Middle Back Pain: Why It Happens and How to Fix It
Middle back pain targets the region between your neck and bottom of your ribcage. Due to attachments to the ribcage, thoracic spine mobility is more limited than the neck or low back. Fortunately, that also means there are proven solutions like improving posture and physical therapy exercises to relieve middle back pain.
Causes of Pain in Middle of Back & How to Fix It
Anatomy of the Thoracic Spine
Before exploring how to fix pain in the middle of the back, let's review some relevant anatomy. Your thoracic spine is composed of 12 vertebrae that stack on top of your ribs. This design creates a stiff yet sturdy column to protect vital organs like your heart and lungs.
Due to limited mobility in your middle back, pain may occur while moving as well as simple functions like breathing and coughing. While stable by design, this section of your spine can still experience problems from poor posture or trauma.
Common Causes of Middle Back Pain
Most middle back pain originates from poor posture or strain/sprains. Let's discuss the most common sources of mid back pain.
Posture (Kyphosis)
It's hard to keep your thoracic spine happy with modern life. Sitting at a desk, on your phone, or driving forces you to round your upper back (a position called kyphosis). While occasional, this position causes stress over your mid-back muscles and joints when performed daily.
Ever notice yourself slouching while working on your computer or hunching over when reading? These are simple examples of postural stress that can contribute to your middle back pain.
Muscle Strain (Rhomboids/Trap's)
Rhomboid muscles are located between your spine and shoulder blades. Trapezius (Trap's) muscles span from the base of your neck to your middle back. Both muscle groups help stabilize your posture and allow you to move your shoulders.
Activities like lifting heavy objects, sneezing/coughing, or twisting awkwardly can strain these muscles and cause pain in the middle of the back worsens with activity.
Rib Fractures and Muscle Strains (Intercostals)
Injury from falls, car accidents, sports, or even violent coughing can fracture your ribs or strain the muscles between them (intercostals). Pain is typically sharp and localized to the site of injury that's exacerbated by breathing or twisting motions.
Facet & Costovertebral Joint Dysfunction
Facets joints are the connections between vertebrae in your spine and costovertebral joints are where your ribs connect to your spine. If these joints become stiff or irritated, you may feel localized pain or discomfort with rotation and/or side bending motions.
Thoracic Spine Symptoms to Look Out For
Symptoms will vary depending on the cause, but there are a few clues that your pain stems from the thoracic spine:
- Dull, Aching Pain: Pain between your shoulder blades that is dull and achy may be due to poor posture.
- Sudden sharp pain in middle of back: If you feel a sudden sharp pain in middle of back when twisting, reaching for something, or taking a deep breath. This could be due to muscle strain, rib involvement, or irritated joints.
- Morning Stiffness: Stiffness when getting out of bed or waking up "locked up" is another indicator.
- Radiates around the ribs or into your chest: Always rule out cardiac and pulmonary issues if pain is severe or you have shortness of breath.
These symptoms can overlap with many serious conditions, so if you experience numbness, weakness, loss of bowel control, or sudden, unexplained pain in your back: contact your medical provider.
Things to Avoid If You Have Pain in Middle of Back
You may have heard that bed rest is best for treating pain. That's simply not true. While you should avoid aggravating activities, prolonged sitting or bed rest can actually worsen pain and stiffness.
Instead, focus on staying active within your comfort level and trying the stretches below. These will help you learn how to relieve middle back pain.
Seek Medical Care if You Have Middle Back Pain with:
- Numbness, Tingling, Weakness In Arms Or Legs
- Loss of bladder or bowel control
- Unexplained Weight Loss or Fever With Back Pain
- Sudden, Unexplained Pain that Won't Improve
How to Relieve Middle Back Pain Fast At Home
The best part? You can learn how to relieve middle back pain at home. Implementing these stretches and making minor lifestyle adjustments will drastically improve your pain.
Foam Rolling Your Thoracic Spine
Use a foam roller to release your mid-back stiffness. Foam rolling stretches and relaxes tight muscles.
- Lie on your back with a foam roller under your mid-back horizontally.
- Place your hands on your head, with elbows pointed forward.
