Conditions · Upper back pain

Upper & Mid Back Pain Treatment in Midtown NYC

For pain between the shoulder blades, or a mid back that tightens up after long days at a desk.

Hiro Nakano, DC, DACBSP · USA Fencing medical staff · 2021 Tokyo Olympic Games, Team USA volunteer medical staff

How I treat it

Find what’s wrong — and why

A diagnosis from your history and a full exam of your upper back, neck, shoulders, and ribs. Pain between the shoulder blades can start from a nerve in the neck, so I always check there.^[1] Then why it happened — how you sit, bend, lift, and breathe through your day.

How I work →

Hands-on care, checked on the spot

Hands-on care is the core of my work, learned in our family’s clinic in Japan, opened in 1926, and the same approach I use with USA Fencing’s national team. I choose the method and pressure from that day’s exam, then recheck how you turn, reach, and breathe right after treatment.

My background →

Home exercise that fits your life

You don’t need to come in three times a week. Strength for your upper back and shoulder blades can be built at home — in one trial, as little as two minutes a day helped office workers with neck and shoulder pain.^[2] I teach it here, we record it on your phone, and I check and adjust it at each visit.

Your first visit →

The upper back pain I see

Most of the upper backs I see hurt between the shoulder blades, or lower down in the mid back. Some started suddenly — reaching, lifting, a sneeze, a bad night’s sleep. Most built up over months of long days at a desk, and come back whenever work gets busy.

With upper back pain, I always think about the neck first. A pinched nerve in the neck often shows up as pain around or between the shoulder blades^[1] — sometimes before any arm symptoms. So my approach here looks a lot like my approach to neck and low back pain.

Upper back pain is common at every age, but it gets far less research than neck or low back pain.^[3] So I use what we know from both, and from what I see every day in the clinic.

Here is how care usually unfolds.

1. Today’s pain: find what’s wrong — and ease it

First, I make sure the pain is coming from your musculoskeletal system at all. The heart, lungs, gallbladder, and even shingles can show up as pain in the upper back. Your history and exam usually make this clear. When they don’t, I’ll send you for the right test or to the right doctor. But if you are not sure about this, text me. Sometimes you need a different kind of doctor.

What the research shows: a heart attack doesn’t always feel like chest pain. In a registry of more than a million people hospitalized with a heart attack, 42% of women and 31% of men had no chest pain.^[4] Symptoms can show up instead as pain in the upper back, jaw, or arm. Upper back pain with nausea, shortness of breath, or sweating needs a doctor right away.

Then I work from a differential diagnosis — a short, ranked list of what’s most likely going on. With pain between the shoulder blades, the neck is always on that list. I check how your neck moves, whether turning or tilting it brings on the pain, and the sensation, strength, and reflexes in your arms.

What the research shows: in 50 people who had surgery for a single pinched nerve root in the neck, pain in the neck or around the shoulder blades came before any arm or finger symptoms in 70% — and it went away soon after surgery in 92%. The researchers concluded that pain in and between the shoulder blades can come directly from the pinched nerve root.^[1]

When it’s needed, I order X-rays or an MRI directly.

Then hands-on care to ease pain and stiffness — on the mid back, ribs, and neck — and we recheck how you turn, reach, and breathe right after treatment. Many people notice a change in the first visit or two.

What the research shows: research on treating upper back pain itself is still limited. In a small pilot trial, spinal manipulation of the mid back did better than a placebo treatment.^[5] And a review of 13 trials found support for mid-back manipulation in some people with neck pain.^[6]

2. Why it happened: the part most people skip

“It’s your posture.” “You sit too much.” “Your shoulders are rounded.” Those can play a part — but they’re rarely the whole answer.

The upper back sits between your neck and your lower back, and it moves with both. When your hips don’t bend well, your mid back often rounds to do the work instead — when you pick something up, tie your shoes, or lift a bag. So I look at how you bend and lift, especially the hip hinge, and how your shoulder blades, ribs, and breathing share the load.

Then your daily life: how long you sit, how your desk and screen are set up, how you carry your bag or your child, how you sleep. Short nights, stress, or poor nutrition can keep tissue from settling down, no matter how good the exercises are.

Find what is wrong, then why it happened. That’s where my treatment starts.

3. When the pain improves, we check what you can do

Feeling better is meaningful progress. The next question is whether your upper back is ready for your workday, your workouts, and the rest of your life.

At follow-up visits, I reassess both your symptoms and how you move. Can you turn and reach overhead without it pulling? Bend and lift from your hips instead of your mid back? Get through an afternoon at the desk without the ache coming back? These observations help me decide what to work on next.

