The middle back, called the thoracic spine, is below the neck but above the bottom of the rib cage.
The thoracic spine includes 12 vertebrae (backbones) and 12 spinal disks (which sit between the bones).
Each of the thoracic vertebrae attaches to your ribcage. You also have ligaments and muscles in the thoracic spine.
Middle back pain can occur if any of these become injured or irritated as a result of illness, injury, or other health problems.
In this article, I’ll outline some of the symptoms of middle back pain, its causes, and how it’s diagnosed. I’ll also talk about treatments for mid-back pain, and tell you when you should see a doctor.
Symptoms of Middle Back Pain
The cause of the pain determines the symptoms, so they can vary. Some common signs that you have middle back problems could include:
- Dull or aching pain
- Sharp, stabbing pain
- Stiff muscles
- Burning sensation
If your back pain stems from a more serious problem, you may also experience:
- Muscle weakness
- Loss of bladder or bowel control
- Numbness or tingling in the back, arms, chest, or legs
- Chest pain
Some symptoms may be consistent, while others may come and go. If you notice middle back pain, take note of how it feels and when it occurs. Your healthcare provider may use this information to help properly diagnose you.
What Could Cause Middle Back Pain?
A herniated disc, also known as a slipped or ruptured disc, can cause intense pain in the lower back.
These cushioned discs are located between the vertebrae of your spine and allow the bones of your spine to rotate and bend without rubbing against one another.
But sometimes, these discs can be pushed out of place—by heavy lifting, bending, or for unknown reasons.
This out-of-place disc is herniated. When this happens, the bulge from the disc creates pressure on the spine’s nerve roots.
Because it involves a nerve, the symptoms of herniated discs are often similar to other nerve issues:
- Localized pain
- Numbness or tingling in the back
- Numbness or tingling that happens in the leg or other areas affected by the nerve pressure
Arthritis is an inflammatory disorder that leads to degeneration of the cartilage that buffers ligaments, joints, and bones.
There are several types of arthritis and they can all lead to middle back pain.
Each vertebra has two facet joints. If these become inflamed, it will lead to back pain that may include symptoms including:
- Stiff back
- Decreased range of motion
Typically, arthritis does not only happen in one location.
Other joints may also be inflamed and affected by the same symptoms.
Sitting or standing in a slouched or hunched position can put pressure on the middle back.
Many people have poor posture without even being aware of it, yet this is a major cause of spine pressure that may lead to strained muscles, ligaments, and discs.
You may cause injury to your middle back from accidents such as:
- Falling down the stairs or off a ladder
- Sports accidents
- Car accident
- Blunt force trauma
The people at highest risk for middle back injuries are older people and those who may have brittle bones or osteoporosis, and those that have other prior back pain or injuries.
If you fall under these categories and sustain a fall or injury, seek medical care right away.
A comprehensive analysis of 95 studies found a strong association between obesity and low back pain. Being overweight or obese can also be associated with mid-back pain.
Excess weight puts strain on the bones, muscles, ligaments, discs, and joints of the middle back.
One study found that obese women were more likely to have a severe version of a posture called kyphosis, where the shoulders are rounded forward—this posture increases stress on the thoracic spine. The spine was not designed to carry significant forward weight.
If you carry most of your weight in your abdomen, you may be more prone to middle back problems.
Muscle strains or sprains
Sprains and strains involve the tearing or stretching of muscles or ligaments beyond what they are meant to do. In the middle back, sprains and strains are often caused by lifting heavy objects without proper lifting form (using your back instead of your knees to rise).
You can also experience a sprain or strain after a sudden, awkward movement. Most sprains or strains will resolve on their own with rest and using proper lifting technique in the future.
Scoliosis is a condition where the spine curves sideways in an S-shape or C-shape. This causes a shift in how weight is balanced, and can lead to chronic middle back pain. Mild scoliosis in children, teens, or adults does not typically require treatment, but a severe curvature may require a back brace or surgery to correct posture.
Osteoarthritis is a common form of degenerative joint arthritis that affects more than 32 million adults in the United States. As arthritis worsens, bones may end up losing their cushion and rubbing together, triggering pain, stiffness, and swelling.
Ankylosing spondylitis is another type of arthritis that specifically affects the spine, leading to the fusing of backbones. This condition is pretty rare.
It can be difficult to tell which kind of arthritis is causing your back pain. Your doctor will perform an examination and run diagnostic tests to determine if arthritis or something else is the cause of your middle back pain.
