That sharp, burning sensation between your shoulder blades has kept you awake for the third night straight. You’re six months pregnant, exhausted, and wondering if this upper back pain is just another pregnancy symptom or something more serious. While 45% of expecting mothers brace for lower back discomfort, upper back pain during pregnancy catches many by surprise—and understanding what’s normal versus concerning could make the difference between sleepless nights and proper treatment.
This guide breaks down everything you need to know about upper back pain during pregnancy, from common causes to red flags that warrant immediate medical attention. You’ll learn practical relief strategies, understand when symptoms indicate rare complications, and discover what to expect postpartum. Most importantly, you’ll gain the knowledge to distinguish everyday discomfort from symptoms requiring urgent evaluation.
Why Your Upper Back Aches Between Shoulder Blades During Pregnancy
Your growing belly shifts your center of gravity forward, causing your shoulders to round and your upper back to arch. This creates constant tension in the muscles between your shoulder blades as your body compensates for your expanding midsection. The thoracic region bears extra load as your breasts increase in size, pulling your shoulders forward and straining the mid-back muscles.
Postural Changes That Trigger Pain
Your changing posture during pregnancy creates a perfect storm for upper back discomfort. As your belly grows, you naturally lean backward to maintain balance, which forces your upper spine into excessive curvature. This “pregnancy swayback” position stretches your chest muscles while tightening those between your shoulder blades. The added weight of your breasts—often increasing by one to two cup sizes—further pulls your shoulders forward, creating chronic muscle tension.
What to watch for:
– Dull aching between shoulder blades that worsens with prolonged sitting
– Pain that improves when changing positions frequently
– Tenderness in upper back muscles when pressed
– Morning stiffness that eases with movement
Hormonal Effects on Your Spine Stability
Relaxin and other pregnancy hormones loosen ligaments throughout your body, including those supporting your thoracic spine. This increased mobility can cause instability and muscle overcompensation, leading to pain and stiffness in your upper back. While these changes prepare your body for delivery, they also reduce spinal stability, forcing surrounding muscles to work harder to maintain posture.
Spotting Dangerous Upper Back Pain: Red Flags You Can’t Ignore
While most upper back pain stems from musculoskeletal changes, certain symptoms demand immediate medical evaluation. Severe nightly thoracic pain—especially when it wakes you from sleep—is rare and warrants investigation for underlying pathology. Research shows that position-dependent pain (worse when lying flat) should prompt immediate assessment.
Critical Warning Signs Requiring Urgent Care
Seek immediate medical attention if you experience:
- Severe nightly pain: Pain that consistently wakes you 2-3 hours after falling asleep, described as unbearable or excruciating
- Position-dependent symptoms: Pain that significantly worsens when lying flat or supine
- Neurological changes: Numbness, tingling, or weakness in arms or legs
- Breathing difficulties: Pain that correlates with breathing or causes shortness of breath
- Postpartum persistence: Continued severe pain after delivery without improvement
Though extremely rare (affecting only 1 in 1,000-2,000 pregnancies), spinal tumors like ependymoma may initially present as isolated upper back pain without other neurological symptoms. Case studies reveal these tumors often manifest as nightly pain between shoulder blades that worsens when lying down.
Understanding Rare but Serious Causes
Vertebral hemangiomas—present in 10-12% of the general population—can become symptomatic during pregnancy due to venous hypertension. These typically cause back pain in 54% of cases, with symptoms often appearing in the third trimester. Similarly, aortic dissection, while extremely rare (0.0004% of pregnancies), presents with acute thoracic pain or pain between shoulder blades and carries significant risks.
Nontraumatic spinal epidural hematomas can cause abrupt onset neck or back pain followed by paresthesias and neurological deficits within hours. If you experience sudden severe upper back pain accompanied by sensory changes, seek emergency care immediately.
Immediate Relief Strategies for Pregnancy Upper Back Pain
Finding relief from upper back pain during pregnancy often requires a combination of positioning techniques and temperature therapy. These evidence-based strategies target muscle tension, postural strain, and joint instability without medication.
