Upper back pain and mid back pain are just as problematic as neck pain or lower back pain — but they don’t get the same clinical attention, largely because the thoracic spine is anatomically different and its pain patterns are less familiar to most providers. At Dr. French’s Norwalk, CT practice, upper and mid back pain is a significant part of the case mix, and the rib dysfunction that frequently drives it is one of his specific areas of published clinical expertise.
If you’ve been dealing with upper back pain, a sharp stabbing sensation between the shoulder blades, pain that worsens with breathing, or a feeling that something is “stuck” in your mid back — this page explains what’s likely causing it and what the treatment looks like.
Why the Thoracic Spine Is Different
The thoracic spine behaves differently from the cervical and lumbar spine for one primary reason: the ribs. Each thoracic vertebra articulates with one or two pairs of ribs at small joints called costovertebral joints. These joints allow the ribs to move with breathing and arm motion — and when they become restricted or dysfunctional, they produce a distinctive pattern of pain that is frequently misdiagnosed.
The shoulder blades sit on top of the posterior ribcage and attach to the ribs and thoracic spine through multiple muscles. This means rib dysfunction can affect shoulder blade mechanics directly — producing shoulder blade pain, periscapular muscle tension, and even referred shoulder pain that originates in the thoracic cage rather than the shoulder joint itself. See how rib dysfunction causes shoulder pain →
The discs between thoracic vertebrae are smaller than in the cervical or lumbar spine, and the ribs significantly reduce the motion between thoracic vertebrae. This is why disc herniations are far less common in the thoracic spine than elsewhere. But it’s also why the costovertebral joints and the muscles attached to the thoracic cage become the primary pain generators in this region.
What Causes Upper and Mid Back Pain?
Muscle Pain — The Most Common Cause
Muscular pain is the most common source of upper back pain. The upper and mid back hosts an unusually large number of muscles — the trapezius, rhomboids, levator scapulae, serratus anterior, thoracic erector spinae, multifidus, and numerous smaller stabilizers all reside here. Muscles extending to the arms, neck, and lower back originate from this region, which means problems in adjacent areas frequently manifest as upper back pain even when the thoracic spine itself isn’t the primary problem.
Muscle pain presents as soreness, aching, or a bruised feeling — often bilateral across the upper back between the shoulder blades. Poor posture is the most consistent driver of upper back muscular pain, particularly in the trapezius. The sustained rounded-shoulder, forward-head position of desk work, driving, and screen use chronically overloads the upper and middle trapezius as they work to maintain upright posture against gravity.
Rib Joint Dysfunction — The Most Frequently Missed Cause
The costovertebral joints — where the ribs attach to the thoracic vertebrae — can become restricted and painful just like any other spinal joint. When a rib joint loses its normal mobility, the pain it produces is distinctive and often alarming: sharp, stabbing pain in the mid back that worsens with breathing, coughing, or sneezing, and frequently radiates around the side of the chest. Many patients with this presentation go to urgent care or the emergency room suspecting cardiac or pulmonary problems, receive a normal workup, and are sent home without a diagnosis.
The reason rib dysfunction is so consistently missed is that it doesn’t show on standard X-rays or most MRI protocols — it’s a functional joint problem, not a structural one. The diagnosis is made on physical examination by a clinician who knows what to look for: restricted costovertebral joint mobility, tenderness directly over the joint, and reproduction of the pain with specific thoracic and rib provocation tests.
Dr. French has published research on rib dysfunction in Dynamic Chiropractic — a peer-reviewed chiropractic publication — and has treated this condition extensively. Chiropractic adjustment of the restricted costovertebral joint is particularly effective for rib dysfunction because it directly addresses the cause — restoring normal joint mobility resolves the pain quickly in most cases.
Common Causes of Rib Dysfunction
Understanding what causes rib dysfunction helps prevent recurrence. The most common causes Dr. French identifies in Norwalk patients include:
- Overreaching during exercise — bent-over rows with weights, yoga poses involving spinal rotation while reaching, or any exercise that loads the thoracic cage at end range. The rib joint can be forced past its normal range during these movements and become restricted.
- Sustained forward shoulder posture during sleep — sleeping on one’s side with the shoulder scrunched forward places the anterior ribs and their spinal attachments in a loaded position for hours. This is one of the most common causes of waking up with sharp mid back pain. See the sleeping position guide →
- A sudden forceful sneeze or cough — the rapid thoracic compression of a forceful sneeze can shift a costovertebral joint. Many patients recall the exact sneeze that started their pain.
