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Middle Back Pain – Neck

Middle back pain or mid back pain can be variously defined by I have chosen to confine it to the area between the 6th and the 12th thoracic vertebrae, the area of the spine just above the lumbar region.

The lower joints of the neck have been tested and found to be able to refer pain down to the lower edge of the shoulder blade or scapula. They do not seem able to refer pain any further down so have little relevance to the middle back pain area as I have defined it.

The causes – neck pain are similar however to the causes – middle back pain in that most of the pain generating structures are related to the local joints rather than the intervertebral discs. The discs which are strong candidates for pain generation in the lumbar spine are very uncommon reasons for pain in the mid back area.

The middle back pain – spine area is the lower thoracic spine, where the spinal canal is tightly packed by the nerve cord and there is no room for a significant disc protrusion. If there is a rare disc prolapse it puts pressure on the spinal cord and can give serious symptoms such as gait unsteadiness and bladder and bowel control problems which need immediate medical review. The facet joints can be sources of pain as can be the costovertebral or rib joints which can run pain round and generate chest pain.

Middle back pain symptoms vary from an irritating ache becoming a stronger pain as the activity or posture is maintained for too long to a sharp stinging pain from a injured joint.

Management of middle back pain can be guided by a physiotherapist who will assess the mid back area and use various techniques such as middle back pain exercises, mobilisation techniques and postural correction and advice. Chiropractors – middle back pain management is similar to other manual therapy groups but they have their own specific diagnoses and manipulative techniques.

Further information about middle back pain can be accessed at Backpainexpert and



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