Smart Sleep Positioning Techniques
Optimize your sleep setup:
– Use a pregnancy pillow to support your belly and maintain spinal alignment
– Sleep slightly elevated with wedge pillows to reduce pressure on your upper back
– Place a small pillow between your shoulder blades when side-lying
– Avoid flat supine sleeping, especially in third trimester
Sitting posture corrections:
– Position computer screen at eye level to prevent forward head posture
– Use a lumbar support cushion to maintain natural spinal curves
– Take micro-breaks every 30 minutes to stretch and reset posture
– Practice “shoulder blade squeezes” throughout the day (pull shoulder blades together while keeping shoulders down)
Heat Therapy for Pregnancy-Safe Pain Relief
Apply warm compresses to your upper back for 15-20 minutes, 2-3 times daily. Use a heating pad on low setting with protective layer between skin and pad. Take warm showers focusing water stream on affected muscles between shoulder blades. Microwaveable heat packs with herbs provide added relaxation without medication risks.
When cold therapy helps:
– Apply ice packs for acute muscle spasms (first 48 hours)
– Use 10-minute intervals with cloth barrier
– Focus on specific trigger points between shoulder blades
– Combine with gentle stretching for best results
Safe Exercises to Ease Upper Back Discomfort While Pregnant
Regular movement and targeted exercises significantly reduce upper back pain while preparing your body for labor. These pregnancy-safe routines strengthen supporting muscles without strain.
Strengthening Moves That Actually Work
Wall angels (3 sets of 10 repetitions): Stand with back against wall, arms at 90-degree angles. Slowly raise arms overhead while maintaining contact with wall, then lower. This strengthens postural muscles without strain.
Resistance band rows: Attach band at chest height. Pull elbows back, squeezing shoulder blades together. Perform 2-3 sets of 12-15 repetitions, focusing on controlled movement.
Modified cat-cow stretches: On hands and knees, alternate between arching and rounding your upper back. This mobilizes thoracic spine safely throughout all trimesters.
Stretches for Instant Relief
Doorway chest stretches: Place forearms on doorframe, step through gently to stretch chest muscles contributing to rounded shoulders. Hold 30 seconds, repeat 3-5 times daily.
Upper trapezius releases: Sit tall, gently tilt head toward shoulder while keeping opposite shoulder down. Hold 20-30 seconds each side, avoiding neck circles.
Thoracic spine foam rolling: Use foam roller horizontally across upper back, supporting head with hands. Gently roll from mid-back to shoulder blades for 2-3 minutes.
Professional Treatments That Actually Work for Pregnancy Back Pain
When self-care measures aren’t providing adequate relief, several professional treatments remain safe during pregnancy and can provide significant improvement.
Prenatal Massage for Targeted Relief
Qualified prenatal massage therapists target specific trigger points in rhomboids and trapezius muscles that commonly cause upper back pain during pregnancy. Sessions typically last 60-90 minutes with side-lying positioning using proper support. Many women experience noticeable improvement after just one session, with weekly treatments often recommended in third trimester for persistent discomfort.
Chiropractic and Physical Therapy Options
Pregnancy-specific chiropractic adjustments use gentle techniques avoiding abdominal pressure while focusing on thoracic spine and rib mobility. Relief often becomes noticeable after 2-3 sessions when coordinated with your obstetrician. Physical therapists provide postural retraining exercises, manual therapy for joint restrictions, and education on proper body mechanics during daily activities.
What Happens to Upper Back Pain After Delivery
Understanding postpartum recovery helps set realistic expectations and guides ongoing management strategies for upper back pain during pregnancy.
Typical Recovery Timeline
Many women experience rapid improvement as hormone levels normalize within the first six weeks postpartum. However, breastfeeding positioning may create new strain patterns that require attention. Postural muscles regain strength slowly over the first three months, requiring continued attention to ergonomics while nursing.
If your pain persists: Don’t dismiss ongoing upper back pain as “just part of recovery.” Pain that doesn’t improve significantly by six weeks postpartum warrants evaluation. New neurological symptoms developing after delivery, changing pain patterns, or symptoms that return after initial improvement all require medical assessment.
Spontaneous improvement after delivery doesn’t always indicate a benign cause. If your upper back pain included severe nightly episodes, position-dependent worsening, or any neurological symptoms during pregnancy, advocate for thorough evaluation regardless of current pain levels. Your comfort and safety—and your baby’s—depend on addressing both common aches and potential red flags appropriately.