Upper Back Pain And A Rounded Upper Back: Why It Happens, And What Changes It
Upper back pain: the short answer
Upper back pain, the ache between the shoulder blades and across the top of the back, usually comes from an upper back that has stopped doing its job. Desks, phones and steering wheels round it forward. The muscles that should hold it up go quiet, and the neck and lower back take over its work.
A rounded upper back can be changed, at any age. Here is the article in short form:
- A rounded upper back hands its work to the neck and low back.
- Mr Iyengar blamed a sitting life and weak muscle tone.
- UCLA trial, 118 people over 60: yoga lessened the rounding.
- Working the back muscles beat rounding forward, by a long way.
- A sore upper back needs strength as well as stretch.
- Some upper back pain is worth telling your teacher about.
A quick word on Iyengar yoga. Iyengar yoga is the style developed by Mr BKS Iyengar. In the 20th century he did more than anyone to set down traditional Indian yoga, through his books and his teaching, and he pioneered the use of props. It is the style we teach at Flametree, in Darwin and live online.
A chair takes the weight so the arms and upper back can lengthen. Desk work rounds the upper back; this takes it the other way.
Why does my upper back hurt?
Most often, because it has been rounded and still for too long. In Yoga: The Path to Holistic Health, Mr Iyengar lists the usual causes of upper back pain as a sitting life, extra weight and weak muscle tone.
When the upper back rounds, the shoulder blades slide forward and apart. The muscles between them are stretched and working all day just to hold the head up. That is the familiar ache between the shoulder blades.
Then the chain effect starts. Mr Iyengar saw it in Christina, a woman he worked with in Australia in 1992, who had four years of upper back pain, a stiff neck and headaches. Looking at her rounded upper back, he said: “So the job that has to be done by the dorsal/thoracic spine is done by the lumbar and the cervical.” Her neck and lower back were doing the upper back’s job as well as their own.
Can a rounded upper back be changed?
Yes. Many people notice their upper back rounding and their head moving forward as they age. Doctors call a marked rounding hyperkyphosis, and assume it is simply age.
A team at the University of California, Los Angeles tested that. In a 2009 trial, 118 people aged 60 and over with a rounded upper back did yoga three times a week for 6 months, or went to a monthly talk. The yoga group’s rounding lessened on two of the measures used. The researchers called it a critical first step: a rounded upper back can be changed.
Their earlier pilot, with 21 women, had already found the yoga safe for people with a rounded back.
A rounded spine under load squeezes the front of the spine bones. A long, lifted spine shares the load.
Is it better to stretch or strengthen a sore upper back?
Strengthen, mainly, while the front of the chest opens. Two very different studies point the same way.
In a 1984 Mayo Clinic study, 59 women with thin spine bones and back pain after menopause were given different exercises. Of those given exercises that rounded the spine forward, 89% had a new spine fracture. Of those given exercises that arched the back, using the back muscles, 16% did. It was small, and it was not yoga. But the direction of the movement mattered more than the effort.
And in a 2008 Danish trial of 48 women with sore necks and shoulders from desk work, strengthening the shoulder muscles cut their worst pain by about 79% over ten weeks. A sore upper back usually needs the muscles that hold it up working again.
Which way the spine moved mattered. Working the back muscles to hold a long spine did far better than rounding forward.
How does upper back pain from sitting build up?
Slowly, a day at a time. Most of us now sit for work, then sit to drive, then sit to relax. The head pokes forward, the shoulders round, and the chest closes.
Alison West, a senior Iyengar-trained teacher in New York who specialises in backs, adds a human reason. She says some of her kindest, tallest men students stand hunched because they do not want to tower over people. When she lengthens them out, a broad chest appears. Part of her work is helping them be comfortable at their full height.
Habit and feeling shape posture as much as muscle. That is why change takes regular practice, not one good stretch.
Get the free ebook Happy Backs. New to Flametree, or away for 3 months or more? You get 2 free classes + 2 ebooks, only available via this offer. Already coming to class? You can still get the book.
What does an Iyengar class do for upper back pain?
It gets the upper back working again. Geeta Iyengar, Mr Iyengar’s daughter and senior teacher, and the Yoga Rahasya writers come back to the same points again and again:
- Shoulders back and down.
- Shoulder blades moving in toward the chest.
- Chin level, not poking forward.
- Neck soft; teeth and jaw unclenched.
“Open the armpits and you are safeguarding the neck,” Geeta said. In the standing poses the arms are held out and up for many breaths, which is strength work for exactly the muscles a desk lets go. Mr Iyengar gave Christina Triangle Pose at a pillar, with a brick along her upper back, so she could feel it lift.
