Why You Have Middle Back Pain—and What To Do About It
Medically reviewed by Laura Campedelli, DPT
Middle back pain affects the thoracic spine—the part of the spine that supports the rib cage in the middle and upper back. Compared to lower back (lumbar spine) and neck (cervical spine) pain, this type of back pain is rarer, but can still significantly affect your quality of life.
Pain in the middle back can happen for many reasons, including muscle strain, poor posture, injury, or a spinal condition. Fortunately, treatment is available to help improve your symptoms.
What Structures Are In the Middle Back?
To understand middle back pain, it’s important to know about the anatomy of the thoracic spine. Here’s a breakdown of the structures found in this area of your back:
Thoracic vertebrae: Twelve thoracic vertebrae (bones of the spine), T1 through T12, run below the neck and through the middle back. They attach to the twelve pairs of ribs
Thoracic discs: Discs of cartilage serve as cushions between the vertebrae. They can cause pain if they’re damaged or slip out of place
Spinal cord: The vertebrae surround the spinal cord (the thick tube of nerve tissue that runs from the brainstem down), which sends motor commands to the body, receives sensory information, and is helps control reflexes
Thoracic nerves: Twelve pairs of nerves branch outward from the spinal cord at each vertebra, which serve as pathways to coordinate movements and receive sensory information from the body
Muscles: Muscles of the middle back are either intrinsic (which fuse to the spine and provide stability), intermediate (which move the rib cage), or extrinsic (which help control neck and shoulder movements)
How Middle Back Pain Presents
The underlying cause of your back pain affects how the pain presents in your body and the symptoms you experience. Back pain can vary in intensity and duration from person to person. Your pain can be:
Acute: Begins suddenly and lasts anywhere from a few days to a few weeks
Subacute: Begins suddenly but stays longer—usually up to 12 weeks
Chronic: Happens gradually or quickly, but symptoms persist and last over 12 weeks
Pain can affect different parts of your middle back. It can be localized (in a specific area) or generalized (more spread out), often worsening with movement or making it difficult to retain posture. With middle back pain, you may experience one or more of the following symptoms:
Dull and achy pain
Tight or stiff muscles
Pain radiating outward from your spine
Sharp stabs or shocks of pain
However, if a more serious underlying condition is causing your pain, you may develop additional symptoms such as:
Numbness or a “pins and needles” feeling in your limbs or chest
Muscle weakness in your arms or legs
Loss of bladder or bowel control
Potential Causes of Middle Back Pain
Middle back pain can happen for several reasons—chronic spine issues, muscle injury, and normal wear and tear, among other causes. Knowing what's causing your back pain can help determine what treatment you need to ease symptoms.
Muscle Strain or Sprain
A common cause of middle back pain, muscle strains occur when muscles or tendons (which attach muscles to the bones) become stretched out or torn. Similarly, sprains can damage the ligaments that support the spine and contribute to pain in the middle of your back. In addition to both sharp and dull pain, strains and sprains may cause swelling, difficulty moving, bruising, and muscle spasms.
This type of pain occurs due to injury, such as abrupt, awkward, and twisting motions or improper lifting techniques. That said, people who do manual labor, those who lift heavy objects, and athletes are at increased risk.
Poor Posture
Having a poor posture can strain your back and spine. Slouching can also strain the muscles and ligaments of the back, which have to work harder to maintain balance. Pregnancy and working on your feet for long hours may also raise your risk of posture-related back pain.
Injuries and Fractures
Though you’re more likely to hurt your upper or lower back due to injury, the middle back can also be affected. Sports injuries, car accidents, and falls can cause bones in the ribs or spine to fracture. If the spinal cord becomes damaged, you may feel tingling or numbness or experience incontinence (loss of bladder control) alongside your pain symptoms.
Being older than 65, having osteoarthritis (a weakening of the joints), or osteoporosis (thinning bones) all increase your risk of falls and fractures.
Osteoarthritis
Osteoarthritis is an inflammatory condition that significantly affects your bones and overall spine health. This condition often occurs due to natural wear and tear. When osteoarthritis develops, it damages the cartilage between vertebrae (disc degeneration), causing them to rub against each other. This leads to pain and difficulty moving, among other symptoms. You may be at an increased risk of this condition if you:
Are over the age of 65
Were assigned female at birth
Live with obesity
Have a family history of arthritis
Herniated Disc
Vertebral discs are the flat, round pieces of cartilage that serve as cushions between your spine’s vertebrae.