- Slowly lift your upper back off the ground and over the roller.
- Roll slowly up and down your thoracic spine (avoid rolling your neck or low back).
- Pause and breathe into any tight knots you find.
Safety: Avoid this exercise if you have osteoporosis, recent fractures, or known disc pathology.
Doorway Stretch
Your chest muscles naturally tighten up if you're sitting most of the day. When chest muscles get tight, they pull your shoulders forward and put extra strain on your mid-back. Try this doorway stretch to open up your chest and shoulders.
- Stand in a doorway with your arms bent 90 degrees and elbows resting on the door frame.
- Step one foot forward and gently lean through the doorway until you feel a good stretch through your chest/shoulders.
- Hold for 20–30 seconds and repeat 2–3 times.
Heat
Heat works wonders for relaxing tight muscles. Apply moist heat or a warm towel to the mid-back for 15–20 minutes at a time.
Watch Your Posture at Your Desk
Make a few tweaks to your workstation:
- Chair: Invest in a chair with both lumbar support and mid-back support. Keep your feet planted on the ground.
- Monitor: Ensure you're not leaning forward to view your computer screen (eyes should align with the top of the monitor).
- Take Breaks: Get up to walk and stretch every 30–45 minutes.
Give these stretches a try each day to relieve pain and prevent future episodes. If stretches aren't helping your pain improve, it's time to seek professional care.
Physical Therapy for Pain in Middle of Back in Merrick
There comes a time when self-care just isn't enough. If the middle of your back hurts despite your best efforts to stretch and improve posture, it's time to see a professional.
Manual Therapy
Joint mobilizations, soft tissue massage, and myofascial release are wonderful tools physical therapists can use to decrease pain and restore normal movement.
Scapular Strengthening Exercises
Just as weak postural muscles contribute to mid-back pain, strengthening these muscles can help reduce your symptoms and improve function.
When Do You Need To See a Doctor for Middle Back Pain?
Remember earlier when we mentioned your middle back pain may not even be musculoskeletal? If you experience severe pain that comes on suddenly, accompany any of the above red-flag symptoms, or "radiates" into your chest: please seek medical evaluation. Pain can spread from your organs like gallbladder, kidneys, pancreas, or even your heart.
Our expert physical therapists at Summit Physical Therapy can evaluate your posture, spinal mechanics, and perform a thorough movement assessment. Contact our office today to learn how we can help you live your life pain-free.
Don't Live With Mid Back Pain Forever!
If you're dealing with persistent or severe pain in the middle of your back, there's hope! Combining the stretches and ergonomics recommendations above with professional treatment is the key to recovery. Remember, early treatment equals faster recovery.
Don't let middle back pain keep you from doing the things you love. Contact Summit Physical Therapy today if you are suffering from pain in the middle of your back that just won't go away.
FAQs on Middle Back Pain
Can you have pain in the middle of your back from stomach problems?
Yes, pain in the middle of the back can originate from the stomach, gallbladder, and pancreas. These organs can cause pain to radiate into your back when irritated. If you notice you're having back pain along with digestive symptoms like nausea, bloating, or loss of appetite: see your doctor to rule out visceral causes of back pain.
Is it safe to foam roll my middle back?
Foam rolling is safe for the majority of patients with pain in their thoracic spine. If you have osteoporosis, recent fractures, or are concerned about your spinal health: consult your physician or physical therapist before beginning any at home exercises.
Why does it hurt when I breathe deeply?
Due to your ribs attaching to your thoracic spine, pain with inhalation is typically a good indicator that your ribs are involved. This can happen from joint restrictions, muscle strains of the intercostals, poor posture, or inflammation where your ribs attach to your breastbone (costochondritis).
What is the best sleeping position for middle back pain?
Side sleeping with a pillow between your knees or back sleeping with a pillow under your knees are the best positions to maintain neutral spinal alignment. Stomach sleeping can also cause irritation to your mid-back. A supportive mattress and pillow can also make a significant impact.
Can stress cause knots in my shoulder blades?
Yes! Stress causes your muscles to tense up. Chronic stress can lead to trigger points ("knots") in your muscles that cause referred pain and stiffness.
