Middle Back Pain: Signs, Symptoms, Risk Factors, Causes, Diagnosis and Treatment

It has several possible causes, ranging from muscle tension to the collapse of a vertebra or rare diseases.

Upper back pain, also called middle back pain or chest back pain, is a back pain felt in the region of the thoracic vertebrae, which are located between the lower part of the neck and the upper part of the spine lumbar.

The upper spine is solid and stable to support the weight of the upper body, as well as to anchor the rib cage that provides a cavity to allow the heart and lungs to function and protect them.

In most cases, pain is likely to be self-limiting; in that case, no diagnostic tests are required, and simple pain relief is sufficient.

More severe and prolonged cases may require more specific pain management strategies and occasionally investigations of underlying medical conditions.

Signs and symptoms of middle back pain

The thoracic spine begins at the base of the neck and extends to the middle of the trunk. Any pain in this area is considered “middle back pain.”

The exact symptoms of moderate back pain will depend on the underlying cause. Most middle back pain is not severe. However, it tends to have a more serious pathology associated with neck or lower back pain.


Symptoms may include local pain near the spine or refer along the area of ​​the corresponding nerve dermatome.

Symptoms may also include numbness or the feeling of pins and needles when it comes to nerve irritation or compression.

Weakness in the legs or loss of bowel or bladder control in the presence of pain in the thoracic spine may indicate spinal cord compression and should be investigated.

These are some common ailments that contribute to the discomfort of the middle part of the back in men and women:

Tired or irritated muscles

Lifting heavy objects incorrectly or repeatedly doing the same movement can aggravate muscle tissue and damage small blood vessels, causing pain in the middle region of the back.

Injured discs

The discs are located between the spinal vertebrae and act as shock absorbers to absorb shock and facilitate movement.

When a disc is damaged, its inner core, similar to a liquid, can seep through the weakened spot in its hard outer shell.

The filtration material exerts pressure on the nerves, ligaments, and surrounding tissues while threatening the structural integrity of the spine.

Discomfort occurs and, sometimes, debilitating pain when a disc is injured. Disc degeneration or sudden trauma can cause a slipped disc.

Fractured vertebrae

High impact accidents, such as car crashes or violent falls, and extreme deterioration of the spine over time, can cause a vertebral fracture.

Severe back pain that worsens with movement usually correlates with a spinal fracture. In extreme situations, this complication can affect the spinal cord.


Osteoporosis is a condition that occurs when new bone is not created fast enough to replace old bone, resulting in brittle, brittle bones.

Osteoporosis makes the spine vulnerable to structural failure and causes pain as breakages, stresses, and weight changes occur.


As you get older, you increase the risk of diseases that can cause back pain, such as spinal stenosis, a condition in which the spinal canal narrows abnormally.


Spondylitis, a disease that causes inflammation in the spinal joints, may cause pain in the mid-back. Other infections can cause similar results.

Diseases of the spine, such as scoliosis

Scoliosis, a lateral curvature of the spine, can cause pain as the proper weight distribution system of the spine is disrupted and tissues, ligaments, and nerves rupture. Many complications of the spine have similar effects.

Health problems, such as tumors or diseases

Tumors can stimulate pain by altering the inherent architecture of the spine and putting pressure on the nerves, ligaments, and tissues in the middle part of the back.

Risk factor’s

Thoracic spinal pain is significantly associated with concurrent musculoskeletal pain, growth and physical, lifestyle and social, backpack, postural, psychological, and environmental factors.

The specific risk factors identified in adolescents include age (getting older) and poorer mental health.

Causes of middle back pain

The most common causes of back pain are caused by muscle irritation, intervertebral discs, spinal facet joints, ribs, or soft tissue problems (e.g., ligaments/fascia).

Commonly, interscapular pain is derived from the lower cervical spine. Factors contributing to the injuries include; lack of strength, poor posture, excessive use injuries (such as repetitive movements), or trauma (such as a car accident or sports injury).

Frequently, chest pain may be aggravated by twisting, bending laterally, and with bent and prolonged spinal postures.

compression fracture of the vertebra can also cause acute and chronic pain in the upper back.

Trauma can cause a fracture, but in women over 50 without significant trauma or someone who is known to have osteoporosis, a spontaneous vertebral compression fracture is possible.

You may suffer from moderate back pain if you encounter:

  • Rigidity, especially in the morning.
  • Muscle spasms.
  • Sensitivity.
  • Numbness.
  • Shooting pain.
  • Bad posture.
  • Weakness.
  • Shoulder, neck, or hip pain.
  • Problems to sleep.
  • Headache.
  • Fatigue.

Depression and anxiety can also accompany your middle back pain.

In case of chest pain, shortness of breath, jaw pain, loss of bladder control, severe abdominal pain, or paralysis occurs in the leg, seek emergency medical attention since these complications can mean a problem that puts lives at risk.

Other less common causes of thoracic back pain include:

  • Spinal disc herniation often has radicular pain (wrapping around the ribs associated with numbness and burning pain).
  • Spinal tumors.
  • Rib fractures can simulate chest pain / radicular pain.

Other possible sources of reference pain in the thoracic region include visceral organs such as the lungs, gall bladder, stomach, liver, duodenum, pleura, and heart.

Middle back pain has long been considered a “red flag” to alert health professionals to the possibility of cancer ( metastasis or spread to the spine).

Therefore, this is not a sensitive or specific phenomenon and can not be relied upon in isolation.


The word “thoracic” means belonging to the thorax, and the thoracic column comprises the upper part of the spinal column that corresponds to the thorax area.

The upper vertebral column includes twelve vertebrae, and each of the nine upper vertebrae of this section is attached to a rib on each side of the spine.

Each of the ribs then curves around the side of the body and attaches to the sternum in the front. This forms a robust structure (the rib cage) that supports and protects the internal organs: the heart, lungs, and liver.

Diagnosis of middle back pain

The detailed physiological tests that prove what percentage of the pain in the thoracic spine is caused by disc, facet, rib, or muscle have not yet been completed, so the answer to what causes the pain often remains unanswered.

Suppose chest pain occurs with weakness or numbness of the legs, bowel or bladder incontinence, and fall. Immediate magnetic resonance imaging is indicated.

Treatment of middle back pain

Nonspecific pain of the thoracic spine is usually treated with one or a combination of the following treatments:

  • Exercise / active and passive physical therapy.
  • Deep massage or massage therapy.
  • Ice and heat therapy.
  • Analgesics such as non-steroidal anti-inflammatory drugs.
  • Physiotherapists, chiropractors, or osteopaths commonly perform joint manipulation.
  • If there is a specific tender point, then massage or injections at the trigger point may be helpful.

A painful vertebral compression fracture can be treated with analgesics and rest or vertebroplasty or kyphoplasty surgery. If the cause is thought to be osteoporosis, oral or intravenous bisphosphonates can be administered to reduce the risk of fractures.

Non-surgical treatment options for middle back pain

Family history, pregnancy, obesity, smoking, a sedentary lifestyle, and stress can increase the risk of developing pain in the middle part of the back.

Begin to track your symptoms; write down what triggers your pain and alleviates it. If your discomfort can be mitigated with over-the-counter medications, ice packs, or thermal pads, you may be supporting a tense muscle that will resolve itself.

If the root cause of your pain does not respond to conservative treatment, more extensive measures may be necessary to restore comfort.

Pain mapping procedures apply numbing medications to suspect nerves to temporarily reduce pain and determine the exact location of your problem.

We can also recommend having an imaging program, such as a CT scan or an MRI. When the precise location of your pain is identified, effective and safe strategies can be constructed to address your condition.