Herniated disc (also known as “slipped” disc) occurs when the gel-like fluid inside the disc pushes through holes in the exterior cartilage, putting pressure on the spinal nerves and/or the peripheral spinal nerves, depending on where it takes place. This causes pain, numbness, and irritation. The risk factors for herniated disc include:
Age over 65
Obesity
Lack of physical activity
Work that involves heavy lifting, repetitive movements, standing, or sitting for long hours
Smoking tobacco
Spinal Conditions
Scoliosis causes a sideways curve in your spine. It can affect the structure of your spinal cord and cause pain. Alongside pain, this condition can cause the shoulders to become uneven, the hip to lean on one side, or the ribs to stick out. This condition usually develops in childhood or adolescence and can progress as you get older.
Spinal stenosis is a narrowing of the spinal canal. This condition can cause pain in your middle back. This condition occurs as a result of other spinal issues like scoliosis or osteoarthritis. Spinal stenosis pressures the spinal cord, which can cause pain, numbness, tingling, and problems with the legs. Being of older age and having a history of a spine injury can increase your risk of this condition.
Less Common Causes
While more rare than other causes of spinal pain, the following conditions can sometimes cause intense pain in your middle back:
Cancer: Tumors in the spinal canal or surrounding areas
Organ problems or inflammation: Gallstones, kidney problems, lung disease, and heart disease
Psychiatric conditions: Depression, anxiety, and post-traumatic stress disorder can all cause chronic pain throughout your body
When to Contact a Healthcare Provider
While middle back pain often goes away on its own, you may need medical care if a more serious condition is causing symptoms. Call your healthcare provider if you’ve had pain for more than three days, had an injury, or are experiencing symptoms after surgery. Let them know if you’re having problems with any prescribed medication or are planning on making changes to your lifestyle.
Some cases of middle back pain warrant emergency support. Alongside back pain, call 911 if you experience:
Sudden weakness in the limbs or groin
Loss of mobility
Incontinence or loss of bowel control
Severe and worsening pain
Signs of anaphylactic shock due to medications, such as breathing difficulties, swelling, hives, nausea, and abdominal cramps
Diagnosis
To diagnose back pain, healthcare providers try to figure out the underlying cause of your symptoms by performing or ordering a series of tests, including:
Medical history: Your provider will ask about your symptoms, personal history of injury or surgery, or family history of back problems. They’ll discuss your medications, lifestyle habits, and overall health status.
Physical exam: To evaluate the severity of your symptoms, your provider will physically assess your reflexes, posture, sensation, and ability to move your arms, legs, and neck.
Imaging scans: Your provider might order an imaging scan to evaluate fractures, herniated discs, or other causes of pain. X-rays, magnetic resonance imaging (MRI) scans, computerized tomography (CT) scans, and bone scans are common options.
Blood tests: Blood tests help providers detect signs of inflammation, cancer, or other diseases that may be causing symptoms.
Treatment
Your exact treatment plan for your middle back pain will depend on the severity of your condition and the underlying cause of your pain. Fortunately, a variety of at-home remedies and medical treatments are available to calm symptoms.
At-Home Treatments
In many cases, home remedies alone can help reduce middle back pain significantly. Consider the following:
Applying a heating pad to promote blood flow and muscle healing
Using ice or a cold pack to ease swelling and inflammation
Avoiding strenuous activities to limit the possibility of a back injury
Getting exercise to strengthen back muscles
Eating nutritious foods to manage obesity, which can worsen back pain
Avoiding smoking to reduce inflammation
Taking over-the-counter pain medications such as Motrin (ibuprofen), Tylenol (acetaminophen), or Bayer (aspirin)
Medical Treatments
If home remedies aren't enough to treat symptoms, your healthcare provider may consider a range of medical approaches. These might include::
Medications such as muscle relaxers, pain medications, and neuromodulators to reduce pain
A pain-relief or numbing medication infection directly into your spine
Physical therapy to improve strength, mobility, and flexibility in your back
Surgery to repair misplaced discs or treat damaged nerves
Complementary therapies like spinal manipulation (physically manipulating the spine with a massage) or acupuncture (using needles to stimulate specific parts of the body)
A Quick Review
Middle back pain affects the region around the cervical spine, which is connected to your rib cage. Many conditions can cause pain in your middle back, such as muscle strains or sprains, spine issues like herniated discs, or conditions like osteoarthritis.
Your treatment plan will depend on the cause of your back pain but may include home remedies like using ice packs or medical treatments like prescription-strength medications.
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