Mid-back pain

Mid back pain usually arises from the physical structures of the thoracic spine itself. The symptoms often worsen with posture, activity, and certain movements. Symptoms may improve with rest, stretching, and targeted treatments. Our goal is to identify the pain generator, guide patients through appropriate nonoperative care when possible, and offer advanced procedural or surgical solutions when needed.

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Causes

Mid back pain is typically caused by a structural problem related to wear/strain/inflammation/4 alignment/instability.

Please review our information on thoracic spine anatomy.
Structures in the thoracic spine that can cause mid back pain include:

  • Thoracic vertebrae: Either stressed or fractured
  • Intervertebral discs: Degenerated or injured
  • Facet joints: Irritated arthritic
  • Joints with the rib: Irritation or inflammation:
  • Muscle and fascia: Strain or postural stress
  • Ligaments: Strain or injury

Symptoms

Below are some of the typical presenting mid-back pain symptoms:

  • aching or burning pain in the mid-back
  • stiffness between the shoulder blades
  • pain with twisting or bending
  • pain with prolonged sitting or computer work
  • discomfort when taking deep breaths or rotating the torso
  • pain that worsens with lifting or repetitive activity
  • localized tenderness in the mid-back

Some patients may also experience referred pain around the rib cage or chest wall, depending on the structures involved.

Conditions

Evaluation

Treatment

Treatment depends on the cause, the duration of symptoms, imaging findings, and the degree to which symptoms interfere with life. Many patients improve without surgery. When symptoms persist, a structured stepwise approach can help identify the right next step.

Preventative

Please see other section on preventative care for spinal disease. Below are some more specific recommendations for cervical spine care:

  • Posture and ergonomics: Small changes in workstation setup, monitor height, phone use, and driving position can reduce repetitive strain.
  • Activity modification: Avoiding repeated aggravating movements during flare-ups.
  • Sleep positioning: Supportive pillows and avoiding sustained neck rotation or excessive flexion may reduce overnight strain.
  • Strength and mobility: A guided or self directed program can improve muscular support and restore range of motion.
  • General wellness: Sleep, health diet, avoid nicotine, everything in moderation

Conservative

Please see other section on conservative care for spinal disease. Below are some more specific recommendations for cervical spine care:

  • Physical therapy: Focuses on posture, cervical mobility, deep neck flexor strengthening, scapular stabilization, and home exercise strategies. Typically the most important conservative care option.
  • Chiropractic care: Focuses on alignment and non-procedural options. Can be very useful for chronic pain that is refractory to therapy.
  • Home exercise program: Best if planned by physical therapy, but this is not always possible. Click here for our general recommendations for home exercises for neck pain
  • Medication: anti-inflammatory medications, muscle relaxants, or other symptom-directed medications may be appropriate under medical guidance.
  • Heat / Ice
  • Immobilization: Limited short-term support may be helpful, though prolonged immobilization is usually avoided.

Procedural

Please see other section on procedures for spinal disease. Below are some more specific recommendations for cervical spine care:

  • Trigger point injections: may help selected patients with significant muscular pain and spasm.
  • Facet injections: may help reduce inflammation and clarify the pain source.
  • Medial branch blocks/radiofrequency ablation: blocks can identify pain generator, radiofrequency ablation may provide longer-lasting relief.
  • Epidural steroid injections: may reduce disc / nerve related pain

We do not perform procedural care for the spine, however, we partner with several pain management physicians and can help guide you in the right direction.

Surgical

When surgery may be considered

Surgery is generally reserved for patients with:

  • persistent symptoms despite appropriate conservative treatment
  • structural pathology that correlates with the pain pattern
  • instability or deformity
  • associated neurologic compression in selected cases

Possible surgical strategies

Depending on the diagnosis, surgery may involve:

  • decompression
  • fusion
  • stabilization
  • correction of structural pain generators

Please review our section on thoracic spine surgery for more information.

Emergency warning signs

Please follow this link to see when to seek emergency care.

Frequently asked questions

Is thoracic back pain common?
Thoracic pain is less common than neck or lower back pain but can still occur due to muscle strain, posture issues, or degenerative changes.

Can poor posture cause thoracic pain?
Yes. Prolonged forward posture or desk work can place significant strain on thoracic muscles and joints.

Do thoracic spine problems require surgery?
Most thoracic spine problems improve with conservative care. Surgery is typically reserved for structural problems or neurologic compression.

