Yoga guide
Upper back pain, anywhere from the base of your neck to the bottom of your shoulder blades, is common and usually comes from tired, sore muscles after long, still spells rather than damage. No trial has tested yoga for it directly, but yoga eased long-lasting neck pain about as well as other exercise, and strengthening the muscles between the shoulder blades has the best evidence of all.
Pain between the shoulders can occasionally come from the heart or lungs, so the NHS asks you to see a GP about it, and chest pain or sudden breathlessness needs 999.
This guide covers what usually causes upper and middle back pain, what the evidence shows, gentle poses to start with, the back-strengthening poses, posture, who should change what, and a free class with a 3D demo of every pose.
Between 3.5% and 34.8% of people have upper back pain over a year, and around 30% in many jobs; in one survey, 28% of office workers had it. It usually comes from tired, sore muscles after long, still spells, not from damage.
The NHS asks you to see a GP for back pain "coming from the top of your back (between your shoulders), rather than your lower back". Chest pain, or sudden breathlessness with pain in your chest or upper back, needs 999 (see the warning signs).
We found none. The nearest evidence is neck pain, where yoga eased pain and disability more than usual care in the short term, about as well as other exercise.
Ten weeks of specific strength training cut the worst neck muscle pain by about 79% in women with computer-heavy jobs, and strengthening the neck, shoulder blades and arms eased long-lasting neck pain in a Cochrane review. In a lab study, locust with the arms forward worked the muscles between the shoulder blades hardest of 15 poses.
Reviews find no agreement that posture causes back pain, and young women who sat upright had more neck pain later than those who slumped. In studies of healthy people, strengthening changed upper back posture and stretching didn't. Move often rather than holding one "correct" position.
Our editorial starting point: gentle breathing and movement first, then back-strengthening poses repeated 3 to 5 times and held 3 to 5 seconds, 2 or 3 times a week (the dose the UK osteoporosis consensus suggests for back-strengthening exercise), and a short mobility break every hour you sit.
Our upper back pain guide describes it as pain "between the shoulder blades, or anywhere from the base of the neck to the lower tips of the shoulder blades". Middle back pain is lower, between the bottom of the shoulder blades and the bottom of the ribs. Research usually lumps both together as pain in the thoracic spine, the part of the spine that carries the ribs.
Across 33 studies, between 3.5% and 34.8% of people had upper back pain over a year, more often children, teenagers and women. In working adults, most groups reported around 30%, and in 1,185 office workers, 28% had upper back symptoms over a year, more often women and people under 30. It has been studied much less than neck or lower back pain, and no study has followed how adults recover from middle back pain.
In working adults, upper back pain went with a high workload, problems with the workstation, boring tasks and high mental pressure. In women with long-lasting pain in the trapezius (the large muscle across the top of the back and shoulders) from monotonous computer work, strengthening the painful muscle eased the pain a lot, which fits tired, overworked muscles rather than damage.
Pain in the upper back can occasionally come from the heart or the lungs. The NHS lists chest pain that spreads to the back as a 999 sign, and pain in the chest or upper back among the signs of a blood clot in the lungs, and it asks you to see a GP for pain between your shoulders. The warning signs below use the NHS's wording.
Many people have both. The neck trials below are the closest yoga evidence, and our yoga for neck pain guide covers the neck.
We found no randomised trial of yoga for upper or middle back pain: a search found 2 records, and neither was one. The upper back has been studied far less than the neck or the lower back, so this page borrows from neck pain trials and from exercise trials in office workers, and says so.
For neck pain lasting 3 months or more, yoga reduced pain and disability more than usual care in the short term (3 trials, 188 people, with no serious side effects in the 2 that reported them), and a broader review of 10 trials (686 people) found similar short-term effects. A review of 25 reviews found no clear difference between exercise types, yoga included, and no long-term results for yoga, and a comparison of 40 trials found yoga, Pilates, tai chi and qigong about as effective as strengthening and control exercises, on very low-quality evidence.
In 48 women with long-lasting trapezius pain from monotonous, computer-heavy jobs, 10 weeks of specific strength training for the painful muscle cut their worst pain by about 79%, while leg cycling gave only a brief drop. In 198 workers with frequent neck and shoulder pain, band exercise for 2 or 12 minutes a day, 5 days a week, cut pain by 1.4 and 1.9 points out of 10 in 10 weeks. A Cochrane review found moderate-quality evidence that strengthening the neck, shoulder blades and arms eases long-lasting neck pain.
In 20 experienced women, locust with the arms reaching forward made the middle and lower trapezius work hardest of 15 static poses, while warrior II, dancer and reverse tabletop worked them little. It's a small lab study, so compare poses only within it.
