Why Do I Keep Having Pain in My Upper Back?

Many patients ask me, “Why do I keep having pain in my upper back?”

Interscapular pain means discomfort felt between your shoulder blades—the area over the upper back and thoracic spine. It’s pretty common and usually comes from muscles or joints, but sometimes it can signal something deeper.

Here are some of the most common causes:

1. Muscle strain or tension

2. Poor posture (especially sitting at a desk or looking down at a phone)

• Overuse (lifting, workouts, repetitive motion)
• Stress → tight upper back muscles

3. Joint or spine issues

• Thoracic spine stiffness or misalignment
• Rib joint irritation
• Disc problems (less common in this region, but possible)

4. Postural dysfunction

• Rounded shoulders / forward head posture
• Weak mid-back muscles + tight chest muscles

5. Referred pain

Pain can show up between the shoulder blades but come from somewhere else:

• Neck (cervical spine issues)
• Shoulder problems
• Organs (less common but important)

Less common but important causes

These are worth paying attention to if symptoms don’t fit a simple muscle issue:

• Gallbladder irritation (often right-sided, after fatty meals)
• Heart-related pain (can refer to upper back, especially with other symptoms)
• Lung issues (pain with breathing, coughing)

What it typically feels like

• Dull ache or tightness
• Sharp pain with movement or deep breathing
• Burning or “knot-like” sensation
• Worse after sitting or certain activities