Fix how you move, then build strength

For upper back pain, the pattern is usually the same. First we fix how you move through the day — how you sit, bend, and lift, and learning the hip hinge. Then we build strength in your upper back, shoulder blades, hips, and legs, so your back can handle what your day asks of it.

A plan that fits your life

New Yorkers are busy, and fitting three clinic visits a week into your schedule is hard. So I give you a realistic amount of rehab, sized to your life, your schedule, and what your back can handle right now. Some people keep a band at their desk and do two minutes between meetings, or practice a few hip hinges while the coffee brews. That still works, as long as you do it.

What the research shows: in a trial of office workers with frequent neck and shoulder pain, as little as two minutes a day of band exercises reduced pain.^[2]

Your daily positions matter

There’s no perfect posture. The goal is to change positions often, set up your desk so it’s easy to move, and give your back more capacity — so the positions you can’t avoid stop hurting.

Taught in the clinic, done at home

I teach each exercise here, we practice it together, and we record it on your phone. Then you do it at home, on your own time, and I check and adjust it at each visit. How your back responds the next day guides the next step.

The goal isn’t just “no pain.” It’s getting through a full workday, carrying your groceries and your kids, training, and sleeping without waking up stiff.

4. Staying active: turning rehab into a habit

I also treat rehab as the start of your future exercise routine. Everyone needs regular exercise, and everyone has to make time for it. A sore upper back gives you a reason to start — a good opportunity to begin investing in your long-term health.

That’s why I start small. A few minutes a day that fits into your routine is easier to keep than an hour you can’t find. Once it sticks, we build on it.

What the research shows: habits form when you repeat a simple action in the same daily context — like your morning coffee or a break between meetings. Simpler actions become automatic faster, and missing a day now and then doesn’t undo the progress. On average, it took about two months.^[7]

For many people, upper back pain becomes the reason they finally start strength training — and stick with it. Many come in every two to four weeks to treat what needs attention and update the plan. Some finish when they feel good; others have kept it up for years.

What the research shows: people who do muscle-strengthening activities have about a 10–17% lower risk of death from any cause.^[8]

Why not just crack it?

Many people with upper back pain crack their own back, or get it adjusted, and feel better for a while. That relief is real. But if nothing else changes, the pain usually comes back.

What the research shows: in a trial of 191 people with chronic neck pain, 20 sessions of spinal manipulation alone did worse than programs that included strengthening exercise — and the difference was still there two years later.^[9]^[10] Combining hands-on care with exercise also relieves pain faster than exercise alone.^[11] Most of this research is on the neck; the upper back is studied far less, and I use the same approach for both.

That’s why I use them together. Hands-on care eases pain and stiffness quickly, and we recheck how you move right after treatment. Better movement and strength then keep it that way.

Not sure if this fits your situation?

Send me a text and tell me what’s going on. Most questions are easier to answer once we talk.

Book an Initial Visit Text a Question

Common questions

Is my upper back pain coming from my neck?

It can be. A pinched nerve in the neck often causes pain around or between the shoulder blades, sometimes before any arm symptoms.^[1] I check your neck at every first visit.

Why does it hurt on only one side?

One-sided pain between the shoulder blades usually comes from a joint, a muscle, a rib, or a nerve in the neck on that side. Less often it comes from an organ — the gallbladder can cause pain near the right shoulder blade, and the heart can cause pain on the left. The history and exam usually tell the difference.

Could it be a fracture or osteoporosis?

In older adults, sudden mid-back pain after a fall, a hard cough, or lifting can be a small fracture of a vertebra from osteoporosis. If that’s possible, I order an X-ray and a bone density (DEXA) scan directly.

I don’t exercise. Can I still do this?

Yes. Many of the people I see haven’t exercised in a long time. We start with what your back can handle now and build gradually. You don’t need a gym, and you don’t need to be fit to start.

Do I need to come in several times a week?

No. Most of the work happens at home. Many people come weekly at first, then every two weeks, then less often as things improve.

When should I see a doctor right away?

Call 911 if upper back pain comes with chest pressure, shortness of breath, sweating, nausea, or lightheadedness — women in particular often have heart attacks without chest pain.^[4] A sudden, tearing pain in the back is also an emergency. See a doctor soon if your back pain comes with a fever, unexplained weight loss, a history of cancer, or new weakness, numbness, or trouble walking.

Ready to get back to what matters?

You don’t need to be fit or confident to start. Tell me what’s bothering you and what you want to be able to do again.