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In 26 office workers with long-lasting neck pain, adding 15 minutes of upper back mobility exercise twice a week for 6 weeks eased pain and disability as much as adding spinal manipulation. In one unblinded workplace programme of mobility, strength and stretching exercises, the share of office workers reporting neck and upper back pain fell from 54% to 25% over 6 weeks, with no change in a comparison group; it measured whether people had pain rather than how much, and we read its results only in summary. Mobility poses feel good and may help, but treat them as the warm-up for the strength work.
Twice-daily neck and shoulder stretches eased office workers' neck pain more than advice on desk set-up alone in one trial, and stretching reduced pain in 5 of 6 studies in a 2025 review. But a Cochrane review found that stretching alone may not help long-lasting neck pain (low-quality evidence), while strengthening does.
In trials of long-lasting musculoskeletal pain, exercise that allowed some pain did slightly better in the short term and no worse later. Our back pain rule applies (see pain during practice).
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Our 25-minute yoga for posture class 2 or 3 times a week (our editorial starting point), with each back-strengthening pose repeated 3 to 5 times and held 3 to 5 seconds. That's the dose the UK osteoporosis consensus suggests for back-strengthening exercise, at least twice a week, and the Royal Osteoporosis Society suggests posture exercises 2 or 3 days a week with a rest day in between.
Short, frequent breaks are better than long, rare ones, and physiotherapists say your best posture is your next one. A few mobility moves every hour you sit count: our desk yoga guide has them.
If the pain keeps returning, add band rows or our upper back strength routine on 2 days a week (our suggestion): the strength trials that helped ran for 10 weeks.
The NHS says back pain usually improves within a few weeks. See a GP or physiotherapist if it hasn't improved after a few weeks of looking after it at home, or it stops your day-to-day activities.
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A review of 41 reviews found no agreement that spine posture causes back pain. In 686 young people, young women who sat slumped or in between at 17 were less likely to have persistent neck pain at 22 than those who sat upright. Adults with neck pain held their heads a little further forward than adults without, in snapshot studies that can't show which came first, and a rounded upper back wasn't linked with shoulder pain.
In 23 studies of healthy people, strengthening changed upper back and neck posture and stretching didn't, and a 2025 consensus of stretching researchers "does not recommend stretching to promote postural changes".
In adults over 60 with a rounded upper back, 6 months of yoga classes improved two of three measures of the curve, by 4.4% and 5%, and 6 months of spine strengthening reduced it by 3 degrees on X-ray. Our yoga for posture guide covers this.
The Chartered Society of Physiotherapy says "There is no perfect posture or right or wrong desk set up". Changing position often matters more than sitting straight.
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Crocodile breathing: 5 minutes of easy nose breathing, about 4 seconds in and 6 out; cat-cow: 8 slow waves; thread the needle: hold 30 to 60 seconds, about 5 to 10 slow breaths, each side, 2 rounds; thoracic rotation: 6 each side, with the breath; the side-lying open book: 8 to 10 slow openings each side, pausing 2 seconds at the end; gate pose: hold 30 to 60 seconds, about 5 to 10 slow breaths, each side, 2 rounds (the moves' pages). Extended puppy: 3 holds of 20 to 30 seconds (our upper back pain guide), and child's pose: 1 minute between the strength poses, forehead on a block (our editorial starting point). Skip lying face down late in pregnancy.
3D demoCrocodile breathing (prone diaphragmatic breathing)Beginner · No equipment
3D demoCat-cowBeginner · No equipment
3D demoThread the needle (Parivrtta Balasana)Beginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoSide-lying open bookBeginner · No equipment
3D demoGate pose (Parighasana)Beginner · No equipment
3D demoExtended puppy pose (Uttana Shishosana)Beginner · No equipment
3D demoChild's Pose (Balasana)Beginner · No equipmentLocust: 3 to 5 lifts, and low cobra: 5 lifts, each held 3 to 5 seconds, with locust's arms by your sides at first and then reaching forward; sphinx: 2 holds of 3 to 5 breaths; bird dog, one limb at a time: 5 each arm and leg, holding 3 to 5 seconds (our yoga for posture class). The seated upper-back lift: 3 to 5 repetitions, each held 3 to 5 seconds, at least twice a week, and band rows: 3 sets of 10 to 15, stopping 2 to 3 reps short of failure (the moves' pages). Y-T-W raises: 2 sets of 6 to 8 of each letter, and wall angels: 2 sets of 8 to 10 (our upper back pain guide). Keep your neck long and your eyes down in the face-down lifts.
3D demoLocust pose (Salabhasana)Beginner · No equipment
3D demoLow cobra (Bhujangasana)Beginner · No equipment
3D demoSphinx pose (Salamba Bhujangasana)Beginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box
3D demoBand rowBeginner · A band + An anchor point
3D demoProne Y-T-W raisesBeginner · No equipment
3D demoWall angelBeginner · A wallMountain pose: 5 to 10 slow breaths, 2 or 3 times, and breath reach: 5 breaths, breathing out for longer than in (the moves' pages). High lunge: 3 to 5 breaths each side, and chair pose: 3 holds of 5 breaths (our yoga for posture class); warrior II: 5 breaths each side (our morning yoga routine). Lower your arms if your shoulders or neck complain.
