Understanding and Treating Middle Back Pain

Medically reviewed by Gregory Minnis, DPT on October 12, 2017Written by Taylor Griffith

What is middle back pain?

Middle back pain occurs below the neck and above the bottom of the rib cage, in an area called the thoracic spine. There are 12 back bones — the T1 to T12 vertebrae — located in this area. Disks reside between them.

The spinal column protects the spinal cord. The spinal cord is a long bundle of nerves that allows the brain to communicate with the rest of the body.

There are a number of ways the bones, muscles, ligaments, and disks in the spine can irritate or injure the nerves, causing back pain.

Symptoms of middle back pain

There are several different symptoms that encompass middle back pain. Symptoms will depend on the cause of your pain. Some of the most common symptoms of mid back pain include:

  • muscle aches
  • dull pain
  • a burning sensation
  • sharp or stabbing pain
  • muscle tightness or stiffness

Other more serious symptoms may include:

  • tingling or numbness in the legs, arms, or chest
  • chest pain
  • weakness in the legs or arms
  • loss of bowel or bladder control

What causes middle back pain?

1. Poor posture

Repeated pressure on the spine can lead to middle back pain. In some cases, poor posture can cause this pressure. The muscles and ligaments in your back have to work hard to keep you balanced when you slouch. Overworking these muscles can lead to aches and middle back pain.

2. Obesity

One meta-analysis of 95 studies on weight and lower back pain also showed a positive correlation between obesity and back pain. When weight increases, so does the risk of back pain.

3. Muscle sprain or strain

Sprains are the tearing or stretching of ligaments. Strains are the tearing or stretching of muscles and tendons. Regularly lifting heavy objects, especially without proper form, can easily cause a person to sprain or strain their back. Sprains and strains can also occur after an awkward, sudden movement.

4. Fall or other injury

The middle back is less likely to experience injury than the cervical spine (neck) and lumbar spine (lower back). This is because it’s more structured and rigid. However, it’s still possible to injure the middle back. These injuries most often occur as the result of:

  • a hard fall, like down the stairs or from a height
  • a car accident
  • blunt force trauma
  • sports accident

A thoracic spine injury can happen to anyone, but older people are at a higher risk. If you experience back pain after such an incident, contact your doctor immediately.

5. Herniated disk

A herniated disk occurs when the inner, gel-like core of a disk in your back pushes against the outer ring of cartilage, putting pressure on a nerve. Herniated disks are also commonly called slipped disks or ruptured disks.

This pressure on the nerve can result in pain, tingling, or numbness in the middle back and in areas where the affected nerve travels, such as the legs.

6. Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease. It occurs when the cartilage covering your joints breaks down, causing bones to rub together. According to the Centers for Disease Control and Prevention (CDC), 30 million adults have OA in the United States. It’s a leading cause of disability in adult Americans.

7. Aging

The older a person is, the more likely they are to experience back pain. According to the American Association of Retired Persons, back pain is most likely to occur in 30- to 50-year-olds. The aging process naturally wears on the body, including thinning bones, reduction in muscle mass, and a reduction of fluid between joints in the spine. All these things can cause back pain.

8. Fractures

Vertebrae fractures often occur following trauma, such as a fall, car accident, or sports injury. Fractures are also more likely in people with reduced bone density, such as people with OA.

Fractures can cause severe middle back pain that gets worse if you move. If you’re also experiencing incontinence, tingling, or numbness, your fracture may be impacting the spinal cord as well.

Fractures or bone breaks can be very serious injuries. They often require immediate treatment. Treatment options may include wearing a brace, going to physical therapy, and possibly surgery.

How is middle back pain diagnosed?

You must visit your doctor to receive a diagnosis for the condition causing your middle back pain. Your doctor may use the following to help them make a diagnosis:

Physical exam

During a physical exam, your doctor will look at your spine, head, pelvis, abdomen, arms, and legs. If you were in an accident, emergency responders may also put a collar around your neck during this exam to stabilize the spine.

Testing

Your doctor will likely run some tests to help them make a diagnosis. These include neurological and imaging tests.

A neurological test will examine the function of the brain and spinal cord. During this test, your doctor may ask you to wiggle your toes or fingers. This can indicate the status of the spinal cord and nerve endings.

Imaging tests produce pictures of the inside of your body. They may reveal fractures, bone degeneration, or other causes of middle back pain. Tests may include:

These imaging tests will allow your doctor to see any damage to your spine and determine an appropriate course of treatment.

Treatment for middle back pain

Treatment for middle back pain varies based on the cause of the pain. Because back pain is fairly common, most people first attempt to treat it at home using simple, inexpensive, and noninvasive treatment methods. If home remedies don’t help your symptoms, medical treatments or surgery may be required.

Home remedies

There are several methods you can do at home to treat middle back pain:

  • Ice the area and later apply heat. This is one of the most common methods that can provide immediate relief.
  • Consider taking over-the-counter pain medications, such as ibuprofen (Advil) and naproxen (Aleve), to reduce swelling and pain.
  • Stretch and strengthen the back muscles by doing exercises such as yoga.

You can also work toward improving your posture to help ease back pain. Try these tips:

  • Avoid slouching.
  • Keep your shoulders back when standing.
  • Take standing breaks if you sit for long periods of time.
  • If you have a desk job, adjusting your chair and computer monitor height, keyboard, and mouse positioning can all enable good posture.

Medical treatments

If your back pain lasts more than 72 hours and home remedies aren’t alleviating the pain, see your doctor. They may recommend:

Surgeries

If these noninvasive treatments don’t help your middle back pain, your doctor may recommend surgery. There are a number of different procedures that could help your back pain, depending on the cause. Recovery from surgery can take several months.

Some possible surgeries include:

  • Laminectomy. This surgery removes the entire lamina, or the back wall of a vertebrae, to decompress the spinal cord.
  • Laminotomy. This procedure removes part of the lamina to alleviate a pinched nerve.
  • Diskectomy. This surgery removes part of a spinal disk to alleviate a pinched nerve.

Preventing middle back pain

While it may be impossible to prevent an accident that could cause you back pain, there are many things you can do to strengthen your back muscles and protect your spine from middle back pain. Here are some to try:

  • Change your sleeping position. If you sleep on your back, you risk misaligning your spine and causing middle back pain. There are some positions you can try to prevent this from occurring. Try sleeping on your side with a pillow between your knees and sleeping in the fetal position.
  • Adjust your posture. Maintaining good posture gives your back muscles a break and allows them to strengthen. Standing and sitting straight, lowering chair height so your feet sit flat on the ground, moving computer screens to eye level, or getting a standing desk are all strategies to improve posture.
  • See a physical therapist. Improving your core strength, posture, spinal mobility, and endurance are all ways to ensure good spine health. A physical therapist will work with you to create a personalized exercise program to improve your strength and movement.]
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