What Causes Middle Back Pain?

Coping With Middle Back Pain

Did you know that upwards of one-half of all working Americans have back pain as a symptom each year?  And that up to 80 percent of the population will have a “back problem” at some point in their life?

Back pain is also one of the most common problems to visit the doctor’s office – second only to upper respiratory infections.

So, let’s talk about middle back pain.

What Is Middle Back Pain?

Any area of your back – for any number of reasons.

The lower back is more prone to injury than any other part of the back. Our upper backs are also more likely to be sore simply because they get tense – we hold our stress there.

But our middle backs?

Yes, it is absolutely possible to have pain there – but it is less likely.

When we have back pain in the middle back, it is pain in the “thoracic” area of the back.  The “thoracic” area is where the T1 through the T12 vertebrae are housed – “T” standing for “thoracic.”

What Causes Middle Back Pain?

There are several things that could be causing middle back pain.  Some of the more common causes are a strain to the muscles of the back.  This could happen from overuse, such as after playing a sport or a work injury.

Your posture may also be the issue. Poor posture, especially when the posture is continuously poor, will cause the muscles to weaken, and back pain occurs.

Other more acute issues that can cause middle back pain include:

  • A pinched nerve, which most often happens near the ribs.
  • A fractured vertebra, which would typically happen in conjunction with some type of injury.
  • A herniated disc. A disc is the spongy material that is between the vertebrae that act as shock absorbers.  When the disc herniates or pushes out between two vertebrae, it can compress on the nerves of the spine.
  • Osteoarthritis is not an acute condition, but rather a chronic condition. However, it can cause both acute and chronic pain.  Osteoarthritis causes the bones of the vertebrae to wear down.  When this happens, bone spurs can occur. These bone spurs press on the spinal nerves.  Osteoarthritis can affect many areas of the body – the back is just one of many.

Middle Back Pain Treatment

Typically, treatment is noninvasive and aimed at reducing pain as well as strengthening the back.

Your physician may recommend several of these at-home treatments:

  • Contrast therapy is the use of hot and cold compresses to relieve the pain. For example, a hot back followed by an ice pack can be used alternatively on the middle back.
  • Take an over-the-counter medication such as acetaminophen, which can help relieve pain or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen.
  • Getting regular exercise. Low-impact exercises such as yoga (which we will discuss in greater detail), walking, and swimming, as well as core strengthening exercises, are all helpful.

Improving your posture can help greatly.  As previously discussed, if your posture is poor, your muscles may be weak, and this can cause back pain.  To improve your posture – and thus your middle back pain – do the following:

  • Stand with your spine straight and your shoulders back.
  • Do not slouch.
  • When using the computer, take regular breaks to stand and walk around.

Next page: More middle back pain treatments including physical therapy, yoga poses for middle back pain, and general back pain tips. 

Physical Therapy for Middle Back Pain

Physical therapy plays a multifaceted role for the person with middle back pain.  Not only can a physical therapist devise a plan that will help to relieve pain, but they can also help improve posture, core strength, and improve your mobility.

The American Physical Therapy Association (APTA) states, “…a physical therapist is a trained and licensed medical professional with experience in diagnosing physical abnormalities, restoring physical function and mobility, maintaining physical function, and promoting physical activity and proper function.”

What can you expect when you make an appointment with a physical therapist?

  • Your physical therapist will likely perform a physical examination. This will also include a health history as well as a “test” of your physical abilities, such as movement and flexibility and evaluation of posture.
  • You can expect that you will receive a plan of care, which will include short-term and long-term goals.
  • You will receive physical therapy based on the therapist’s evaluation.
  • Upon completion of the program, your therapist should give you self-management recommendations.

Yoga for Middle Back Pain

What about yoga for back pain? Can yoga improve the pain? There have been various studies that evaluate the effectiveness of the practice of yoga for back pain. Most studies conclude that yoga can reduce pain, to some degree.  Most studies do agree that further evaluation needs to be completed to concluded.

What asanas (or poses) can you do at home to improve your back pain?

Cat-cow is a great pose to release tension in the both the middle back and the lower back.  This pose is actually a combination of two poses – cat (marjaryasana) and cow (bitilasana).  Here’s how to do cat-cow:

  • Come down on your hands and knees on a yoga mat or a blanket. Spread the fingers wide so that the weight is evenly distributed.
  • As you inhale, drop the belly towards the mat and lift the pelvis, heart, and face towards the sky. This is cow.
  • As you exhale, arch the back – rounding the spine, bringing your gaze towards the mat. This is cat.
  • Repeat several times, slowly.

Seated twist releases pain in the low back as well as improve flexibility.  Here’s how to do a seated twist:

  • Seated on a yoga mat or on a blanket, sit cross-legged if possible. Sit upright, with the spine as straight as possible.
  • As you inhale, place the right arm behind you. As you begin to twist, place the left hand on the right knee.  Ensure not to use this hand to twist aggressively – use it as a guide.  Gaze over your right shoulder.
  • Hold this twist for three to five breaths.
  • Repeat this twist on the opposite side. You can repeat the twist on both sides if you wish.

Cobra pose, or bhujangaasana, is a gentle back stretch but also strengthens the core.  It is good for back pain in general.  Here’s how to do cobra:

  • Lie flat on your belly on a yoga mat or blanket. Place your hands flat on the mat, directly under your shoulders.
  • As you inhale, begin bringing your shoulders and chest off the mat. Engage your core muscles.
  • Hold this posture for two breaths. Repeat at least two more times.

Bridge pose, or setu bandha sarvangasana, relieves tension in the back and also is a heart opener. It does place pressure on the neck, so if you do have neck issues, you may want to avoid this posture. Here’s how to do bridge pose:

  • Lie on your back on a yoga mat or blanket. Place your feet flat on the mat, several inches from your tailbone.
  • Press your shoulders into the mat, then tuck them under your back. Clasp your hands underneath your hips while raising them off of the mat.
  • Hold this posture for five to seven breaths. To come out of this posture, unclasp the hands, untuck the shoulders from under the back, and slowly lower the spine to the mat.
  • Repeat at least three more times.

General Back Pain Tips

The American Chiropractic Association provided the following tips, which can help prevent generalized back pain:

  • Consume a healthy diet and lose weight if you need to
  • Remain active and avoid prolonged inactivity
  • Warm up or stretch prior to activity
  • Maintain posture at all times
  • Wear comfortable shoes
  • Sleep on a mattress that will minimize the curvature of the spine
  • Lift with the knees, while keeping the object close to the body
  • If you smoke – quit! Smoking results in a reduction in blood flow, which can reduce oxygen levels and deplete nutrients in the spinal tissues.

The Bottom Line…

Does middle back pain get you down? Knowing the cause is extremely important – it can help you treat the underlying cause. For example, if poor posture is causing the pain, fixing the issue may treat the pain completely.  Other causes of back pain may be harder to treat – but knowing that there are ways to treat the pain is helpful.


American Chiropractic Association (Back Pain Facts and Statistics)

Healthline (5 Stretches to Release and Relieve Your Mid Back)

Healthline (Understanding and Treating Middle Back Pain)

Medical News Today (How Can Physical Therapy Help?)

US National Library of Medicine National Institutes of Health (Yoga as a Treatment for Chronic Low Back Pain: A Systematic Review of the Literature)

WebMD (Why Does My Middle and Upper Back Hurt?)

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