Fish, camel, wheel and a deep upward dog drop your head back: leave them out while your upper back or neck hurts, and use sphinx or low cobra with your eyes down. Headstand, shoulder stand and plough load the neck: leave them out, as our yoga for neck pain guide says. With osteoporosis, clear the foam roller with a physiotherapist first. Ease off deep twists such as half lord of the fishes if they pinch your lower back, and avoid deep twisting in later pregnancy (its page).
3D demoFish pose (Matsyasana)Intermediate · No equipment
3D demoCamel pose (Ustrasana)Intermediate · No equipment
3D demoWheel pose (Urdhva Dhanurasana)Advanced · No equipment
3D demoUpward-facing dog (Urdhva Mukha Svanasana)Intermediate · No equipment
3D demoSupported headstand (Salamba Sirsasana)Expert · A wall
3D demoSupported shoulderstand (Salamba Sarvangasana)Advanced · No equipment
3D demoPlow pose (Halasana)Advanced · No equipment
3D demoFoam roller thoracic extensionBeginner · A foam roller
3D demoHalf lord of the fishes (Ardha Matsyendrasana)Intermediate · No equipmentPain between the bottom of the shoulder blades and the bottom of the ribs has been studied even less than upper back pain: a review found a 1-month incidence in adults of under 1%, and no studies of how adults recover. The same gentle movement and back-strengthening poses apply, and our middle back pain guide has more, with its warning signs.
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Some discomfort during exercise is fine, and it doesn't mean you're doing damage: in trials of long-lasting pain, exercise that allowed some pain did no harm. Aim for pain you'd call mild to moderate, no more than about 5 out of 10, that settles within an hour or so and is no worse the next morning. If it is worse, do less next time, not nothing.
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Stop or shrink any movement that sends pain, pins and needles or numbness down your arm.
If a pose that tips your head back or turns it hard brings on dizziness, blurred vision or a sudden headache, come out slowly and sit down. If it doesn't settle within a few minutes, treat it as one of the urgent signs below, and don't repeat that pose (our suggestion, from our yoga for neck pain guide).
Keep the back-strengthening poses: the UK osteoporosis consensus recommends spine-extension exercise, and says "Rotation (twisting) movements should be safe if performed smoothly and comfortably". Avoid deep or repeated rounding, keep the rounding in cat-cow small, and clear the foam roller with a physiotherapist first.
Swap face-down poses for all fours as your bump grows, keep twists gentle and open, and in later pregnancy avoid lying flat on your back for more than a few minutes, as the NHS advises.
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Leave out headstand and shoulder stand, and keep head-down poses such as extended puppy brief: eye pressure rose within a minute in head-down poses in a lab study.
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The sphinx and low cobra pages say to stop if bending back brings on or spreads pain, tingling or numbness down a leg, and to skip them with spinal stenosis. Locust with small lifts or the seated upper-back lift are gentler options.
Start with our 25-minute yoga for posture class 2 or 3 times a week (our editorial starting point): it has the breathing, mobility and back-strengthening poses on this page. The upper back mobility routine adds a foam roller and band strength work, and seated chair yoga suits anyone who can't get down to the floor.
Twenty-five minutes of back-strengthening yoga for posture: arm and leg reaches, face-down back lifts and standing poses with the arms raised.
25 minBeginner15 movesNo equipmentA 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.
12 minBeginner8 movesA foam roller, A wallTwenty minutes of slow breathing, small neck movements, poses that keep your head supported or level, and upper-back strength, with nothing that loads the neck.
20 minBeginner14 movesA stepDeep neck holds and shoulder-blade strength in under 20 minutes: one of the best-supported kinds of exercise for a stiff, sore neck.
18 minBeginner11 movesA band, An anchor pointA 30-minute routine for a rounded upper back in later life, built from the SHEAF trial: floor back-strengthening, posture practice and gentle mobility.
30 minBeginner13 movesA bench or box, A wallA 15-minute routine that moves your neck, upper back and lower back through bending, arching, side bending and twisting, then holds the spine steady.
15 minBeginner12 movesNo equipmentA 15-minute chair yoga routine done entirely sitting: slow breathing, neck, shoulder and wrist stretches, seated twists and side bends, and a calm finish.
15 minBeginner16 movesA bench or boxThese are the warning signs from our upper back pain guides, in the NHS's words. A&E means accident and emergency. In the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111.
