Healthy Living

What Causes Middle Back Pain?

What Causes Middle Back Pain?

Middle back pain, also known as upper back pain or thoracic back pain occurs anywhere between the bottom of the neck to the top of the lumbar spine, where the rib cage ends. The ribs are connected to the sternum (a narrow thickened plate in the center of the chest) and then wrap round the back. If any nerve in this region is injured, irritated or pinched, you may experience discomfort in other parts of the body through which the nerve passes, like your legs, arms, belly and chest.

The thoracic spine, also known as the middle or upper back consists of:

  • Discs that detach every vertebra and take in shock when you move.
  • Twelve vertebrae, bones that are connected to the rib cage, which form the longest area of your back.
  • Ligaments and muscles that hold the spine jointly.

The incidences of middle or upper back pain are lesser than neck pain or lower back pain, since bones in this section of your back are not as flexible as the bones found in your neck and lower back. Instead, these bones along with the ribs ensure your back remains stable and guard very important organs like the lungs and the heart.

You should identify the root cause of your middle back pain for you to get the appropriate and successful treatment. Although your physician can help you identify that, the following are the leading causes:

Soft tissue or muscle complication

The soft tissues like tendons, muscles and ligaments that hold up the spine can be strained or sprained due to overuse or misuse. You can strain or sprain your upper back muscle through:

  • Bad posture: You exert a lot of pressure on your back muscles by sitting with shoulders arched forward and a rounded back. Bad posture is one of the common sources of mid back pain since majority of office staff spent most of their time on the computer. You can easily form a habit of poor posture particularly if you spend a lot of time on your desk.
  • Improper lifting: To protect your spine, you should apply good body mechanisms when lifting something up. Failure to do this will lead to injury and pain.
  • Carrying a backpack which is heavy: Kids are more prone to mid back injury due to carrying a backpack. A backpack that is overloaded can injure your spine, as well as improper carrying of the backpack like using a single strap.
  • Trauma: Incidents like car accidents can result in mid back pain for different reasons. A spinal bone can get fractured or a section of the vertebra can put pressure on a spinal nerve resulting in pain.

Other Spinal disorders

Your mid back can be caused by symptoms linked with other spinal disorders. For instance:

  • Infections: A paraspinal abscess or a spinal epidural abscess can squeeze the spinal nerves in the thoracic spine resulting in other symptoms and pain.
  • Osteoporosis: This is a disorder that affects the bones. It makes them weak, making them prone to fracture and failure to support your weight properly. If your thoracic spine has osteoporosis, you may experience mid back pain. Vertebrae that are weak do not offer enough support for your body, meaning your ligaments, muscles and tendons have to overwork to make up for that. This can result in muscle fatigue, strain or sprain. If your osteoporosis causes a vertebral fracture, you will mostly have a bad posture, which can result in middle back pain.
  • Problematic kyphosis: From a side view, your spine should curve outwards in your thoracic spine area. That curve is known as a kyphotic curve or kyphosis. Problematic kyphosis is when it begins to curve outward a lot. Different conditions like osteoporosis can lead to problematic kyphosis in your upper back, resulting in pain in the mid back.
  • Scoliosis: This leads to an irregular curve in your spine. It makes your spine appear like a C or an S from a back view. If your spine curves to the thoracic spines’ left or right, you may experience pain due to the way the curve affects your muscles, spinal nerves and other soft tissues.

Other Conditions

Mid back pain can occur together with other medical disorders that are not linked to the spine. For instance:

  • GERD (acid reflux)
  • Cardiac disorders like angina
  • Ulcers

The thoracic spine is more stable than the lower back and the neck. It is not very flexible like them since one of its functions is to guard the internal organs found in the chest. It works together with the ribs which are connected to the thoracic vertebrae.

Since the thoracic spine is not very flexible, it is less likely to have disc or joint problems that mostly affect the lower back and the neck. This does not imply that your upper pain is not caused by a herniated disc, although it is rare.

You will also be less likely to suffer from degenerative issues in your thoracic spine. Since the lower back and neck are more flexible, the discs and joints wear out faster due to misuse and overuse.

Other Sources of Back pain

Various factors can cause middle back pain just like lower back pain. These can vary from unexpected trauma or injury to a simple thing like poor posture.

  • Muscular injury: This is the leading source of mid back pain. It mostly develops in the muscles surrounding the shoulders. The glenohumeral joint, which is the shoulders’ main joint, links the torso with the upper arm. It is the most maneuverable joint in the entire body, but also the most unstable. To make up for this susceptibility, the shoulder consists of several strong muscles which hold up the joint, while still allowing it a lot of mobility. These muscles cover the shoulder and the upper back and are susceptible to injury which can result in pain.
  • Lifestyle factors: Some factors in your lifestyle can lead to your middle back pain, by persistently putting pressure on your back. They include:
    • Lack of exercise or exercising a lot the wrong way
    • Overweight
    • Sitting down for a prolonged period, especially with poor posture
    • Lifting things that are heavy
    • Persistent high stress levels
  • Other Causes: There are various medical disorders that may lead to middle back pain. They include spine problems, in addition to a trapped nerve, slipped disc, wear and tear or rheumatism, arthritis of the spinal joints in the chest and neck.


The main symptoms of middle back pain include:

  • Stiffness or tightness of the muscles
  • Pain that is dull, sharp or burning

Severe symptoms that require urgent treatment include:

  • Weakness in the legs and arms
  • Tingling or numbness in the chest, arms or belly
  • Loss of bladder or bowel control


The doctor will inquire about your health history, symptoms and your physical activities. A physical evaluation is then conducted. An imaging test like an MRI or X-ray may also be conducted to determine the cause of your middle back pain.


Majority of individuals suffering from middle back pain can manage their pain with:

  • OTC (over-the-counter) medicines like acetaminophen and non-steroidal anti-inflammatory medicines
  • OTC muscle relaxants like methocarbamol
  • Ice or heat
  • Manual therapy like mobilization, massage or spinal manipulation
  • Exercise

You may require taking a prescription pain drug if your pain becomes severe and you are unable to undertake your normal activities. Surgery is rarely used in the treatment of middle back pain.