Pain guide · Back pain
Pain between the shoulder blades, or anywhere from the base of the neck to the bottom of the ribs. It is common, and it has been studied far less than neck or low back pain.
Warning signs matter more here than for low back pain, so check them first. After that, the plan borrows from low back and neck research: gentle rotation, then rows and shoulder-blade strength.
Exercise is for pain that has been checked or is clearly mild and settling.
In studies, between 3.5% and 34.8% of people had thoracic (upper or mid back) pain over a year. It was more common in children, teenagers and women, and linked to backpack use, other muscle and joint pain and psychological factors. The treatment trials are mainly small pilot studies, such as a 30-person trial of manipulation that its author described as underpowered. So the plan below borrows from low back and neck research.
In office workers, pain in the upper trapezius (the muscle running from the neck to the shoulder) is linked to monotonous computer work. In 48 women in computer-heavy jobs with this pain, 10 weeks of specific strength training for the painful muscle cut their worst pain by about 79%, while leg cycling gave only a small, short-lived drop.
That supports shoulder-blade strengthening such as rows, shrugs and reverse flys. The exact exercises used aren't in the published summary, so the moves here are an editorial choice.
Source 11
Reviews found no consensus that posture causes back pain, though that research is mostly on the low back. Treat upper back mobility and strength work as things that feel good and build capacity, not as posture correction.
A UK consensus advises avoiding postures with a lot of spinal flexion and modifying or avoiding sustained, repeated or end-of-range rounding (consider alternatives to Pilates roll-downs and curl-ups). It suggests back-strengthening exercises, 3 to 5 repetitions held for 3 to 5 seconds, at least twice a week. After a spinal fracture it suggests impact up to about brisk walking, and says exercise may reduce pain, ideally with specialist advice.
Source 14
Some discomfort during exercise is fine, and it does not mean you are doing damage: the WHO counts "hurt does not necessarily mean harm" among the messages people with back pain need. Aim for pain you would call mild to moderate, no more than about 5 out of 10. It should settle within an hour or so and be no worse the next morning. If it is worse, do less next time, not nothing.
If pain climbs day after day, or any warning sign appears, stop and get it checked. The 5 out of 10 figure matches this site's other pain guides and has not been tested in a back pain trial; in trials of long-lasting muscle and joint pain, exercise that allowed some pain did no harm.
Start at the first stage. Each move opens a full guide with a 3D demo.
Weeks 0 to 2, daily, little and often. The doses are the move guides' own where they have one, otherwise editorial starting points.
3D demoThoracic rotationBeginner · No equipment6 rotations each side
Harder: Reverse lunge with rotation
3D demoSide-lying Open Book RotationBeginner · No equipment8 to 10 slow openings each side
Harder: Reverse lunge with rotation
3D demoCat-cowBeginner · No equipment8 slow waves
3D demoCrocodile Breathing (prone diaphragmatic breathing)Beginner · No equipment5 min of easy breathing
3D demoTreadmill walkingBeginner · Cardio machine10 to 20 min · Let the arms swing
Harder: Treadmill jogging
Move on when: Turning and reaching are more comfortable, and the pain is settling.
Weeks 2 to 6. Two or three sessions a week.
3D demoBand rowBeginner · A band + An anchor point3 sets of 10 to 15
3D demoProne Y-T-W raisesBeginner · No equipment2 sets of 6 to 8 of each letter
Easier: Wall angel · Harder: Bent-over reverse fly
3D demoBand pull-apartIntermediate · A band2 to 3 sets of 12 to 15
Easier: Prone Y-T-W raises · Harder: Barbell rear-delt row
3D demoFoam Roller Thoracic ExtensionBeginner · A foam roller5 to 8 breaths at 3 or 4 positions · Skip it with osteoporosis
3D demoExtended puppy pose (Uttana Shishosana)Beginner · No equipment3 holds of 20 to 30 s
Move on when: These feel steady, and the pain is no worse the next morning.
From about week 6. With osteoporosis or after a healed spinal fracture, and with a clinician's advice, swap the foam roller and puppy pose for the back-extensor moves at the end of this stage.
3D demoSupported single-arm dumbbell rowIntermediate · A dumbbell + A bench or box3 sets of 8 to 12 each side
Easier: Incline ring row · Harder: Bent-over barbell row
3D demoFace pullIntermediate · A band3 sets of 12 to 15
Easier: Prone Y-T-W raises · Harder: Barbell rear-delt row
3D demoFarmer's carryBeginner · A dumbbell + A kettlebell3 walks of 20 to 30 m
Harder: Suitcase carry
3D demoLow cobra (Bhujangasana)Beginner · No equipment3 to 5 reps, each held 3 to 5 s, at least twice a week · Back-extensor work: the UK osteoporosis consensus dose; lift with the back muscles, hips down
Harder: Cobra pose (Bhujangasana)
3D demoLocust pose (Salabhasana)Beginner · No equipment3 to 5 reps, each held 3 to 5 s, at least twice a week · The same back-extensor dose
Harder: One-legged bow (half locust)
Move on when: Add load gradually, one change at a time.
Skip deep or loaded forward rounding: Jefferson curls, seated forward folds, rounding in the Pilates spine stretch, and sit-ups. Swap the foam roller and puppy pose for back-extensor work (low cobra or locust, 3 to 5 repetitions held 3 to 5 seconds, at least twice a week), and keep rows, wall angels and brisk walking. Get a clinician's advice first.
The foam roller's own guide says to clear it first if you have osteoporosis; that is a precaution, as the consensus does not discuss foam rolling.
Source 14
There is no need to chase a perfect posture. Break up long spells at a screen with a short walk, a few thoracic rotations or a set of band rows.
Source 12
Keep a foam roller on the upper back. The roller guide says stay off the neck and the low back.
A 10-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.
10 minBeginner7 movesA foam roller, A wallA quick stretch break you can do beside your desk: neck, back, chest, wrists, hips and quads.
5 minBeginner7 movesA wallGentle rolling for the upper back and lats, rotation and segmental spine work, then two easy strength moves. Exercise is what back-pain guidelines recommend.
15 minBeginner11 movesA foam rollerOften there is no single clear cause. It is common, and in studies it was linked to backpack use, other muscle and joint pain and psychological factors, and in office workers to long spells of computer work. Because some causes are serious, check the warning signs first; the NHS advises seeing a GP for back pain at the top of the back, between the shoulders.
Don't wait to find out: back pain with chest pain needs a 999 call. Sudden severe pain in the tummy or back, or pain spreading from the tummy to the back with vomiting, also needs 999 or A&E.
If it comes with chest pain, call 999. If you have a fever or feel generally unwell, get a same-day appointment with a GP or NHS 111. Otherwise, see a GP if it doesn't settle.
Studies found it more common in women. Unexplained back pain with muscle spasms, height loss, or a curved spine or change in posture can be a sign of an osteoporotic spinal fracture, more likely with older age or long-term steroid tablets: see a GP.
Reviews found no consensus that posture causes back pain. Moving more often and building upper back strength are worth doing because they feel good and build capacity, not because there is one correct posture to hold.
Thoracic rotation, the side-lying open book, cat-cow and extended puppy pose are gentle places to start; the foam roller extension suits most people, but not those with osteoporosis. Stretches can feel good, but the little evidence there is points to strength work, which is why the plan builds to rows and shrugs.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