Get emergency help for any of these:
Ask for an urgent GP appointment or contact NHS 111 if you have back pain and you feel hot, cold, shivery or generally unwell, or severe pain that starts suddenly or is getting worse quickly.
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In many areas you can refer yourself to NHS physiotherapy without seeing a GP.
Our upper back pain guides list other conditions that can cause pain in this area and need checking, such as angina, gallstones and shingles, with the signs to look for.
Reviews find no agreement that posture causes back pain. Young women who sat upright at 17 had more persistent neck pain at 22 than those who slumped, a rounded upper back wasn't linked with shoulder pain, and adults with neck pain had only slightly more forward head posture, in snapshot studies. Long, still spells are the likelier problem: move often.
Strengthening the neck, shoulder blades and arms eased long-lasting neck pain, while stretching alone may not, and in 23 studies, strengthening changed upper back posture and stretching didn't.
The opposite overstatement. Strength has the better evidence, but stretching isn't harmful: twice-daily neck and shoulder stretches eased office workers' neck pain more than desk advice alone, and stretching reduced pain in 5 of 6 studies. Use both, gently.
Usually it is muscular, but the NHS asks you to see a GP for back pain "coming from the top of your back (between your shoulders)", and chest pain that spreads to the back, or sudden breathlessness with pain in the chest or upper back, needs 999.
No trial shows it, and the US National Center for Complementary and Integrative Health (NCCIH) advises newcomers to avoid headstands and shoulder stands. For the muscles between the shoulder blades, locust with the arms forward worked hardest of 15 poses in a lab study.
The trials that reduced a rounded upper back a little used gentle back strengthening: 6 months of yoga classes improved two of three measures by 4.4% and 5% in adults over 60, and spine strengthening reduced the curve by 3 degrees. Deep backbends weren't part of them, and their pages carry neck and lower back cautions.
Some discomfort is fine: in trials of long-lasting pain, exercise that allowed some pain did no harm. But keep it mild to moderate, settling within an hour, and stop or shrink anything that sends pain, tingling or numbness down an arm.
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Usually tired, sore muscles after long, still spells at a desk or on a phone; a heavy workload, workstation problems and mental pressure are linked with it too. It's common: between 3.5% and 34.8% of people have it in a year, and about 3 in 10 in many jobs. Less often it comes from the heart, lungs or bones, which is why the warning signs matter.
It's likely to help, but no trial has tested it directly: we found no yoga trial in upper or middle back pain. In long-lasting neck pain, yoga eased pain and disability more than usual care in the short term, about as well as other exercise, and strength work for the shoulder blades has the best support.
Start with slow breathing, cat-cow, thread the needle, the open book and gate pose to get moving, then build strength with locust, sphinx, low cobra and bird dog. In a lab study, locust with the arms forward worked the muscles between the shoulder blades hardest of 15 poses. Upper back mobility exercise did as well as spinal manipulation in office workers with neck pain.
Often, when it's muscular: gentle mobility and back-strengthening poses suit it. But the NHS asks you to see a GP for back pain coming from the top of your back, between your shoulders, and pain there with chest pain or sudden breathlessness needs 999.
Call 999 for chest pain that comes on suddenly and doesn't go away, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, sickness, light-headedness or breathlessness, and for sudden breathlessness with pain in your chest or upper back. Get help the same day for back pain with feeling hot, shivery or generally unwell. See a GP for pain between your shoulders.
Both, with strength first. Strengthening the neck, shoulder blades and arms eased long-lasting neck pain while stretching alone may not, and 10 weeks of specific strength training cut neck muscle pain by about 79% in women with computer-heavy jobs. Stretching still eased office workers' neck pain in a trial, so keep it as well.
Not clearly. Reviews find no agreement that posture causes back pain, and young women who sat upright had more persistent neck pain later than those who slumped. Moving often matters more than holding a perfect position.
Our suggestion is a class like our 25-minute yoga for posture 2 or 3 times a week, with each back-strengthening pose repeated 3 to 5 times and held 3 to 5 seconds, plus a short mobility break every hour you sit. See a GP or physiotherapist if the pain hasn't improved after a few weeks of looking after it at home.
Yes, with changes: back-strengthening poses are recommended, twists should be smooth and comfortable, and deep or repeated rounding should be avoided. New hunching or loss of height, especially with back pain you can't explain, needs a GP check, as osteoporosis can cause spinal fractures that change the shape of the spine.
It can if you push into sharp pain or load your neck: leave out headstand, shoulder stand and plough, and poses that drop your head back, as our yoga for neck pain guide advises. Some discomfort is fine if it stays mild to moderate and settles within an hour or so.
See a GP or physiotherapist if your pain hasn't improved after a few weeks of looking after it at home, stops you doing day-to-day activities or worries you. In many areas you can get NHS physiotherapy without a GP referral.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition such as glaucoma, high blood pressure or osteoporosis, or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
