Neck and upper back pain are some of the most common issues people experience, especially if you spend long hours sitting, working at a desk, and using your phone. Our daily environment sets us up by increasing the likelihood that we will experience neck or upper back pain at some point in our lives. This type of pain can range from mild stiffness to aching discomfort that interferes with daily life. Understanding how and why it happens is the first step to feeling better. Once you figure out why this pain occurs, it makes it much easier to treat it so it doesn’t keep you sidelined! This post will explain what causes neck and upper back pain, how posture and muscle imbalances contribute, and what you can do to reduce tension and improve movement.
Take me straight to the exercises!
**This is not medical advice. Please consult your medical provider for more information.
What Causes Neck and Upper Back Pain
Neck and upper back pain often stem from a combination of poor posture, muscle fatigue and weakness, and movement habits. When you sit for long periods with your head forward and shoulders rounded, the muscles at the front of your body become tight and shorten. The muscles along the backside are forced to work harder to keep your head upright as the muscles in the front continue to pull everything forward. Over time, this imbalance creates tension and stiffness. And this imbalance is what we commonly see when people slouch.
Stress also plays a big role. When your nervous system is in a heightened state, muscles tend to stay shortened and contracted, especially around the neck, shoulders, and jaw. This leads to the familiar “tight shoulders” many people feel during stressful days. Even small daily habits, like staring down at your phone or carrying a heavy bag on one shoulder, can add up over time and contribute to chronic pain and discomfort.
Upper Crossed Syndrome
Commonly, poor posture, in relation to neck and upper back pain, is referred to as “upper crossed syndrome.” Rounded shoulders and slouching are just one component of upper crossed syndrome. The forward shoulders are most often accompanied with issues at the neck and upper back, hence the reference to this syndrome.
Upper crossed syndrome refers to muscular imbalances of the neck, upper back, and chest. The muscles in the chest, the pectoralis major and minor, become tight. This pulls the shoulders and scapulae forward. Muscles on the back of the neck also become tight, including the suboccipitals, upper trap, and levator scapulae. The opposing muscles that become weak are the deep neck flexors, which cause the chin to jut forward. The other muscles along the upper back that are weak are the rhomboids, and lower trap.
This pattern is commonly seen in individuals who have poor posture. In order to fix this postural pattern, it’s not enough to just hold ourselves upright. As this is something that takes time to develop, the same thing can be said for attempting to fix it. It definitely can be fixed! But you will have to work on addressing the individual muscle imbalances that come from it. This means you will have to work on stretching the tight muscles to work on elongating them and strengthening the weak muscle groups. You’ll have to work on all of these muscle groups listed in the picture above to see the best possible outcome.
The Connection Between Posture, Breathing, and Pain
Your posture affects more than how you carry yourself. It influences how you breathe, move, and feel. When your chest and shoulders collapse forward, as demonstrated by the diagram above, the diaphragm doesn’t move efficiently. The ribs also have a harder time expanding, allowing for less oxygen to fill up your lungs. This limits oxygen flow through the body and can increase muscle tension throughout the neck and upper back, as well as the rest of the body.
Practicing good posture isn’t about forcing yourself to sit rigidly straight. It’s about developing awareness and movement variety. The more your body moves through different positions, the less strain you place on one specific area. Being in any one position for too long is not ideal, even if it’s in a “perfect” posture. Your body should be able to seamlessly move in and out of different postures. It really comes down to where you spend most of your time, which should be somewhere in the middle of two extremes (the extremes being fully slouched forward and rigidly straight). Gentle mobility and breathing exercises can help restore this balance and reduce pain.
Simple Exercises to Relieve Neck and Upper Back Pain
Movement is one of the most effective ways to manage and prevent neck and upper back pain. Focus on exercises that promote mobility and stability around the shoulder blades, spine, and neck. These exercises are also foundational for your posture.
Supine Chin Tuck on Towel Roll
This exercise targets the deep neck flexors, placing the neck in a good position to reduce forward head posture.
To appropriately target the deep neck flexors, lie down and fold a small towel roll right under the base of your skull. As the back of your head rests on the towel, push your chin straight back as if you were creating a double chin. Think about pushing your chin straight down into the towel. Hold this position for five seconds, then relax.
Perform 2-3 sets of 10 reps, holding for 5 seconds each time.
NOTE: It’s common to feel a stretching feeling along the back side of your neck with this exercise. This is normal as this movement activates the deep neck flexors (deep layer of muscles in the front of the neck) and allowing the cervical paraspinals to relax (back of the neck). We usually find ourselves in the opposite position with weak deep neck flexors, which then places increased activity and strain on the muscles of the back of the neck, leading to stiff necks, headaches, and pain along the neck, shoulders, and sometimes to the upper back. Strengthening exercises for the deep neck flexors are great for improving your posture.
Scap Squeeze
While seated with your shoulders relaxed, squeeze your shoulder blades together as if you are trying to hold a pencil between them.
Make sure not to accidentally shrug your shoulders upwards towards your ears. Think about squeezing your shoulder blades back and down towards your back pockets.
