Middle back pain is a term that describes discomfort between the neck and the lower back, known as the thoracic region. The thoracic region is a large area of the body with many structures, including the vertebrae (spinal bones) and the corresponding ribs that make up the rib cage. This region protects internal organs including the heart and lungs. Pain in the middle back can be caused by a number of conditions.
Most commonly, middle back pain results from overuse of the muscles or joints.[1] It can also be caused by disc herniation or osteoarthritis. However, pain can be caused by factors not due to an underlying condition, including poor posture, underuse, awkward sleeping posture, or carrying heavy items.[2] Symptoms include muscle aches, sharp pain or a dull ache, and stiffness.
Read more about the symptoms, causes, and treatment of middle back pain.
What are the symptoms of middle back pain?
The symptoms and severity of middle back pain may vary depending on the cause of the problem. Common symptoms may include:
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Pain in the thoracic region (rhomboid pain)
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Muscle aches
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A sharp, or dull, or burning pain
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Radiating pain
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Reduced movement in the back
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Stiffness
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Increased pain with movements, including twisting or reaching.
In some cases, thoracic pain can indicate a more serious condition. Seek medical attention for symptoms including:
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Chest tightness or pain
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Shortness of breath
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Unexplained weakness or numbness
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Sudden jaw pain
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Dizziness or visual changes
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Bowel or bladder incontinence.
What causes middle back pain?
There are a number of causes of middle back pain. Causes can include:
1. Poor posture
Poor posture can cause back pain at any age.[3] It is usually experienced as a dull ache, but can sometimes become a sharp or radiating pain. Poor posture places an increased pressure or load on the supporting structures in the thoracic region, and these muscles, ligaments, and can quickly become fatigued and overworked. Repetitive postures, such as when lifting, sleeping, or during a new exercise, are particular culprits of middle back pain.
2. Muscle sprain or strain
A common cause of middle back pain is overuse. Overuse puts increased load on specific ligaments or muscles. If this load is more than the structure can handle, it can result in a sprained ligament or strained muscle.
Lifting heavy items without proper technique or performing repetitive movements can increase the risk of developing middle back pain.
3. Herniated disc
A herniated disc, commonly known as a slipped or ruptured disc, occurs when the fibrocartilaginous tissue (disc) between the vertebrae (spinal bone) extrudes and compresses the nerves travelling in that area. This can occur suddenly, or as a result of age. The pain is called discogenic pain, and can be sharp, or even radiating.
In some cases, people with disc herniation experience no or mild symptoms. However, in other cases a disc herniation can cause possible spinal cord compression, resulting in sensory loss or weakness. This requires medical input.
4. Spinal stenosis
Spinal stenosis is a term that describes the narrowing of the pathways that nerves travel through in the spine. It is often caused by osteoarthritis, a degenerative joint disease, that affects the cartilage and bones in the spine.
Sometimes, there are no symptoms. In other cases, it may cause a dull, aching pain. Spinal stenosis can also cause nerve compression, which can result in sharp, burning pain that radiates to other areas of the body, such as the legs or arms.
5. Spinal fractures
Middle back pain can be caused by a spinal fracture (a break in a vertebral bone in the spine). Fractures are common in cases of trauma or accidents, such as a hard fall, a car accident, or blunt force trauma. However, a fracture can also develop over time, such as a stress fracture. This can occur in some high-intensity sports such as rowing.
Those with a low bone density, a high falls risk, and poor balance are more at risk of spinal fractures. As these conditions are more prevalent with age, spinal fractures are more commonly seen in the older population.
Spinal fractures require immediate medical assistance. In some cases, surgery may be required to stabilise the fracture. There can be serious consequences of spinal fractures, including the risk of paralysis.
Other causes of middle back pain
Other causes of middle back pain may include:
How is middle back pain diagnosed?
A health practitioner can distinguish between different causes of middle back pain by asking about the history of symptoms and performing a physical examination. This may include observing the thoracic spine, how each joint moves, the neck and head, and other parts of the body including the pelvis, abdominal region, and legs.
