Upper Back Pain While Running: Causes, Treatment, and Prevention
Manhattan Physical Therapy
Running is one of the best ways to improve cardiovascular fitness, maintain a healthy weight, and reduce stress. But if every run leaves you with pain between your shoulder blades or stiffness across your upper back, something is not working the way it should.
While runners often expect sore calves or aching knees, upper back pain is more common than many people realize. It can develop gradually over several miles or appear suddenly during a long run, hill workout, or race. For some people, the discomfort feels like a dull ache between the shoulder blades. Others describe sharp pain that makes it difficult to breathe deeply or continue running.
The good news is that upper back pain while running is usually treatable. In many cases, the problem is related to posture, muscle endurance, running mechanics, breathing patterns, or training errors rather than a serious spinal condition.
What Is Upper Back Pain While Running?
Upper back pain while running refers to discomfort occurring in the thoracic spine, the area between the neck and lower back. The pain may involve muscles, joints, ligaments, ribs, or connective tissues that help stabilize the upper body during movement.
Although the thoracic spine is naturally more stable than the neck or lower back because it connects to the rib cage, it still plays a vital role in maintaining posture, absorbing forces, and allowing efficient arm swing and breathing during running. Pain may occur:
Between the shoulder blades
Along one side of the spine
Around the ribs
Near the base of the neck
Across the upper shoulders
With deep breathing during a run
Some runners only experience symptoms after several miles, while others notice pain almost immediately after starting.
Common Symptoms
Upper back pain may present differently depending on the underlying cause. Symptoms can include:
Dull aching between the shoulder blades
Sharp pain during arm movement
Burning sensation across the upper back
Pain that worsens during deep breathing
Neck stiffness accompanying upper back pain
Difficulty maintaining an upright posture
Pain that improves after rest
How Common Is Upper Back Pain in Runners?
Compared with knee pain or shin splints, upper back pain receives less attention in running communities. However, research shows it is far from rare.
A systematic review published in BMC Musculoskeletal Disorders analyzed 33 studies on thoracic spine pain and found that the 12-month prevalence ranged from 15.0% to 27.5%, while lifetime prevalence ranged from 12.0% to 31.2% in the general population. The review also highlighted that thoracic spine pain is a significant musculoskeletal condition that can affect daily activities and quality of life, although it is often studied less extensively than neck or lower back pain.
The researchers further reported that thoracic spine pain is relatively common among both adults and adolescents, emphasizing the importance of early evaluation and appropriate treatment to address underlying movement, posture, or muscle-related factors before symptoms become persistent.
For runners, repetitive impact, prolonged upright posture, continuous arm movement, and breathing demands place additional stress on the thoracic spine and surrounding muscles. When mobility, strength, or endurance cannot keep up with these demands, pain often develops.
Research Spotlight
A large prospective cohort study published in the British Journal of Sports Medicine followed 5,205 recreational runners and found that 72% of running-related injuries were overuse injuries, highlighting the importance of proper training progression, adequate recovery, and addressing biomechanical factors before they lead to persistent symptoms. Although lower-extremity injuries were the most common, the findings reinforce the need to identify movement impairments that may contribute to excessive stress throughout the body.
In clinical practice, physical therapists often find that poor thoracic mobility, postural deficits, and weak upper back or core muscles can alter running mechanics. Correcting these issues may improve movement efficiency, reduce unnecessary strain on the shoulders and neck, and lower the risk of recurring overuse injuries.
What Causes Upper Back Pain While Running?
Upper back pain rarely has a single cause. Instead, several contributing factors usually work together.
1. Poor Running Posture
Poor posture remains the most common reason runners develop upper back pain. Many people spend hours sitting at desks, driving, or looking down at phones before heading out for a run. These positions encourage rounded shoulders, a forward head posture, and reduced mobility through the thoracic spine.
As fatigue develops during a run, maintaining good posture becomes increasingly difficult. The shoulders rise toward the ears, the upper back rounds forward, and muscles that should stabilize the shoulder blades become overworked. This creates excessive strain on:
Rhomboids
Levator scapulae
Thoracic paraspinal muscles
2. Weak Upper Back and Core Muscles
Running is a full-body activity. Strong core muscles help stabilize the spine, while the muscles surrounding the shoulder blades maintain proper arm mechanics. Weakness in these muscles often leads to:
Excessive shoulder elevation
Increased upper trapezius activity
Reduced shoulder blade stability
Poor trunk control
Early muscle fatigue
3. Limited Thoracic Spine Mobility
The thoracic spine should rotate and extend smoothly during walking and running. Unfortunately, prolonged sitting often reduces mobility in this region. Limited thoracic mobility may cause:
Restricted arm swing
Compensatory neck movement
Increased shoulder tension
Rib joint stiffness
Pain during deep breathing
4. Poor Breathing Mechanics
Efficient breathing requires coordinated movement between the diaphragm, rib cage, and thoracic spine. When runners rely primarily on shallow chest breathing instead of diaphragmatic breathing, muscles in the neck and upper shoulders begin assisting with every breath.
