpoint pain right beside the spine, often worse with a deep breath, a cough or a twist. It tends to sit at one level rather than along the length of a muscle.
- Shoulder problems: rotator cuff problems can send pain to the back of the shoulder and shoulder blade. Pain when lifting the arm out to the side or overhead points more toward the shoulder.
- Spinal compression fracture: sudden pain after a minor fall, lift or cough in someone with thin bones (osteoporosis). The pain is usually central, over the spine itself.
- Shingles (herpes zoster): burning or stinging on one side of the back or chest, followed within a few days by a band-shaped rash.
- Organs: the heart, lungs, aorta and gallbladder can all refer pain to the upper back. This pain usually does not change with movement or pressure on the area, and often comes with breathlessness, sweating or nausea.
Pain that changes when you move is usually a muscle or joint. Pain that ignores movement deserves a different kind of check.
Is this normal?
- It hurts when I breathe in deeply: this is common in the first days, because several upper back muscles attach to the ribs and move with them. If pain on breathing comes with breathlessness, a fast heartbeat or coughing blood, treat it as an emergency.
- There is a hard knot in the muscle: spasm and a firm, tender band are common around a strain. They usually soften over 1 to 3 weeks as movement returns.
- It is worse first thing in the morning: stiffness after a night without moving is common and usually eases within about 30 minutes of getting up. Pain that wakes you every night and does not change with position is worth getting checked.
- It flared up after a few good days: strains often flare when activity rises faster than the muscle can handle. A flare that settles within 1 to 2 days usually means building up more gradually, rather than a new injury.
If it isn’t going to plan
It is week three. You still turn your whole body to reverse the car, and reaching back for the seatbelt still catches. The thought in your head is that you just need to rest it a bit longer and it will settle.
With a muscle strain, more rest often works against you. Healing muscle fibers lay down new tissue in line with the load they are given. Without that load, the muscle stays weak and guarded, and the joints around it stiffen. The spasm that protected the area in the first week can outstay its usefulness.
Pain that persists can also mean the strain was never the whole picture. The neck, an irritated rib joint and long, still hours at a desk often keep the upper back sore. The next step is an assessment with a physical therapist or doctor. Questions worth asking:
- Is this a muscle strain, or could it be coming from my neck or a rib joint?
- Which movements, and how much load, are right for this stage?
- How should I set up my work hours and breaks while it settles?
- What signs would mean I need imaging or a doctor’s review?
When can I…
| Activity | Typical range |
|---|---|
| Sleep on that side | Often within a few days to 2 weeks, once lying on the sore side is comfortable |
| Drive | Once you can turn to check blind spots and brake quickly without a sharp catch; often within 1 week for a mild strain |
| Reach overhead | Often 1 to 3 weeks for a mild strain |
| Lift | Light loads often within 1 to 2 weeks; heavier lifting usually 4 to 6 weeks, built up gradually |
| Desk work | Often within a few days, with a change of position every 20 to 30 minutes |
| Manual work or sport | Usually 2 to 6 weeks for a mild strain; 6 to 8 weeks or longer for a moderate strain |
If you have had surgery, your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Heart signs: upper back pain with chest pain, pressure or tightness, breathlessness, sweating, nausea, or pain spreading to the arm or jaw.
- Tearing pain: sudden, severe, tearing or ripping pain between the shoulder blades.
- Lung signs: sudden sharp pain on breathing with breathlessness, or coughing blood.
- Major injury: back pain after a major fall, a car accident or a heavy blow.
- Spinal cord signs: new weakness or numbness in both legs, unsteady walking, or loss of bladder or bowel control.
See a doctor today if
- Possible fracture: sudden back pain after a minor fall, lift or cough if you are over about 50, have osteoporosis or take long-term steroid medicine.
- Signs of infection: back pain with fever, chills or feeling generally unwell.
- Possible shingles: a burning band of pain on one side of the back or chest, with or without a new rash.
- Unrelenting pain: severe pain that no position eases.
Get it checked soon if
- Slow progress: the pain is not clearly easing after about 2 weeks.
- Night pain: the pain keeps you awake most nights.
- Arm symptoms: pain, tingling or numbness spreads into the arm.
- Wider health: back pain with unexplained weight loss, or a history of cancer.
More on this area: upper and mid back conditions.
A strained upper back usually recovers with gradual movement and patient, steady loading.
Written by Louise Yow, Neck & Shoulder Physio.