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Middle Back Pain

Middle back pain (mid back pain) and upper back pain are not located to precise areas of the back but I have taken the upper back to be the area from below the neck (C7) to the sixth thoracic vertebra T6. I have then taken middle back pain to be pain from T6 to T12 where the lumbar spine begins.

Mid and low thoracic pain is not as common as neck and back pain but can be very distressing and make sufferers take action to relieve middle back pain symptoms as soon as they can. Due to the fact that symmetrical pains do not always occur it is possible to have left middle back pain or right middle back pain.

Further resources are at Back Pain Expert and Wrong Diagnosis.


Middle Back Pain - Spine

The thoracic spine is designed to allow rotation but to restrict forward and backward movement (flexion and extension) to avoid compressing the heart and lungs. This makes the whole thoracic cage, the spine with the ribs attached at the back and the front, a much more stable spinal area than the neck or low back.


Middle Back Pain - Neck

The lower neck joints can refer pain down to the thoracic spine but is generally limited to the base of the shoulder blades, so such symptoms are unlikely to be involved in middle back pain as defined here. Upper back pain symptoms are varied but are likely to include shoulder blade pain, upper back pain between shoulder blades, upper back muscle pain or upper back pain left side or right. Upper back pain during pregnancy can also occur but less commonly than lower back pain or sacroiliac pain. 

Middle Back Pain Causes

While the upper back pain causes are clearly linked to poor posture such as in sitting positions at desks using computers, the causes (middle back pain) are harder to pin down. It is less related to neck pain and shoulder pain as upper back pain. Rarer than upper back pain, it may be secondary to a strain or sprain in some minor traumatic incident such as in sport. A fall may also trigger a pain in this area by direct trauma.

Typical lumbar back pain causes such as degenerative disc problems, disc prolapses and nerve root problems similar to sciatica in the leg are very rare and if you have very severe low thoracic pain you should consult your doctor. Kidney pain may present in the flank areas each side of the lower thoracic and upper lumbar spine. Chest pain is often related to a serious cardiac condition but can be musculoskeletal in origin, although any doubt about the origin about this or lung pain it should be checked promptly with your medical advisor.

Middle Back Pain Treatment

Back pain treatment is often difficult as the underlying anatomical and nerve problems are not well understood but a physiotherapy approach to assessment and treatment of middle back pain may be useful. Physiotherapy techniques used include:

  • Massage

  • Exercise therapy, either generalised such as swimming or locally specific to middle back pain exercises.

  • Mobilisation or manipulation techniques for the painful joints. Chiropractors' middle back pain treatment is similar to that of other manual therapists apart from their own diagnostic categories and an emphasis particularly on manipulation.

  • Trigger point techniques.

  • Acupuncture.

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