Over several miles, these accessory breathing muscles become overworked. This often leads to:
Tight upper trapezius muscles
Neck stiffness
Pain between the shoulder blades
Reduced running efficiency
Earlier fatigue
5. Overtraining
A sudden increase in mileage, speed work, or hill training places greater demands on muscles that have not yet adapted. Common training errors include:
Increasing weekly mileage too quickly
Running consecutive hard workouts
Skipping recovery days
Returning too quickly after illness or injury
6. Inefficient Arm Swing
Your arms help balance rotational forces while running. Crossing the arms excessively across the body, swinging too forcefully, or running with clenched fists increases muscular demand across the shoulders and upper back. Efficient arm movement should remain relaxed, with elbows bent around 90 degrees and hands passing close to the hips during the backward swing.
7. Muscle Imbalances from Daily Life
Many runners unknowingly bring workplace posture into their running. Hours spent sitting often produce:
Tight chest muscles (pectoralis major and minor)
Weak middle and lower trapezius muscles
Weak rhomboids
Reduced shoulder blade control
Forward head posture
Running simply exposes these underlying problems rather than causing them outright.
8. Less Common Causes
Although less frequent, upper back pain during running may also result from:
Rib joint dysfunction
Thoracic facet joint irritation
Stress fractures
Scoliosis
Shoulder injuries
Cervical spine disorders
Gastrointestinal conditions causing referred pain
How Is Upper Back Pain While Running Diagnosed?
A physical therapist or sports medicine provider will identify the source of pain through a physical examination and movement assessment. This typically includes:
Medical and training history
Posture evaluation
Running gait analysis
Thoracic spine mobility testing
Shoulder and core strength assessment
Breathing pattern assessment
Imaging such as X-rays or MRI is rarely needed unless there is trauma, persistent pain, numbness, weakness, fever, unexplained weight loss, or suspicion of a fracture or another medical condition.
Upper Back Pain Treatment While Running
Treatment should address the cause, not just the symptoms. Most runners improve with conservative care.
Physical Therapy
A personalized rehabilitation program may include:
Manual therapy to improve thoracic and rib mobility
Postural correction
Core and scapular strengthening
Running gait retraining
Breathing retraining
Progressive return-to-running plan
Activity Modification
You do not always need to stop running. Instead:
Reduce mileage temporarily
Avoid speed work or hills
Run on flatter terrain
Resume training gradually as symptoms improve
Strength Training
Strengthening improves endurance and posture during longer runs.
Focus on:
Middle and lower trapezius
Rhomboids
Rotator cuff
Core muscles
Glutes
Improve Thoracic Mobility
Daily mobility work helps restore normal movement.
Exercises include:
Foam roller thoracic extensions
Open-book rotations
Cat-cow stretch
Thread-the-needle stretch
Correct Your Breathing
Practice diaphragmatic breathing to reduce strain on the neck and shoulders.
Pain Relief
Short-term symptom relief may include:
Heat before activity
Ice after running if soreness develops
Soft tissue massage
Foam rolling
Taping when recommended by your therapist
Best Exercises for Upper Back Pain While Running
How to Prevent Upper Back Pain While Running
Most cases are preventable.
Warm up for 5-10 minutes.
Increase weekly mileage by no more than 10%.
Strength train twice weekly.
Stretch your chest and thoracic spine.
Avoid sitting for long periods without movement.
Replace worn-out running shoes.
Maintain proper running posture.
Include recovery days in your training plan.
Upper back pain doesn't have to interrupt your training. At Manhattan Physical Therapy, our physical therapists identify the root cause of your pain and create a personalized rehabilitation program to improve posture, mobility, strength, and running mechanics. Call us today at (212) 213-3480 to schedule your evaluation and get back to running with confidence.
Frequently Asked Questions
Why does my upper back hurt only during long runs?
Muscle endurance often decreases as fatigue develops, causing posture to deteriorate and increasing stress on the thoracic spine.
Can poor posture cause upper back pain while running?
Yes. Rounded shoulders and a forward head posture are among the most common contributors.
Can breathing cause upper back pain?
Yes. Shallow chest breathing overworks the neck and shoulder muscles, leading to pain during longer runs.
When should I see a physical therapist?
If pain lasts longer than one week, keeps returning, affects your running, or is associated with numbness, weakness, or severe pain, seek a professional evaluation.
What Do They Say About Us?
Alexander Liu
"Everyone on the team at Manhattan Physical Therapy is super nice and caring. They were able to pretty quickly diagnose my knee and hip problems and immediately put me to work to reduce the pain.."
Henry Myerberg
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Manhattan Physical Therapy
✆ Phone (appointments):
(212) 213-3480
Address: 385 5th Ave, Suite 503, New York, NY 10016