The kidneys sit underneath the rib cage on the left and right sides of the spine, more towards your back than your stomach. When there are problems with your kidneys, you may experience middle back pain, as well as other signs:
Kidney problems can become severe quickly, so if you have these symptoms, call your healthcare provider immediately.
Any bone in the body can be fractured, including the bones in the middle spine. These may be vulnerable to injury from contact sports, falling, or being in an automobile accident.
Osteoarthritis and osteoporosis may also increase the risk of experiencing bone fractures in the spine.
Compression fractures are a minor type of fracture that can affect the thoracic, or middle, spine. Even though they are tiny cracks, they can still lead to extreme pain in the middle back.
Signs of a fracture in the spine can include:
- Worsening pain with movement
- Radiating back pain
- Reduced range of motion
- Tingling, numbness, or incontinence if an injury also affects the spinal cord
Signs of a fracture in the back require emergency medical evaluation. You may require a workup including labs and x rays, a CT scan, or an MRI, and you may ultimately need surgery, although some fractures are treated with a brace and physical therapy to regain range of motion and strength.
A rarer cause of middle back pain could be a spinal tumor. If it grows in the middle back, it can place pressure on the spine, affect alignment, and interfere with normal muscle function, nerve signaling, and more.
Middle back pain problems can be diagnosed by your doctor. They may do any of the following:
- Physical examination: Your doctor will closely look at your spine, neck, head, and pelvis to see if there are any obvious misalignments. If your back pain was caused by a sports injury or a car accident, a neck brace may be used to prevent any further damage while assessments are being made.
- Imaging tests: Imaging tests like X-rays, CT scans, ultrasounds, or MRIs could be used to determine what is causing your back pain. You may also be given a neurological exam that looks at how well your arms, legs, fingers, or toes respond to sensory stimuli.
Once your physician has assessed your spine, they will be able to determine a diagnosis and set a treatment plan.
Your treatment plan for middle back pain depends on the diagnosis.
Unless your pain is severe, your doctor may suggest at-home management as first-line care.
If your pain worsens or fails to improve, make sure to let your provider know so that they can recommend the right additional treatment or further evaluation.
Back pain can be managed with over-the-counter or non-medically-prescribed treatments that include:
- Pain relievers like ibuprofen (Motrin), naproxen (Advil), and acetaminophen (Tylenol)
- Lidocaine patches
There are many things you can do at home to relieve middle back pain:
- Ice pack or heating pad
- Posture training
- Changing your sleep position
- Practicing gentle yoga to increase flexibility
Certain exercises may also help to strengthen your back, but if you are not sure what is causing your pain, wait for your doctor to say it’s OK before beginning an exercise program.
Exercising while you have unhealed compression fractures or other injuries could significantly worsen your pain and condition, leading to longer recovery times.
If your back pain does not improve with at-home interventions or others such as physical therapy, steroid injections, pain medicine or muscle relaxers, surgery may be required.
Types of back surgery include:
- Discectomy: Removes the damaged portion of a herniated disc.
- Laminotomy: The lamina is a bony plate in the arch of each vertebra that can sometimes put undue stress on the spinal column. In a laminotomy, part of the lamina is removed.
- Laminectomy: In a laminectomy, the entire lamina is removed.
- Fusion: Spinal fusion surgeries permanently connect vertebrae together.
These procedures are all designed to remove parts that are causing pain, or add support to alleviate pain.
Back surgery can take many months to fully recover from and may have other complications, so your doctor will only recommend it if it is absolutely necessary.
When to See a Doctor
If you have back pain that does not resolve after 3 days, get a medical assessment.
If your back pain comes on very suddenly, is severe, or is accompanied with other symptoms like chest pain, tingling or numbness, or loss of bladder and bowel control, seek immediate medical care.
If you develop back pain after a fall or an accident, go to an emergency room or call an ambulance. Spinal cord injuries are not always immediately obvious, but can have severe consequences if left untreated.
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Frequently Asked Questions
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
Incidence and prognosis of mid-back pain in the general population: A systematic review. (2017).
Herniated disk. (2021).
The association between obesity and low-back pain: a meta-analysis. (2009).
Effects of obesity on breast size, thoracic spine structure and function, upper torso musculoskeletal pain and physical activity in women. (2020).
Osteoarthritis (OA). (2020).
Kidney diseases. (2020).
Compression fractures of the back. (2021).
Spinal tumor. (2021).
Spine surgery — discharge. (2021).