Upper Back Pain: Ribs, Posture, and Why That “Stuck” Feeling Happens

Written By Dr. Cassandra Hoy

Upper back pain can show up in a lot of different ways. Sometimes it’s a dull, stiff ache between the shoulder blades after a long day at a computer. Other times, it’s sharp, sudden, and even makes it painful to take a deep breath.

One of the most common (and misunderstood) causes I see in practice?
Rib-related upper back pain—often described as a rib “going out.”

Let’s break that down, along with other common causes of upper back discomfort, what’s happening in your body, and what you can do to feel better.

A Quick Anatomy Refresher

Your upper back (thoracic spine) is designed for stability and support, not large ranges of motion.

Key structures involved:

  • Thoracic spine (mid-back vertebrae)

  • Ribs (attach to the spine in the back and wrap around to the front)

  • Costovertebral joints (where ribs meet the spine)

  • Muscles:

    • Trapezius

    • Rhomboids

    • Levator scapulae

    • Paraspinals

Because your ribs attach directly to your spine, every breath and every twist involves both your ribs and your upper back.

When a Rib “Goes Out”

This phrase isn’t technically anatomical—but it does describe a real and very common condition.

What’s usually happening:

  • A rib joint becomes irritated, restricted, or slightly misaligned

  • The surrounding muscles spasm to protect the area

  • Movement (especially breathing or twisting) becomes painful

What It Feels Like

Patients often describe:

  • Sharp, pinpoint pain near the spine or between the shoulder blades

  • Pain with deep breathing, coughing, or sneezing

  • Pain when twisting, reaching, or rolling over in bed

  • A feeling of something being “stuck,” “locked,” or needing to “pop”

Sometimes it comes on suddenly—after:

  • Twisting awkwardly

  • Reaching overhead

  • Sleeping in an unusual position

  • Even just a deep breath or sneeze

How Chiropractic Care Can Help

A chiropractic adjustment in this region typically:

  • Restores motion to the rib and spinal joint

  • Reduces muscle guarding

  • Improves comfort with breathing and movement

Many patients feel:

  • Immediate relief

  • Easier, deeper breathing

  • Less sharp pain with movement

Depending on the case, I may also incorporate:

  • Soft tissue work before or after

  • Gentle mobilization instead of a high-velocity adjustment

  • Breathing or movement retraining

What You Can Do at Home

1. Lacrosse Ball or Tennis Ball Release

  • Place a ball between your upper back and a wall

  • Gently lean into it and move slowly

  • Focus on tender spots near the shoulder blade or spine

  • Breathe deeply while holding pressure

💡 Tip: If breathing into the spot feels intense but relieving, you’re in the right place.

2. Thoracic Extension on a Foam Roller

  • Place a foam roller across your upper back

  • Support your head with your hands

  • Gently extend backward over the roller

  • Move segment by segment

This helps restore mobility to a naturally stiff area.

3. Gentle Rotation Movements

  • Open book stretch

  • Thread-the-needle

  • Seated rotation

These help ribs and spine move together again.

4. Breathing Into the Rib Cage

This is often overlooked but very powerful.

  • Place your hands on your lower ribs

  • Breathe into your hands, expanding the rib cage

  • Focus on slow, controlled breaths

This helps:

  • Reduce guarding

  • Restore rib motion

  • Calm the nervous system

Postural Upper Back Pain (The Slow Burn)

Not all upper back pain is sharp and sudden.

A lot of people experience:

  • Achiness

  • Tightness

  • Fatigue between the shoulder blades

This is often related to prolonged positions, especially:

  • Sitting at a computer

  • Looking down at a phone

  • Driving

What’s Happening

Common pattern:

  • Tight muscles:

    • Pectorals

    • Upper traps

    • Levator scapulae

  • Weaker or underactive muscles:

    • Rhomboids

    • Mid/lower trapezius

    • Deep neck flexors

Over time, this creates a feeling of:

  • Stiffness

  • “Burning” between the shoulder blades

  • Needing to constantly stretch or crack your back

Simple Preventative Strategies

Movement Snacks (My Favorite)

👉 20 seconds every 20 minutes

  • Stand up

  • Roll shoulders

  • Gently extend your back

  • Take a few deep breaths

Small, consistent movement makes a huge difference.

Strength + Activation

Focus on:

  • Rows (bands or weights)

  • Scapular retraction exercises

  • Wall angels

  • Prone Y / T exercises

These help your body hold better posture naturally instead of forcing it.

Ergonomic Tweaks

  • Screen at eye level

  • Support your lower back

  • Keep keyboard close

  • Change positions often

When to Seek Help

Consider getting evaluated if:

  • Pain is sharp and not improving

  • Breathing is consistently painful

  • Pain keeps coming back in the same spot

  • You feel “stuck” and can’t move normally

Final Thoughts

Upper back pain is incredibly common—but also very treatable.

Whether it’s:

  • A rib joint that’s irritated

  • Muscles that are overworking

  • Or a posture pattern that’s been building over time

Your body is usually just asking for:
movement, support, and a little bit of help getting unstuck.

Dr. Cassandra Hoy
Next

What Really Happens to Your Body in a Car Accident