- Sports and rotational loading — golf swings, tennis forehands, throwing sports, and any activity involving rapid thoracic rotation can stress the costovertebral joints, particularly in players who lack adequate thoracic rotation and compensate with excessive rib cage loading.
- Direct trauma — a fall, impact, or compression of the chest can directly injure the costovertebral joints.
Postural Upper Back Pain
The forward rounded shoulder posture of prolonged desk work, commuting, and screen use is the most consistent structural contributor to chronic upper back pain in Fairfield County’s professional population. The combination of thoracic kyphosis increasing, the rhomboids chronically lengthened and weakened, and the pectorals chronically shortened and tight creates a predictable pattern of upper and mid back pain that medications don’t touch because the mechanics driving it don’t change when you take a pill.
Chiropractic adjustments to the restricted thoracic segments, combined with specific rhomboid and mid-trapezius strengthening exercises and postural correction guidance, address this pattern at its source. Learn how to fix your posture →
Large Chest and Pregnancy-Related Upper Back Pain
Some women experience chronic upper back pain driven by the combined weight and forward pull of a large chest. The weight of the breasts, bra strap pressure on the trapezius, and the self-conscious forward-rounded posture many women adopt all contribute to chronic upper trapezius and rhomboid strain. The same mechanism operates during pregnancy as the breasts enlarge and the center of gravity shifts. Chiropractic care addresses the thoracic and cervical mechanics this posture creates, and specific exercises strengthen the posterior chain muscles to provide structural support. Learn more about pregnancy chiropractic care →
Intercostal Nerve Pain
The intercostal nerves run between each pair of ribs from the thoracic spine around to the front of the chest. When these nerves are irritated — by rib joint dysfunction, thoracic disc involvement, or compression from the surrounding structures — they produce burning or electrical pain that radiates around the side of the chest, sometimes extending to the front of the body. This pattern is called intercostal neuralgia and is sometimes misidentified as chest pain, pleurisy, or cardiac symptoms.
The distinguishing feature of intercostal neuralgia from cardiac or pulmonary causes is its relationship to thoracic movement — it typically worsens with specific spinal positions, twisting, or deep breath. Cardiac chest pain is less affected by position and movement. If there is any uncertainty about cardiac involvement, Dr. French refers for medical evaluation before proceeding with treatment.
Organ-Referred Pain
Several internal organs can refer pain to the upper and mid back. The gallbladder refers to the right shoulder and upper back. The stomach and esophagus can produce mid back pain. Atypical cardiac presentations — particularly in women — can include upper back and shoulder pain rather than the classic chest pain, usually accompanied by anxiety, sweating, or nausea. Chiropractors are trained to identify these patterns and refer appropriately. If your upper back pain is accompanied by fever, unexplained weight loss, shortness of breath, or the systemic symptoms above, medical evaluation takes priority over chiropractic treatment.
Rib Dysfunction and Its Connection to Shoulder and Chest Pain
Because the ribs wrap from the thoracic spine around to the sternum at the front of the chest, rib dysfunction can produce pain in locations far from the spine. This is one of the most clinically important aspects of understanding upper back pain:
Chest pain (costochondritis) — when rib dysfunction affects the anterior cartilaginous joints where the ribs meet the sternum, pain at the front of the chest results. This is called costochondritis and is the most common non-cardiac cause of chest pain that sends patients to the emergency room. Adjusting the restricted posterior costovertebral joint can resolve the anterior chest pain because the entire rib is one continuous structure.
Scapular and shoulder pain — as discussed on the shoulder pain page, the shoulder blade rests on the posterior ribcage. Restricted ribs disrupt scapulothoracic rhythm and produce shoulder blade pain and rotator cuff impingement that won’t resolve until the underlying rib dysfunction is addressed.
Periscapular muscle tension — the serratus anterior, rhomboids, and lower trapezius all attach to the ribs. Rib dysfunction creates chronic tension in these muscles as they compensate for the restricted joint beneath them — producing the deep, persistent muscle aching between the shoulder blades that many patients describe.
How Dr. French Treats Upper Back and Rib Pain
Chiropractic Adjustments
Chiropractic adjustment is the most effective treatment for costovertebral joint dysfunction — it directly addresses the cause by restoring normal joint mobility. When the restricted rib joint starts moving correctly, the pain resolves quickly in most cases. Patients who’ve been dealing with this type of pain for months, trying medications that provide no relief because they do nothing to address the mechanical cause, often experience dramatic improvement after the first adjustment.