Although not always required, a doctor may also request diagnostic testing to further assess the middle back pain. This may include:
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Neurological testing - To assess the nerves in the relevant area, a doctor may perform a series of neurological testing checking for strength, sensation, reflexes, and more. If there are any abnormal findings, this can help diagnose the cause of the middle back pain.
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Imaging - In some instances, imaging tests such as an X-ray, CT scan, MRI, or ultrasound are used to assess the health of the bones and soft tissue. These imaging tests can help diagnose fractures, osteoarthritis, and other soft tissue injuries.
This can help rule out any underlying or serious causes of middle back pain before any treatment is considered.
How is middle back pain treated?
Treatment for pain in the thoracic region varies, depending on the severity and cause of the pain. Thoracic pain is quite common, and often responds well to conservative treatments such as rest and gentle exercise.
Self-care strategies
Common self-care strategies to manage symptoms of middle back pain can include:
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Rest - Relative rest can help reduce the stress on the area and alleviate any pain or symptoms.
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Ice or heat packs - When used appropriately, cold or heat therapy to the affected area can offer immediate symptomatic relief in the short-term.
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Over-the-counter medications - Some over-the-counter medications can reduce pain and discomfort in the thoracic region, including anti-inflammatories or topical pain relief. It is important to discuss the best option with your doctor if there are any concerns.
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Gentle exercise - Slowly introducing gentle exercise can help reduce symptoms. Speak to a physiotherapist if there is any uncertainty about which exercises may be best.
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Posture correction - As posture can contribute to middle back pain, correcting poor posture can go a long way to alleviating the symptoms. Try breaking up long periods of sitting with short walks, avoid slouching, and set up the desk, chair, and monitor at the correct height.
Physiotherapy for middle back pain
A physiotherapist can diagnose and treat a broad range of conditions, including middle back pain. Depending on the cause of the pain, possible treatments may include strengthening or stretching exercises or specific movements. This is particularly helpful in cases where the pain is from overuse or underuse. Physiotherapists also use strategies such as taping, massage, or drying needling to improve function of the thoracic spine by reducing pain.
This treatment may also include assessing the desk setup and workspace to correct any postural issues. In this way, a physiotherapist can help resolve symptoms and improve functioning in everyday activities.
Medical treatment
If the pain continues, or is severe and unrelenting, it is important to see a doctor. A doctor may recommend:
Surgery
There are several surgical options for middle back pain. However, this is often only considered when other conservative (non-surgical) treatment options have not been successful. In cases where the pain is caused by trauma, a severe injury, or an underlying disorder, surgery may be the first line of treatment.
Your doctor may recommend a review with a surgeon to discuss several different procedures, depending on the cause of the pain.
These procedures may include:
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Laminectomy - This surgery involves the removal of the lamina (part of the vertebral bone) to ‘decompress’ or remove pressure on the spinal nerves.
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Discectomy - This surgery involves removing part of the intervertebral disc to reduce pressure on any affected nerves.
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Spinal fusion - In rare cases, several vertebrae are ‘fused’ with a metal plate to reduce movement. This is often reserved for spinal fractures or dislocations.
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Neurolysis - This procedure involves applying an agent (physical or chemical) to reduce the nerve signal transmission, thereby reducing pain.
Recovery post-operatively can be extensive. In some cases, a brace may be required for a period of time after the procedure. It is important to note that surgery is not always successful, and pain can become persistent or ‘chronic’ (lasting more than three months).
Prevention of middle back pain
Whilst it may not be possible to completely eliminate the risk of developing pain, there are a few strategies that can prevent the occurrence of middle back pain:
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Sleeping position - An awkward sleeping posture, or sleeping on old pillows or mattresses, can be a risk factor for middle back pain. Check any pillows to see if they need to be swapped out for a more supportive one.
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Posture - People spend a lot of time sitting. Continually working on posture can help prevent the recurrence of middle back pain. When sitting in front of a computer, set the monitor at eye level, use a lumbar pillow to support the spine in a seated posture, and ensure any seats are at the correct height to enable the feet to sit flat on the floor.
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General health - Maintaining an exercise regime and healthy diet can help keep the body and spine strong.