Supported backbends over a chair, done carefully, open the front of the chest. Twists from the upper back, with a chair holding the pelvis, bring back its turn.
Half Moon Pose with a block. The arms reach in one long line and the chest turns open, the opposite of a day at the desk.
Why are short holds used for a sore upper back?
Because a sore back is a guarded back, and force makes it guard harder. New students stay in each pose a short time, come out, and go in again. Mr Iyengar’s advice to a teacher working with a painful neck was: “Just touch and go, touch and go.”
The four things that shape every Iyengar class, the order of the poses, how often each is repeated, the precise actions inside it and how long you stay, are all set gently for a sore upper back.
Four things shape every class. For a sore upper back, short holds, repeated, with the arms working hard.
What should I tell my teacher about upper back pain?
Tell your teacher before class about any upper back or neck injury, and if you have thin bones, so they can adapt the poses.
Feel free to check with your professional advisers if you wish, but also give yoga a try.
Where can I get help for upper back pain in Darwin?
For upper back pain in Darwin, come to class at Flametree’s Woolner studio or join live online from anywhere in Australia. Our beginner classes all work the arms, shoulders and upper back, and every class is adjusted to the people in it. The Wednesday evening Yoga For Backs class, in the studio, focuses on backs.
See also dowager’s hump, stiff neck, mid back pain, how to reduce lower back pain and Yoga For Posture.
Happy Backs, our free ebook, has a section on the desk back: neck, shoulders and upper back.
Your free copy of Happy Backs is waiting. New to Flametree, or away for 3 months or more? You get 2 free classes + 2 ebooks, only available via this offer. Already coming to class? You can still get the book.
Frequently asked questions
What causes pain between the shoulder blades?
Most often a rounded upper back held still for hours. The shoulder blades slide forward and apart, and the muscles between them work all day to hold the head up. Desks, phones and driving add to it.
Can yoga fix a rounded upper back?
It can change it. In a 2009 UCLA trial, 118 people aged 60 and over with a rounded upper back did yoga three times a week for 6 months, and their rounding lessened on two measures. The researchers called it a critical first step: a rounded upper back can be changed.
Is upper back pain from sitting at a desk?
Often. Long sitting rounds the upper back forward and lets the muscles that hold it up go quiet. In a Danish trial of desk workers, strengthening the shoulder muscles cut their worst neck and shoulder pain by about 79% over ten weeks.
Should I stretch or strengthen my upper back?
Mostly strengthen, while the front of the chest opens. In a 1984 Mayo Clinic study, back-arching exercises using the back muscles did far better than rounding exercises. In an Iyengar class the arms and upper back work hard in the standing poses.
Can a rounded upper back cause neck pain?
Yes. When the upper back stops carrying its share, the neck takes on its work. Mr Iyengar saw this in Christina in 1992: her rounded upper back had left her neck and lower back doing its job, with a stiff neck and headaches as the result.
Is upper back pain a sign of something serious?
Usually not. Most upper back pain is muscular. Tell your teacher before class about any injury, and if you have thin bones, so they can adapt the poses.
How long does it take to improve a rounded upper back?
Months of regular practice. The UCLA yoga trial ran three times a week for 6 months. Many people feel the ache ease sooner, but the shape changes slowly, so it is a practice for months and years.
Where can I get help for upper back pain in Darwin?
Flametree Yoga Studio teaches Iyengar yoga at Woolner in Darwin and live online. Beginner classes work the arms, shoulders and upper back, and the Wednesday evening Yoga For Backs class focuses on backs. Every class is adjusted to the people in it.
Where to next
- New to yoga, or coming back? Start with our half price 10 class pass with 2 classes free, in Darwin or live online.
- For a workplace, team or group: book private yoga classes for groups, online, at a Flametree studio or at your venue.
- Want to see class times first? Look at the beginner timetable.
Flametree Yoga Studio, Darwin and live online. This article is general information, not medical advice. Feel free to check with your professional advisers if you wish, but also give yoga a try.
Sources: Greendale GA and colleagues, Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: results of a randomized controlled trial, Journal of the American Geriatrics Society, 2009; Sinaki M and Mikkelsen BA, Postmenopausal spinal osteoporosis: flexion versus extension exercises, Archives of Physical Medicine and Rehabilitation, 1984; Andersen LL and colleagues, two contrasting types of exercise for chronic neck muscle pain, 2008; BKS Iyengar, Yoga: The Path to Holistic Health; BKS Iyengar, Australian remedial classes, 1992; Alison West, Guys Talking Yoga, episode 53 (2023); Yoga Rahasya. Further reading: Crow and colleagues, Iyengar yoga for spinal pain, 2015. Full references are in the Happy Backs and Strong Bones, Steady Feet ebooks.