Thoracic spinal adjustments address the vertebral restrictions that commonly accompany rib dysfunction. The thoracic spine and ribs function as an integrated unit — restriction in one typically produces restriction in the other.
Theragun Percussion Therapy
The periscapular muscles — trapezius, rhomboids, levator scapulae — that become chronically tight from rib dysfunction and postural loading respond well to Theragun percussion therapy. Breaking up fascial adhesions and reducing trigger points in these muscles alongside the joint adjustments produces faster and more complete relief than adjustments alone.
Postural Rehabilitation
Prevention of recurrent rib dysfunction and upper back pain requires addressing the postural and movement patterns that caused it. Specific exercises targeting the rhomboids, mid-trapezius, and thoracic extensors counteract the rounded-shoulder posture driving most chronic upper back pain. Modifications to exercise technique — particularly for the bent-over rows and overhead movements that most commonly cause rib dysfunction in active patients — prevent recurrence.
Frequently Asked Questions About Upper Back Pain
Yes — upper and mid back pain responds very well to chiropractic care, particularly when caused by rib joint dysfunction, thoracic joint restriction, or postural muscle imbalance. Dr. French has published research on rib dysfunction and has specific expertise in diagnosing and treating the costovertebral joint problems that drive much of the upper back pain that other treatments haven’t resolved.
Sharp upper back pain that worsens with breathing is the classic presentation of costovertebral joint dysfunction — a restricted or misaligned rib joint where the rib attaches to the thoracic vertebra. Many patients with this presentation are evaluated for cardiac or pulmonary conditions first. When those are ruled out, chiropractic evaluation of the thoracic spine and rib joints typically identifies the mechanical cause. Chiropractic adjustment is very effective for this condition.
A rib out of place — clinically called costovertebral dysfunction — occurs when one of the small joints where a rib attaches to the thoracic vertebra becomes restricted or slightly misaligned. It produces sharp mid back pain that worsens with breathing, movement, or pressure. It’s caused by overreaching, sudden twisting, forceful sneezing, or sleeping in a position that stresses the thoracic cage. Chiropractic adjustment directly addresses the restricted joint and typically resolves the pain quickly. Learn more about rib dysfunction →
Yes — the ribs run from the thoracic spine around to the sternum. When the costovertebral joint at the back becomes restricted, the anterior attachment at the sternum can also become irritated, producing chest pain called costochondritis. This is the most common non-cardiac cause of chest pain. If there’s any uncertainty about whether chest pain is cardiac in origin, medical evaluation should occur before chiropractic treatment.
Yes — the shoulder blade rests on the posterior ribcage and is controlled by muscles attaching to the thoracic spine and ribs. Rib dysfunction disrupts shoulder blade movement and produces periscapular pain and muscle tension between the shoulder blades. Treating the rib dysfunction resolves both the upper back pain and the associated shoulder blade symptoms.
Waking up with upper back pain is a classic sign of sleeping position-related rib dysfunction. Sleeping on one side with the shoulder scrunched forward loads the anterior ribs and their spinal attachments for hours, and the position can cause a costovertebral joint to shift. Adjusting pillow and shoulder position while sleeping prevents this. See the sleeping position guide →
Upper back pain is rarely cardiac in origin, but the possibility must be considered — particularly if it’s accompanied by chest pain, shortness of breath, sweating, nausea, or arm pain. If any of these accompany your upper back pain, seek medical evaluation immediately. Most upper back pain is musculoskeletal and has a mechanical cause, but the red flag symptoms above warrant urgent medical assessment before chiropractic treatment.
Schedule Upper Back Pain Treatment in Norwalk, CT
If you’ve been dealing with upper back pain, mid back pain, or the sharp stabbing pain between the shoulder blades that gets worse with breathing — Dr. French’s Norwalk, CT office offers a thorough evaluation to identify the specific cause and the most direct treatment path.
Call (203) 939-9700 or book online. Same-day appointments available. Located at 148 East Avenue, Suite 1D, Norwalk, CT 06851 — I-95 Exit 16, free parking.
Serving upper back pain patients from Norwalk, Westport, Wilton, Darien, New Canaan, Weston, Stamford, and Fairfield County, CT.