Upper back pain affects 1 in 10 men and 1 in 5 women each year. The 12 vertebrae making up the thoracic spine, which begins at the base of your neck and extends to the bottom of your rib cage, are the longest and least flexible within the spinal column. And while one of the most stable portions of the spine, upper back pain can cause great discomfort—especially before and after sleeping.

What Causes Upper Back Pain

Upper back pain before and after sleeping can be brought on by several factors, including poor posture, overuse injuries, excess sitting and hunching if you work in an office, sports injuries, and muscle strains. Other factors like being overweight, smoking, and even heavy backpacks and purses frequently create upper back pain problems. One often overlooked cause is sleeping position.

Bill Fish, certified sleep science specialist and co-owner of Tuck Sleep, points out, “There is no question that your preferred sleeping position could result in some back pain.” According to Fish, 41 percent of people sleep in the fetal position. It’s also the most popular sleeping position and helps keep your spine aligned at night. With the proper mattress and pillow support for your neck, shoulders, and hips, sleeping on your back will also relieve any pressure on the spine.

“If you are sleeping on your stomach and notice you are suffering some back pain, there probably is a reason,” Fish says, “It knocks your spine completely out of alignment.” He points out that the upper back pain comes from your body’s weight pushing the core into the sleep surface and misaligning the spine.

Much like when recovering from back surgery, it is important to adjust your sleeping positions to minimize discomfort overnight for your upper back pain.

With many people using smartphones and tablets—particularly in bed as a means to wind down—more doctors and chiropractors are seeing patients with an upper back condition they refer to as “tech neck.”

Certified personal trainer and owner of Bdefined Fitness, Bridgit Kin-Charlton explains how tech neck and other everyday activities can effect the cervical spine and lead to upper back pain.

“We spend the majority of our day in spinal flexion—driving, texting, scrolling, sitting at our desk, watching TV—causing the muscles of our upper back to become overstretched, and the opposing muscles in our chest to become tight.”

A simple change to help stop upper back pain before and after sleep includes standing often and moving periodically.

“Static positions that are the same for extended periods are never good for us,” Dr. David Shapiro, DC, CEO of Complete Spine Solutions, explains. “Movement is important not just to avoid pain, but also for your overall health.”

Preparing Your Bed

Other lifestyle changes to combat upper back pain at night include changing your bedding and nighttime routine. While daily stretching and exercises strengthen your back, ensuring the most comfort and support while sleeping is key to battling upper back pain. Your old mattresses may be contributing to your back pain, and experts suggest a firmer mattress is the way to go. Fish says, “A great first step is to take a yardstick and placing it across the mattress to see if there is a ’dip’ in the mattress.” If there is a crevice, or dip, replacing your mattress might be part of the resolution to your upper back pain.

If your mattress is not the problem, you could be lacking much-needed support in your pillow. The pillow support and height may be different for whatever sleeping position you tend to favor.

“The proper pillow can be the difference between a great night of sleep and walking around feeling not only tired but sore each day,” says Fish. “Someone who predominantly sleeps on their side will need a pillow with more height to properly support their head and neck, while someone who sleeps on their back, wouldn’t need that same height.”

Best Sleeping Positions

Once you’ve settled into the bed, you'll want to choose the sleeping position that prevents long-term discomfort in the upper back and neck. The best sleeping positions are on your back or your side. When sleeping on your back or side, support the curvature of your neck with one pillow while using a flatter pillow for lying down your head.

On your side, choose a pillow that allows your neck to aligns with your head to keep your spine straight and reduce the chance of discomfort or strain during the night. A flatter pillow for the head is again recommended.

Prepare a Good Sleeping Environment

Half the battle for sleeping well when you have upper back and neck pain is your sleeping environment. Starting with a good mattress topper, supportive pillows, and a comfortable bedspread can make for a night of better sleep.

Your bedroom configuration also matters. Setting your bedroom to a comfortable temperature, use lower watt light bulbs for a more ambient effect, and reducing screen time while lying in bed can help you sleep a lot better.

How Can I Relieve Upper Back Pain?

Exercise

Exercise is one of many conservative treatments that helps combat upper back pain. Rowing exercises are among the best for strengthening the muscles of your posterior chain and improve upper back strength.

“In order to reduce upper back pain, it is important to stretch the muscles of the anterior chain (front of the body) and strengthen the muscles of the posterior chain (back of the body),” says Kin-Charlton. “Consider adding standing cable rows, high face pulls, and rear cable flys to your strength training program. It is just as important to stretch and lengthen the muscles of your anterior chain.

Stretching

Stretching often or doing yoga can improve posture and back strength to relieve upper back pain. You may notice this discomfort more at night after your body reaches a deep stage of relaxation. Meditation before bed can release stress brought on throughout the day and can help put back pain at ease.

Along with stretching, Kin-Charlton says the head-chest stretch is another move that can help ease upper back pain. “Seated or standing, interlock your fingers, bend your elbows, and raise your arms above your head. Gently squeeze your shoulder blades together and move your elbows and hands backward.”

Kin-Charlton explains how the head-chest stretch can be done sitting or standing, starting with your fingers interlocked. Bend your elbows while raising your arms above your head and squeeze your shoulder blades together. You can vary the height of your hands to stretch shoulders and/or chest (i.e. hands behind head, hands on top of the head, hand a few inches above the head.

Massage

Along with these exercises and stretches, you can do at home to improve your upper back pain, many patients use massages as an overall health benefit. According to the National Massage Therapy Association (AMTA), 85 percent of consumers have used massage for medical reasons. License massage therapist, Margaret Lee says a common misconception of massage is that it’s a luxurious stress reliever when in actuality, it’s an easy and effective way to manage back pain.

“The top benefit is pain relief. Relief is achieved when fresh oxygenated blood is circulated to the problem area,” Lee explains. “The therapist will perform several different strokes and modalities that will break up scar tissue, remove lactic acid, and detangle muscle fibers all while adding length to the muscles.”

After a massage, patients experience less back pain and increased mobility, however, Lee points out that just one massage won’t take away all of your upper back pain problems. For longer and more effective results, she recommends a seven-week massage treatment plan to massage your pain away.

“I recommend a one-hour session once a week for three weeks,” Lee says. “On week four, take a break, and weeks five through seven you will have a 30 minute to one-hour session once a week.”

After completing the first seven weeks of this treatment plan, Lee advises to keep up with at least a one-hour session every three to four weeks.

Could Upper Back Pain Mean Something More Serious?

There is always a chance that your upper back pain could be caused by a much bigger problem. Degenerative Disc Disease (DDD), a herniated disc, and osteoarthritis are possible underlying problems causing your upper back pain. Shapiro cautions that while pain should never be ignored, normal muscle soreness from exercising is nothing to be concerned about. He warns, however, that you should question intense pain that doesn’t go away over time. If you notice symptoms like fever, chills, tingling in your chest or stomach along with your upper back pain you should see your doctor.

“Sharp, shooting, radiating, severe, unexplained acute pain or chronic pain lasting more than a few days could be your body's way of telling you that something more serious is going on,” Shapiro says.