Published by PMR of NY & CT
Pain when swallowing is hard to ignore. You swallow with every bite and sip, and many times in between, so a pain that shows up in your upper back or the back of your neck each time can make an ordinary meal feel uneasy.
Pain when swallowing commonly starts in the throat or the esophagus, the tube that carries food to your stomach, and needs a medical diagnosis. Neck or upper back muscle and joint pain may also be present. After a medical evaluation, chiropractic care may help with a separate musculoskeletal problem. This guide covers common causes, warning signs that need care right away, and how the team at Physical Medicine & Rehabilitation of NY & CT (PMR) approaches neck and upper back pain.
Why swallowing can hurt in your back or neck
Swallowing is a quick chain of muscle movements that carries food from your mouth to your stomach. The esophagus runs down the middle of your chest, just in front of your spine, so irritation there can be felt behind the breastbone or between the shoulder blades. Cleveland Clinic notes that pain from esophageal spasms can spread to the neck, arm or back.
Higher up, your throat sits directly in front of the bones and deep muscles of your neck, so a problem in any of them can show up as neck pain when swallowing.
Common causes of pain when swallowing
Throat and esophagus
These are the most common causes, and they need a doctor rather than a chiropractor:
- A sore throat. The CDC notes that viruses cause most sore throats. Strep throat is more likely with fever, swollen lymph nodes in the front of the neck and white patches on the tonsils.
- Mouth and tooth problems, such as mouth sores, a tooth infection or an abscess
- Something stuck in the throat, such as a fish or chicken bone
- Acid reflux and esophagitis, an irritated or inflamed esophagus
- Esophageal spasms, which can make swallowing painful and cause chest pain that spreads to the back
- Irritation from pills, including some antibiotics, osteoporosis medicines, potassium tablets, aspirin and anti-inflammatory pain relievers, especially when taken without enough water
Less often, a growth in the throat or esophagus is the cause. The American Cancer Society notes that these symptoms are more often caused by something else, but pain that lingers should be checked.
Neck conditions that need a doctor's diagnosis
- Calcific tendinitis of the longus colli, an inflammation of a deep muscle in front of the upper spine. It typically causes sudden pain at the back of the neck, stiffness and painful swallowing, sometimes with a mild fever. A CT scan tells it apart from an infection, and it usually settles with anti-inflammatory medicine.
- Eagle syndrome, in which an unusually long bone below the ear, or a stiffened ligament attached to it, presses on nearby nerves. Throat or neck pain often gets worse when you chew, yawn or turn your head.
- Bone spurs on the front of the neck bones, as in diffuse idiopathic skeletal hyperostosis (DISH), which can press on the esophagus and make swallowing difficult
Muscles and joints
Muscle and joint problems can coexist with swallowing symptoms. After a medical evaluation, chiropractic care may help address these neck and upper back problems:
- Posture strain. Hours of looking down at a phone or laptop can pull on your neck muscles. Our post on tech neck covers simple fixes.
- Whiplash and other neck injuries. The Quebec Task Force classification of whiplash-associated disorders lists difficulty swallowing among the symptoms that can occur with any grade of whiplash. After a crash, get checked by a doctor first; severe neck pain after an injury needs emergency care. Our whiplash treatment page explains recovery.
- Stiff joints and tight muscles in the neck and upper back, which can add to aching between the shoulder blades
- Muscle tension. Tension in the throat and neck can cause globus sensation, a painless feeling of a lump in the throat. Cleveland Clinic notes that acid reflux is its most common cause.
Clues that point to your muscles and joints
No checklist replaces an exam, but these patterns can help you and your clinician decide where to start. Pain is more likely to involve muscles and joints when it:
- Also changes when you turn or tilt your head, shrug, twist or press on a sore spot
- Comes with stiffness, especially after sleep or a long stretch at a screen
- Started after a strain, an awkward sleeping position or a minor injury
- Comes without a sore throat, fever, heartburn or trouble getting food down
Pain that happens only when you swallow, sits behind the breastbone, or comes with heartburn, a sour taste or food that feels stuck points to the esophagus. If swallowing has hurt for more than a few days, see a doctor first.
