If you’ve ever felt that stubborn, nagging knot between your shoulder blades, the one that never quite goes away, you’re not alone. Maybe you’ve tried massages, stretching, or having someone dig their elbow into the spot for relief. It might feel better temporarily, but then… it comes right back.
So what’s actually going on?
The truth is, recurring upper back pain is usually caused by two overlooked issues: not moving through your full range of motion and not strengthening the muscles afterward. Let’s break this down.
Why Your Upper Back Pain Keeps Returning
1. You’re Not Reaching the End Range of Motion
Most people don’t move their upper back (thoracic spine) enough and more importantly, they don’t move it fully.
Your thoracic spine is designed to:
- Bend forward (flexion)
- Straighten backward (extension)
- Rotate side to side
- Slightly side bend
But here’s the catch:
The biggest limitation for most people is extension—fully straightening and opening the upper back.
Because we spend so much time sitting, hunched forward, and looking at screens, our upper back gets stuck in a rounded position. Even when we try to stretch, we often don’t go far enough to actually restore that full movement.
On top of that, many people compensate by moving their lower back instead of their upper back—so the problem never truly gets addressed.
What helps:
- Practice controlled rotation (keeping hips still)
- Gently explore your “easy” direction first, then reassess the restricted side
- Use a rolled towel or pillow under your upper back to encourage extension
- Focus on breathing deeply to help your ribs and spine relax
2. You Love Stretching… But Skip Strengthening
Stretching feels good—no doubt about it. But if you stop there, the relief won’t last.
Once you gain mobility, you need to build strength to maintain it. Otherwise, your body falls right back into the same dysfunctional patterns.
This is especially important if you’re naturally more flexible or “loose-jointed” (hypermobile). In those cases, too much stretching without strength can actually make things worse.
What helps:
- Gentle core exercises (like small, controlled leg raises)
- Focus on control, not intensity
- Keep movements small and precise to avoid compensation
It Might Not Just Be Your Spine
Upper back pain isn’t always just about the spine—it can also come from the shoulder.
One key player is a muscle called the subscapularis, located deep near your shoulder blade (accessible through the armpit area). When this muscle gets tight, it can create that familiar “knot” sensation in your upper back.
But here’s the important part:
Muscles don’t get tight randomly. It’s usually due to imbalance.
In this case, the opposing muscles (the ones that pull your arm outward) may be too weak, forcing the subscapularis to overwork.
Fixing the Imbalance: External Rotation
A simple but powerful exercise to restore balance is external rotation.
How to do it correctly:
- Keep your elbows tucked at your sides
- Bend elbows at 90 degrees
- Keep wrists straight and palms facing down
- Slowly rotate your arms outward
- Hold for 2 seconds, then return
Common mistakes:
- Moving the wrists instead of the shoulders
- Letting elbows drift away from your sides
- Straightening or bending the elbows during movement
When done properly, you should feel a deep, controlled burn along the back of your shoulder and down your arm—not in your wrists or biceps.
The Bigger Picture
Upper back pain is rarely caused by just one thing. It could be:
- Limited mobility in your spine
- Muscle imbalances in your shoulders
- Poor posture habits
- Lack of strength to support movement
The key is figuring out why it’s happening in your specific case.
Final Takeaways
If your upper back pain keeps coming back:
- Don’t just stretch—move through full range
- Pair mobility work with strength training
- Pay attention to shoulder mechanics, not just your spine
- Focus on quality of movement, not quantity
And if the pain persists, it’s always a good idea to consult a qualified professional who can assess your movement patterns and guide you properly.
About the Team
Hoang (“Juanita”) is the Owner of Hands-on Therapy Services, where she has built her dream therapy-owned practice dedicated to helping people recover from injuries and avoid unnecessary pills, injections, and surgery. Whether patients are recovering from surgery or seeking alternative solutions, her mission is to provide effective, hands-on care for the best possible outcomes.
She is an occupational therapist, a certified hand therapist, and the author of multiple free guides available on the site, as well as the internationally sold book “The Hands-on Approach: How to Get Rid of Hand and Shoulder Pain Without Pills, Injections, And Surgery.”
Carole is an occupational therapist and certified lymphedema therapist originally from France. With a background as a licensed massage therapist and yoga instructor, she brings a holistic, patient-centered approach to care. She is passionate about helping individuals regain independence and improve their quality of life.
Having lived and worked in Miami for over 25 years, Carole is trilingual, speaking English, French, and Spanish.
Outside of work, she enjoys teaching and practicing yoga, volunteering at a local animal rescue, and spending time with her family—including her dog and two beloved cats.
