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Why Do I Get Upper Back Pain When Lying Down?

Published January 22, 2021
| Written By SpineNation Editorial Staff   | Medically Reviewed by Allen Conrad, BS,DC,CSCS
Tags:  Cervical Spine
For some people, upper back pain is present all the time. But for others, the pain gets worse when lying down flat or at night when they sleep. They may also only have upper back pain at night or when they wake up in the morning. Finding a comfortable position when resting that is taking less pressure off of your upper back may help you get better rest.

Upper back pain can have many causes. Common ones include muscle strain or overuse, poor posture, or an injury. More serious causes include a spine condition such as a herniated disc or, less commonly, cancer, or infection of the spine.

What is upper back pain?

Upper back pain can occur anywhere from the base of the neck to the middle of the ribs. It can also involve the shoulder blades or the ribs.

The upper back has:

  • Vertebrae, the bones of the spine. There are 12 vertebrae in the upper and middle back (which is called the thoracic spine). The ribs attach to the vertebrae in the back and to the sternum in the front.
  • Spinal (or intervertebral) discs that separate the vertebrae and provide cushioning and support.
  • Muscles and ligaments that hold the spine together.
  • Two shoulder blades that are attached to the upper back and shoulders by muscles and ligaments.

Upper back pain is less common than pain in the neck or low back since the spine in the upper back is less flexible. This is because the upper and middle spine, ribs and sternum form a tough cage to protect the heart, lungs and other vital organs.

What causes upper back pain?

In general, upper back pain may be caused by:

  • Muscle strain or overuse
  • Injuries to the muscles, ligaments or spinal discs that support the spine
  • Poor posture during work or leisure activities, especially for long periods without a break
  • Herniated disc, degenerative disc disease, or another condition that puts pressure on the spinal nerves
  • One or more fractured vertebrae
  • Osteoarthritis in the spine. This occurs when the cartilage of the joints and discs breaks down. It is more common in the neck and lower back.
  • Myofascial pain, which is related to the connective tissue that wraps around and supports the muscles of the back.
  • Whiplash or a motor vehicle accident.

Could upper back pain be caused by something more serious?

Less commonly, upper back pain may be caused by other problems, such as infection or cancer.

A bacterial infection such as a spinal epidural abscess happens when germs and pus form in the space between the bones in your spine and the membrane of your spinal cord. The abscess becomes painful when it swells. It’s treated through antibiotics, but in some cases surgery is necessary to remove the matter.

In rare instances, lung cancer can be the cause of upper back pain. Cancer that has spread don into the bones can create pain in the upper back.

What are the symptoms of upper back pain?

Common symptoms of upper back pain are:

  • A dull, sharp, or burning pain
  • Tightness or stiffness in the muscles of the back

More serious symptoms that should be checked by a doctor right away include:

  • Tingling or numbness in your arms, chest, belly, or legs
  • Weakness in your arms or legs
  • Loss of control of your bowel or bladder
  • Pain or throbbing in your abdomen
  • Fever
  • Unexplained weight loss

Why does my upper back hurt when lying down?

Dr. Alice Holland, a physical therapist at Stride Strong Physical Therapy in Portland, Oregon, says if your upper back pain only happens when lying down or while sleeping, it provides clues as to what’s behind your pain. Some possible causes include:

  • Lying down puts more pressure on the part of the back that is affected, such as the vertebrae, spinal discs, spinal nerves, muscles, ligaments, or connective tissue. Holland says this can happen if you have abnormal rounding of the upper back (kyphosis), which makes lying on your back uncomfortable.
  • Your pillow or mattress aren’t a good fit. “It could hint that your pillow is too high or too low or unsupportive when you are sleeping,” says Holland. Your mattress may also be too hard or not provide enough support.
  • A lack of movement while lying down for a long time may cause muscles to become more stiff or tight.
  • If you toss and turn a lot while sleeping, this can put additional strain on the back muscles or spine.

