Lumbar and cervical (neck) pain conditions are much more common than thoracic pain complaints. Thoracic pain consultations make up only 15% of spinal pain patients who visit a health professional.

Non-serious conditions make up the bulk of thoracic spinal problems. However, serious underlying pathology is a more common finding in thoracic pain. New cases of thoracic pain should be reviewed by a doctor.

Thoracic Anatomy

Non-medical people call the thoracic spine by different names, including the upper back, the mid-back and the middle back.

The lumbar spine and cervical spine are mobile parts of the spine that are specialised for mobility. The thoracic spine, however, is specialised for stability as the rib cage incorporates the lungs and heart and movement must be limited to protect these internal organs.

There are twelve vertebrae in the thoracic spine, with narrow discs between each vertebra. Facet joints, small flat joints, exist in pairs on the sides of each vertebra.

Thoracic Spine Anatomy

Middle Back Pain

The middle back area, although not a clinically recognised area of the spine, runs roughly from the seventh thoracic vertebra to the twelfth. This area of the spine has limited movement and is very stable.

The neck and low back, being mobile and subject to high stresses, suffer conditions rare in the thoracic spine, such as degenerative disc disease, spinal stenosis and a prolapsed disc.

The mid back is much more likely to suffer from joint and muscle related problems.

When the middle back is investigated with MRI or CT scanning it is uncommon to find anything that could be considered a cause for a patient’s pain. For this reason, spinal surgery to the middle back is seldom appropriate.

Who Gets Middle Back Pain?

Middle back pain may be more common in children and young people, and in adults in people with other musculoskeletal problems also. In younger people risk factors may be poor school chairs, carrying backpacks, particular sports and being female.

Middle Back Pain Causes

  • Sudden injury from falls or trauma. Damage or injury to the middle back can start off pain problems.
  • Poor posture or repeated small strains. This can strain the muscles and joints in the thoracic spine, leading to postural strain pains with time.
  • Joint dysfunction. Changes in the joints and the ligaments and capsules that surround them can limit movement and cause pain.
  • Myofascial pain syndrome. This can be a widespread or localised syndrome where abnormal activity in the muscles produces trigger points within the muscles of the upper and middle back.

Middle Back Pain Treatment

Many cases of middle back pain settle without treatment or are managed with exercise and normal daily activities. A physiotherapist can perform a thorough assessment to establish the driving factors in maintaining thoracic pain.

A physio can treat joint dysfunction with spinal mobilisations or manipulations, exercises and stretches to stretch tight structures and strengthen weak muscles. More general exercise programmes are useful to keep the muscle balance and prevent middle back pain from recurring or increasing in severity.

Treatment of myofascial pain is aimed at causative factors such as maintaining static posture and doing small repetitive movements. This occurs often in long-term computer work. The physio will work at developing and maintaining endurance and strength in the mid back muscles.

In myofascial pain syndrome, a physiotherapist will stretch out short, painful muscles and strengthen weak and lengthened muscles. Using vapocoolant spray, stretching, acupuncture, massage or trigger point injections are the main techniques for managing myofascial pain.

Last Review Date: 11-12-2019

Next Review Date: 09-12-2021