What Causes Upper Back and Chest Pain?

When upper back and chest pain occur together, the symptoms can vary widely depending on the cause or severity. Some people may experience mild discomfort or tightness while others may have sharp or intense pain. This pain may be one-sided (left or right) or on both sides. Below are potential causes of upper back and chest pain appearing at the same time.

Common Causes of Upper Back and Chest Pain

Some of the more common causes of upper back and chest pain include:

Muscle strain

Several muscles in the chest and upper back are used together while performing activities related to the upper body, such as rowing, throwing a ball, lifting weights, painting walls, or washing windows. It is possible for muscles in both the chest and upper back to be strained at the same time, such as from overuse or lifting something that is too heavy.

It is also possible for a muscle strain in the chest to refer pain to the upper back and vice versa. For example, a strain in an intercostal muscle (muscle between adjacent ribs) can cause a band of pain felt along the rib in both the chest and upper back area.

See Upper Back Pain from Intercostal Muscle Strain

Thoracic spondylosis

Degeneration in the thoracic spine, also called thoracic spondylosis, can involve thoracic osteoarthritis, thoracic degenerative disc disease, and other wear-and-tear conditions of the thoracic spine. As the spine eventually starts to degenerate with age, one or more intervertebral foramina (bony openings where the spinal nerves exit the spinal canal) may become smaller, called foraminal stenosis. With less space, a spinal nerve may become compressed or inflamed, causing pain to radiate from the spine in the upper back along a rib to the chest.

Watch Spondylosis Video

Slipping rib syndrome

A traumatic injury, such as from a major collision or fall, can potentially displace a rib where it connects to the spine at the costovertebral joints in the upper back. Also called slipping rib syndrome, a displaced rib can irritate or compress a nearby intercostal nerve, which may cause sharp or electric-like pain to travel along the path of the rib from the spine to the upper abdomen or chest. Slipping rib syndrome most commonly occurs at the 8th, 9th, or 10th rib. While rare, sometimes slipping rib syndrome occurs with no known injury or trauma.

Sometimes upper back and chest pain may have more than one cause. For instance, a bike collision may cause a herniated disc, fracture, and muscle strain that all contribute to the upper back and chest pain.

Other Causes of Upper Back and Chest Pain

Some other causes of upper back and chest pain may include:

Thoracic herniated disc

When a thoracic disc’s tough outer layer (annulus fibrosus) tears or partially tears and the gel-like inner layer (nucleus pulposus) begins leaking outward, the nearby nerve root can become inflamed and painful. While relatively rare, a thoracic herniated disc may radiate pain along the path of the nerve from the upper back to the chest.¹Kato K, Yabuki S, Otani K, et al. Unusual chest wall pain caused by thoracic disc herniation in a professional baseball player. Fukushima J Med Sci. 2016; 62(1):64-7. doi: 10.5387/fms.2015-25 .^,2Baranto A, Borjesson M, Danielsson B, Hellstrom M, Sward L. Acute chest pain in a top soccer player due to thoracic disc herniation. Spine (Phila Pa 1976). 2009; 34(10):E359-62. doi: 10.1097/BRS.0b013e3181a16d41.

Watch Thoracic Herniated Disc Video

Myofascial pain syndrome

This condition of unknown cause includes painful trigger points that can appear in muscles and fascia (connective tissues) in different parts of the body, including the upper back and chest. Trigger points can feel tender or tight, and when pressed they can refer sharp or intense pain to other nearby areas.

Fibromyalgia

This syndrome usually involves widespread pain, fatigue, trigger points, and associated mental health issues. The upper back is a common location for myofascial pain in people with fibromyalgia. Many other locations in the body may also become painful, including the chest.

Costochondritis

This condition involves inflammation in the cartilage that connects the sternum (breastbone) to the ribs, which can cause pain in the chest. This pain may also be referred to the back.

Costovertebral osteoarthritis

This condition involves wear-and-tear breakdown of the cartilage within the costovertebral joint(s)—where the rib connects with the thoracic spine.

Heart conditions

Various heart conditions may cause pain in the chest and upper back or shoulder(s):

• Angina occurs when the heart muscle does not get enough blood.³Angina (chest pain). American Heart Association website. https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain. Accessed September 12, 2019.
• Heart attack involves heart muscle damage, typically due to reduced or complete loss of blood supply from the blockage of an artery.⁴Heart attack. U.S. Department of Health & Human Services, National Heart, Lung, and Blood Institute Website. https://www.nhlbi.nih.gov/health-topics/heart-attack. Accessed September 10, 2019.
• Pericarditis is inflammation of 2 thin layers (pericardium) that surround the heart.⁵Symptoms and diagnosis of pericarditis. American Heart Association website. https://www.heart.org/en/health-topics/pericarditis/symptoms-and-diagnosis-of-pericarditis. Accessed September 12, 2019.

While heart conditions are most commonly associated with chest pain, it is important to note that chest pain is not always present or severe. Heart-related pain may also be felt in other areas, such as the shoulder or upper back.

Lung conditions

Some lung conditions may cause upper back and chest pain:

• Pleurisy is inflammation of the linings (pleura) of the lungs and chest wall.⁶Pleurisy and other pleural disorders. U.S. Department of Health & Human Services, National Heart, Lung, and Blood Institute website. https://www.nhlbi.nih.gov/health-topics/pleurisy-and-other-pleural-disorders. Accessed September 12, 2019.
• Lung cancer tumor(s) may grow in a manner that eventually causes pain in the chest and upper back (or shoulder).⁷Lung cancer symptoms. Lung Cancer Association website. https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/lung-cancer/learn-about-lung-cancer/symptoms/. Accessed September 12, 2019.^,8Symptoms of lung cancer. Canadian Cancer Society website. https://www.cancer.ca/en/cancer-information/cancer-type/lung/signs-and-symptoms. Accessed September 12, 2019.

Painful lung conditions may also involve increased pain when breathing.

Many other causes of upper back and chest pain exist. Visit a doctor for any unexplained chest pain that persists or recurs. Seek immediate medical attention if upper back and chest pain are accompanied by any red flag symptoms, such as numbness, weakness, nausea, dizziness, fever, chills, or problems with balance or coordination.

Read more about Causes of Upper Back Pain