How chiropractic care can help
Chiropractic care does not treat painful swallowing itself, sore throats, reflux or other disorders of the throat and esophagus. After medical evaluation of the swallowing symptoms, it may help with a separate strained muscle, stiff joint or posture-related neck or upper back problem.
At PMR, a visit starts with your history and an exam of how your neck, upper back and shoulders move. If your symptoms point to your throat, esophagus or heart, we'll refer you to your primary care doctor or a specialist such as an ear, nose and throat doctor or a gastroenterologist.
When muscles and joints are involved, chiropractic care may include:
- Gentle adjustments or mobilization to ease stiff joints in the neck and upper back
- Soft tissue work to relax tight neck, shoulder and upper back muscles
- Exercises that strengthen the deep muscles supporting your neck
- Changes to your desk, screen height and sleep setup
The National Center for Complementary and Integrative Health reports that spinal manipulation may help some neck pain, but the evidence has limitations. Temporary soreness or stiffness can occur. Rare serious complications, including tears in neck arteries and stroke, have been reported; their frequency and the causal relationship remain uncertain. Discuss risks, benefits and alternatives with your clinician before neck manipulation. Mobilization and exercise may be options when manipulation is not appropriate.
Your plan may also draw on PMR's neck pain treatment and upper back pain treatment, with physical therapy or massage alongside chiropractic care. If swallowing still hurts as your neck and back improve, we'll help you look for another cause.
Easing discomfort at home
If you have none of the warning signs below, these steps may help while you heal:
- Keep your neck moving gently, and use a warm compress on stiff muscles
- Raise your screen to eye level and take short breaks from looking down
- Eat slowly, chew well and choose softer foods for a few days
- Take pills with plenty of water, and don't lie down right after
- Ask your doctor or pharmacist before taking a pain reliever, since aspirin and anti-inflammatory medicines can irritate the esophagus
When to get medical care right away
Call 911 or go to the nearest emergency room if you have:
- Trouble breathing, noisy breathing, drooling or trouble swallowing your own saliva
- Food stuck in your throat or chest that won't go down
- Chest pain, pressure or tightness, or pain that spreads to your arm, back, neck or jaw
- Severe neck pain after a crash, fall or other injury
- A fever with a stiff neck and a severe headache
- Vomiting blood, or black or bloody stools
See a doctor soon if:
- Pain when swallowing lasts more than a few days or keeps coming back
- You have a sore throat with a high fever, swollen glands or a rash
- You're losing weight without trying
- Hoarseness lasts more than two weeks, or you have a lump in your neck or an earache with a sore throat that won't go away
Frequently asked questions
Why does my upper back hurt when I swallow?
Upper back pain when swallowing most often starts in the esophagus. Reflux, inflammation or spasms there can cause pain behind the breastbone that spreads to the back. Less often, a strained muscle or stiff joint is involved, and that pain usually also changes when you move. Have a doctor check it, and call 911 for chest pressure or pain that spreads to your arm or jaw.
Why does the back of my neck hurt when I swallow?
A throat infection can make the lymph nodes in your neck swollen and sore. A rare inflammation of a deep neck muscle, calcific tendinitis of the longus colli, typically causes pain at the back of the neck, stiffness and painful swallowing. If your neck is also stiff and sore when you turn your head, without throat symptoms, a strained muscle or stiff joint may be involved.
Can a pinched nerve cause pain when swallowing?
Not usually. A pinched nerve in the neck typically causes pain, numbness or tingling that spreads into the shoulder and arm. Bone spurs on the front of the neck bones can rarely press on the esophagus and make swallowing difficult, which needs imaging and a physician's care.
Can a chiropractor help with pain when swallowing?
After a medical evaluation, a chiropractor may help with a separate muscle or joint problem in your neck or upper back, such as after a strain or a whiplash injury a doctor has checked. Chiropractic care does not treat swallowing disorders, infections or reflux. Painful or difficult swallowing needs medical assessment before hands-on neck treatment.
Request an appointment at PMR
If neck or upper back pain is making meals or daily life uncomfortable, our team can examine your neck and upper back, explain what we find and build a plan around your routine. If something needs a doctor's attention first, we'll tell you. Request an appointment and our team will contact you to schedule a visit at PMR of Danbury or PMR of Brewster.
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