Dr. Eugene Charles, a chiropractic physician and applied kinesiologist in New York City, says if the pain is worse at night, it could be a serious medical problem, or it is because you notice the pain more because you are less distracted.

“Hope for the second, but don't rule out the first,” says Charles. Charles is the author of Journey to Healing: The Art and Science of Applied Kinesiology.


When should I see a doctor about upper back pain?

If you are concerned about the upper back pain, you should see a doctor or other health professional. If you have any tingling, numbness or weakness in your arms, chest, belly or legs, or other serious symptoms, see a doctor right away.

What information should I share with my doctor?

To help your doctor determine what is causing your symptoms and the best way to treat your condition, make note of the following:

  • What symptoms you have, including the part(s) of your body that are affected.
  • How severe the pain is, and whether you have upper back pain at night only.
  • If your symptoms get worse while lying down, is it right away or only after lying down for a long time or after sleeping.
  • Does anything make the pain go away, such as changing position while lying down, propping up your back with pillows, etc.

How is upper back pain diagnosed?

Your doctor will first ask you about your symptoms, your overall health, past injuries or surgeries, and your work, and recreational activities. This will be followed by a physical exam.

Your doctor may also have you undergo an X-ray, MRI or another imaging test to see if something such as a herniated disc, compressed spinal nerve, or broken vertebra is causing your pain. Other tests may be needed to determine the cause of your pain or to rule out certain conditions.

How to treat upper back pain

Treatment for upper back pain depends on the cause. Mild to moderate back pain can often be managed with:
  • Rest
  • Ice or heat packs
  • Over-the-counter medications, such as non-steroidal anti-inflammatory drugs (Advil, Aleve, aspirin, Motrin or others), or acetaminophen (Tylenol or others)
  • Manual therapy, such as physical therapy, massage, Thai yoga massage, chiropractic or osteopathic manipulation
  • Exercise, Pilates, or yoga

Change your sleeping position

If your pain is worse at night or when lying down flat, your doctor or physical therapist may suggest that you try several things to decrease your upper back pain in bed, such as:

  • Keep your spine in a neutral position by using a different mattress or foam mattress topper for additional support or using pillows to support your spine.
  • Sleep in a different position, such as sleeping on your back or alternating sides if you are a side sleeper.
  • “Invest in a supportive and just-right pillow for your head and neck curvature,” says Holland. 

Stretch your upper back

Strengthening and stretching your back muscles may also provide some relief because they can help balance the spine. Holland says you can also use a foam roller to increase the flexibility of the upper spine.

“As your spinal curve improves, you may to readjust your pillow again,” says Holland. “The height of it could be a moving target depending on whether you can change the way you sleep or your curvature.”

Consult with your doctor if problems persist

If your pain is severe enough that you have difficulty doing your daily activities, your doctor may recommend a prescription pain medication.

Surgery is a less common treatment for upper back pain, but may be used to treat some spine conditions, such as a herniated disc or degenerative disc disease.


Many things can cause upper back pain when lying down or while sleeping. If you are concerned about your pain, you should see a doctor, especially if you have any tingling, numbness or weakness in your arms or legs, or other serious symptoms.

A doctor can help you determine the cause of your upper back pain and the best treatment. Many cases of upper back pain can be treated with rest, heat or ice packs, over-the-counter medications or manual therapy. Other treatments may needed for more severe conditions such as spine conditions.
Updated: January 22, 2021

Information provided within this article is for educational purposes and is not a substitute for medical advice. Those seeking specific medical advice should consult his or her doctor or surgeon. If you need to consult with a specialist, you may be able find a health care provider in our Specialist Finder. SpineNation does not endorse treatments, procedures, products or physicians.

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  • Cervical Disc Herniation, also called a slipped disk or ruptured disk, occurs when a tear in the tough outer covering of a spinal disc allows the spongy center to bulge out. A cervical disc herniation occurs in the part of the spine in the neck, or cervical region.

Contributors and Experts

Dr. Allen Conrad, BS,DC,CSCS is a Doctor of Chiropractic and a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association (NSCA).