Hold this position for ten seconds and repeat ten times.
Seated Thoracic Extension
Sit in a chair with a firm backrest. Roll up a large towel and place it against the backrest so that it rests right across your shoulder blades.
Place your hands behind your head and gently arch your upper back over the top of the chair. Hold this position for 3-5 seconds, then return back to sitting up straight. If you have difficulty getting your hands behind your head or if the stretch is too aggressive, you can cross your arms across your chest instead.
Try to focus on only arching your upper back across the foam roll and not letting your lower back arch too much. We are focusing on the movement of your thoracic spine in this exercise, not your lumbar spine.
Perform 2-3 sets of 10 repetitions.
Doorway Pec Stretch
Start with both of your arms out to your sides at shoulder height, bending your elbows to 90 degrees (goal post position).
Place your forearms against the doorway in the goal post position. Step forward with one of your legs and shift your weight forward, being careful not to arch your lower back. You should feel a stretch across your chest.
Hold for 20-30 seconds and repeat 2 more times.
Theraband Row
For this exercise, you will need a band. Anchor the band in a doorway, around a doorknob, or around a railing. It just needs a secure spot around your waist or torso height.
Anchor your band and hold each end in your hands. Drive your elbows backwards, keeping the elbows close to your body. Make sure to squeeze your shoulder blades together too to prevent your shoulders from rounding forward. Hold this position for a brief pause, then relax back to start.
Make sure when you pull your elbows back that you don’t shrug your shoulders upwards. Keep your shoulders down and back towards your back pockets to avoid them from wanting to shrug up towards your ears.
Complete 3 sets of 10-12 reps.
How to Prevent Neck and Upper Back Pain
When trying to prevent neck and upper back pain, consistency matters more than intensity. Doing a bunch of these exercises all at once won’t do much for you in the long run. It is about consistently doing a little bit so that you can reap the rewards over a span of time. Just as it takes time to see improvement with building strength in the gym, the same goes for these exercises and your posture. Remember, you are building strength of your postural muscles—this takes time.
Learning to move your body regularly throughout the day rather than sitting still for long periods of time is a major way to set yourself up for success. If you work a desk job, getting a walking pad can be a great way to add in some steps during your work day. Setting reminders to stand, stretch, or walk every hour, or even just a couple times throughout the day, is beneficial to your overall wellbeing and health. You can even do a few of the exercises above while sitting at you desk!
Another trick is to pay attention to your workspace setup. This is where all of your hard work can fall apart. You can be consistent with all of your postural exercises, but if you spend 8-10 hours a day at a poorly designed work desk, your exercises cannot undo that amount of time in a poor posture. Your screen should be at eye level and your keyboard positioned so your elbows rest comfortably near your sides. Keep your shoulders relaxed while typing and make sure your back is supported so you aren’t slouching. Remember to take short breaks to reset your posture and break up the monotony of sitting in the same position all day. If you are interested in seeing a more in depth look at a workspace setup, head to this blog post HERE.
The Role of the Nervous System in Chronic Pain and Muscle Tension
Stress management also plays a key role in prevention of pain. Your body can’t tell the difference between mental and physical stress. Muscle tension from stress can come from different sources, including mental stress, anxiety, and physical stress. Whether it’s a tough workout, a tough meeting, or tough emotions, the end result is the same: tight, guarded muscles. This is how your body deals with stress. If you already have tight muscles from poor posture, ignoring your stress and nervous system will only keep you constantly feeling tight and wound up. Eventually, pain will ensue.
This creates a cycle: stress fuels tension, tension fuels pain, and pain fuels more stress. Without intervention, the loop continues. The good news is that breaking the cycle doesn’t require big, time-consuming changes. It starts with small, consistent resets. Practices like deep breathing, short walks, and gentle stretching can help calm the nervous system and reduce muscle tension. If you are interested in learning more about how the nervous system is related to your chronic pain and tension, head to this blog post HERE.
When to Seek Professional Help
If neck and upper back pain continues for several weeks, interferes with sleep, or causes numbness or tingling in the arms, it’s important to seek professional care. A physical therapist can assess your movement patterns, identify areas of imbalance, and develop a personalized program to help you move safely and without pain.
Early intervention helps prevent chronic tension and allows your body to heal more effectively and quickly.
TL;DR
Neck and upper back pain are common, but manageable with the right approach. Posture, stress, and repetitive habits often play a role, leading to muscle tightness and fatigue. Focus on gentle mobility, strengthening, and regular breaks throughout your day to support your posture and reduce pain. If symptoms persist, a physical therapist can help identify the root cause and guide you toward lasting relief. This post reviews what causes neck and upper back pain, how posture and muscle imbalances contribute, and what you can do to reduce tension and improve movement.
Tera Sandona is a licensed Doctor of Physical Therapy (DPT) and the founder of PT Complete. She helps high-achieving women break out of cycles of chronic pain, stress, and burnout through her Regulate and Rebuild Method, a sequenced approach that addresses the nervous system first and builds strength second. Her work focuses on helping women finally understand their bodies, rebuild strength, and create lasting resilience that fits real life.