When should I see a spine specialist?
If thoracic pain persists, worsens, or is associated with neurologic symptoms, specialist evaluation may be appropriate.

5. Conditions Section

Conditions that can cause mechanical thoracic symptoms

Several structural problems in the thoracic spine may produce mechanical pain.

Thoracic muscle strain

Muscle strain is one of the most common causes of mid-back pain.

This may occur due to poor posture, lifting, sports activity, or prolonged sitting.

Common features

  • localized pain in the mid-back
  • muscle tightness or spasm
  • tenderness between the shoulder blades
  • pain with movement or posture changes

Thoracic facet joint pain

Facet joints in the thoracic spine can become inflamed or arthritic.

Common features

  • pain with extension or rotation
  • localized mid-back discomfort
  • stiffness with activity

Costovertebral joint dysfunction

The joints where the ribs attach to the spine can become irritated.

Common features

  • sharp pain near the rib attachments
  • pain with deep breathing or twisting
  • localized tenderness near the rib joints

Degenerative disc disease

Age-related changes in thoracic discs may contribute to chronic mid-back pain.

Common features

  • deep aching pain
  • stiffness with prolonged posture
  • intermittent flare-ups

Postural thoracic pain

Modern work environments often involve prolonged sitting and forward posture.

This can place increased stress on thoracic muscles and joints.

Common features

  • fatigue between the shoulder blades
  • soreness with desk work
  • muscle tightness in the upper back

Thoracic compression fractures

In some patients, particularly those with osteoporosis, vertebral compression fractures may cause thoracic pain.

Common features

  • sudden onset mid-back pain
  • pain with movement or standing
  • tenderness over the affected vertebra

Scheuermann’s kyphosis

A structural curvature of the thoracic spine that may cause chronic mechanical pain in adolescents or adults.

6. Treatment Pathway Section

Treatment for mechanical thoracic symptoms

Treatment depends on the underlying cause of symptoms and how significantly they affect daily function.

Many patients improve with conservative care.

Preventative and self-care strategies

Posture and ergonomics

Improving workstation setup and sitting posture can reduce strain on the thoracic spine.

Strength and mobility exercises

Strengthening the upper back muscles and improving thoracic mobility can reduce recurrence of symptoms.

Activity modification

Temporary changes in activity can allow irritated structures to recover.

Sleep positioning

Supportive sleep positioning may reduce strain on the mid-back.

Conservative treatment options

Physical therapy

Therapy often focuses on:

  • posture correction
  • thoracic mobility
  • scapular stabilization
  • strengthening of supporting muscles

Medications

Short-term medication strategies may help manage inflammation or muscle spasm.

Examples may include:

  • anti-inflammatory medications
  • muscle relaxants

Supportive treatments

Heat, massage therapy, and other supportive measures may help relieve muscular pain.

Procedural options

In selected cases, procedures may help treat persistent thoracic pain.

Examples include:

Thoracic facet injections

These may help reduce inflammation and confirm facet joints as a pain source.

Trigger point injections

Used for muscular pain that does not improve with conservative treatment.

Vertebral augmentation procedures

Procedures such as kyphoplasty may be considered for painful compression fractures.

Surgical options

Surgery is rarely required for purely mechanical thoracic pain but may be considered in selected situations such as:

  • unstable compression fractures
  • structural deformity
  • severe degenerative disease
  • symptomatic thoracic disc pathology

Possible procedures may include:

  • thoracic decompression
  • thoracic fusion
  • stabilization procedures

7. Evaluation Section

How mechanical thoracic symptoms are evaluated

Evaluation typically includes:

  • detailed history of symptoms
  • physical examination
  • posture assessment
  • evaluation of spine mobility
  • imaging studies such as X-rays, MRI, or CT when appropriate

Diagnostic injections may sometimes help identify the exact source of pain.

8. Red Flags Section

Symptoms that require prompt medical evaluation

Patients should seek medical attention if thoracic pain occurs with:

  • progressive weakness or numbness
  • difficulty walking or balance problems
  • fever or signs of infection
  • unexplained weight loss
  • history of cancer with new back pain
  • severe trauma
  • sudden severe pain with known osteoporosis

Thoracic pain is less common than neck or lower back pain, so persistent or unusual symptoms should be carefully evaluated.

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