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Back and neck MediBilbao Salud

Middle Back Pain: Causes, Relief, Exercises and When to Worry

Middle back pain affects the thoracic spine, the part of the back between the base of the neck and the bottom of the rib cage. It is less common than neck or lower back pain because this area is stabilised by the ribs, but it is a frequent complaint in people who sit for long periods, lift, twist or carry loads. Most cases are muscular and improve with movement and simple measures. This guide explains, from a physiotherapy point of view, the common causes, how to relieve it and the warning signs to watch for.

Topic
Physical therapy
Updated
Reading time
5 minutes
Reviewed by
Dr. Itziar Gotxi Erezuma · Medical doctor (ENT) · Bizkaia Medical Association no. 484809757

The thoracic spine

The thoracic spine has 12 vertebrae, each connected to a pair of ribs. This makes it stiffer and more stable than the neck or lower back, but the many small joints between vertebrae and ribs can become stiff or irritated. Several muscle groups attach here, including the trapezius, rhomboids and spinal muscles, so strain and sustained postures commonly cause pain. Pain in this area is also described as mid back pain, mid spine pain or thoracic spine pain.

Common causes

  • Muscle strain: lifting, twisting, sports or sudden movements.
  • Posture and prolonged sitting: long hours at a desk, on a phone or driving with a rounded back; see forward head posture.
  • Stiff spinal and rib joints, sometimes after sleeping awkwardly; see back rib pain.
  • Stress and muscle tension.
  • Degenerative changes such as osteoarthritis of the spine with age.
  • Disc problems: less common in the thoracic spine than in the neck or lower back.
  • Postural changes such as kyphosis or scoliosis.
  • Osteoporotic fractures in older people, sometimes after minor strain.

Pain that comes from elsewhere

Some conditions cause pain felt in the middle back without a spinal problem: shingles before the rash appears (burning pain on one side), gallbladder problems (right side, after fatty meals), stomach ulcers, kidney problems (lower down, to the side, with urinary symptoms), lung conditions and, rarely, heart or aortic problems. Pain that does not change with movement or position, or comes with other symptoms, should be checked by a doctor.

How to relieve middle back pain at home

  • Keep moving: gentle walking and normal activities within comfort speed recovery; bed rest makes stiffness worse.
  • Heat: a warm shower or heat pack for 15 to 20 minutes relaxes tight muscles.
  • Painkillers: paracetamol or ibuprofen for a few days if suitable.
  • Change position often: get up from the desk every 30 to 45 minutes.
  • Adjust the workstation: screen at eye level, back supported, elbows at desk height.
  • Sleep: a supportive pillow and a position that keeps the spine neutral.

Exercises for the middle back

  • Seated rotation: arms crossed on the chest, rotate gently to each side, 10 times.
  • Thoracic extension over a chair: hands behind the head, lean back gently over the top of the chair, 10 times.
  • Cat-cow: on hands and knees, round and then arch the back slowly, 10 times.
  • Open book: lying on the side with knees bent, open the top arm across to the other side, 10 per side.
  • Shoulder blade squeezes and rows with a band, 2 to 3 sets of 12.
  • Wall angels: slide the arms up and down a wall keeping the back in contact.

For more ideas see posture exercises and back and neck stretches.

When physiotherapy helps

If pain lasts more than a few weeks or keeps coming back, a physiotherapist can assess posture, joint mobility and muscle strength, use manual therapy to ease stiff joints and design a progressive exercise programme. Ergonomic advice and gradual return to sport or heavy work help prevent recurrences.

Preventing middle back pain from coming back

  • Build movement breaks into the working day: stand, walk and rotate the upper back every 30 to 45 minutes.
  • Strengthen the muscles between and below the shoulder blades two or three times a week with rows, band pull-aparts and prone arm raises.
  • Keep the chest open: alternate long periods of sitting with extension and rotation exercises.
  • Lift close to the body, bend the hips and knees and avoid twisting while carrying loads.
  • Carry bags on both shoulders or use a backpack with both straps.
  • Stay generally active: walking, swimming and cycling all keep the thoracic spine mobile.

Pain between the shoulder blades has its own guide: pain between the shoulder blades.

Warning signs that need a doctor

  • Chest pain, breathlessness, sweating or pain spreading to the arm or jaw: call emergency services.
  • Fever, feeling unwell or unexplained weight loss.
  • A history of cancer, osteoporosis or long-term steroid use.
  • Pain after a fall or significant injury.
  • Numbness, weakness or tingling in the legs, or problems controlling the bladder or bowel.
  • Constant pain that is worse at night and unrelated to movement.
  • A burning, one-sided pain with skin sensitivity, which may be shingles.

Key points to remember

  • Most middle back pain is muscular or postural.
  • Staying active, heat and simple painkillers help.
  • Mobility and strengthening exercises reduce recurrences.
  • Pain with general symptoms or that does not change with movement needs assessment.

Questions about middle back pain

These answers are general information and do not replace an examination or individual medical advice.

What causes middle back pain?

Most often muscle strain, prolonged sitting with poor posture, stiff joints and lifting or twisting.

How long does middle back pain last?

Most episodes improve within a few days to a few weeks.

When should I worry about middle back pain?

With chest pain, breathlessness, fever, weight loss, a history of cancer, pain after a fall or leg symptoms.

Can stress cause middle back pain?

Yes. Stress increases muscle tension around the shoulder blades and upper back.

Is heat or ice better for middle back pain?

Heat usually helps muscular pain and stiffness more. Ice may help in the first day after a strain.

What is the best sleeping position for middle back pain?

On the back or side with a supportive pillow that keeps the spine aligned.

Sources

  1. NHS · Back pain
  2. NHS · Kyphosis
  3. NHS · Shingles
  4. NHS · Heart attack

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.