What is Mid Back Pain?

Mid back pain is pain, stiffness, soreness, or discomfort involving the thoracic spine, which is the middle portion of the back between the neck and lower back. The thoracic spine includes vertebrae, intervertebral discs, facet joints, ribs, ligaments, muscles, spinal nerves, and the spinal cord.

The thoracic spine is more rigid than the cervical spine and lumbar spine because it connects to the rib cage. Mid back pain may come from muscles and soft tissues, spinal joints, discs, compression fractures, spinal deformity, trauma, or less commonly, nerve compression. When a thoracic nerve root is irritated, the pain may travel around the chest wall or ribs. This is called thoracic radiculopathy.

De Novo Brain & Spine evaluates adult patients with mid back pain when symptoms suggest a thoracic spine condition, nerve compression, spinal cord compression, compression fracture, scoliosis, kyphosis, trauma, tumor, infection, or persistent pain that may require neurosurgical review.

Common Signs and Symptoms

Mid back pain symptoms depend on the underlying cause, location of irritation, and whether the thoracic spinal nerves or spinal cord are involved.

Common signs and symptoms may include:

• Aching, sharp, burning, or stabbing pain in the middle back
• Stiffness or reduced movement in the upper or mid back
• Muscle tightness or spasms around the thoracic spine
• Pain between the shoulder blades
• Pain that worsens with twisting, bending, lifting, deep breathing, coughing, or certain positions
• Pain that wraps around the ribs, chest wall, or abdomen when a thoracic nerve root is irritated
• Numbness, tingling, or burning along the ribs or trunk
• Pain after a fall, motor vehicle accident, sports injury, or other trauma
• Pain associated with spinal deformity, such as scoliosis or kyphosis
• Weakness, numbness, balance problems, or trouble walking if the spinal cord is affected
• Worsening pain at night or pain that does not improve with rest in selected cases

Seek urgent medical evaluation for mid back pain with progressive weakness, numbness, trouble walking, loss of coordination, bowel or bladder changes, fever, unexplained weight loss, history of cancer, severe pain after trauma, or pain with worsening neurological symptoms. Seek emergency medical care or call 911 for chest pain, shortness of breath, sudden weakness, sudden speech difficulty, loss of consciousness, or symptoms that may suggest a stroke or heart-related emergency.

What Causes This Condition?

Mid back pain can have many causes. Some are related to muscles and posture, while others involve the thoracic discs, joints, bones, nerves, spinal cord, ribs, or nearby structures.

Possible causes and related conditions may include:

• Muscle strain from posture, lifting, twisting, overuse, or prolonged positioning
• Thoracic sprains and strains involving ligaments or soft tissues
• Myofascial pain involving irritated muscles and trigger points
• Thoracic facet joint disease, involving the small joints in the back of the spine
• Costovertebral or rib joint irritation, involving the joints where the ribs meet the spine
• Thoracic degenerative disc disease
• Thoracic herniated disc, which can irritate a nerve root or, in selected cases, compress the spinal cord
• Thoracic radiculopathy, or nerve root irritation in the mid back
• Thoracic spinal stenosis, which is narrowing around the spinal cord or nerve roots
• Vertebral compression fracture, often related to osteoporosis or trauma
• Osteoporotic spinal fracture
• Traumatic spinal fracture
• Kyphosis or scoliosis, which can change spinal alignment and loading
• Spinal instability in selected cases
• Spinal tumor, infection, or inflammatory disease in selected cases
• Referred pain from non-spine conditions in selected cases, which may require medical evaluation outside of spine care

These causes and risk factors do not mean every patient with mid back pain has a serious spine condition. Treatment planning depends on symptoms, examination findings, imaging results when needed, neurological function, injury history, and overall health.

How It Is Diagnosed?

Mid back pain is diagnosed through medical history, physical examination, neurological examination, and imaging or additional testing when appropriate. The goal is to determine whether the pain is muscular, joint-related, disc-related, nerve-related, fracture-related, deformity-related, or caused by another condition.

Common diagnostic steps may include:

• Medical history and symptom review to understand pain location, duration, triggers, injury history, rib or chest wall symptoms, neurological symptoms, prior treatment, and red-flag symptoms
• Physical examination to evaluate posture, spinal alignment, range of motion, muscle tenderness, spasm, rib movement, and painful motion
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, balance, and signs of spinal cord or nerve root involvement
• X-rays of the thoracic spine to evaluate alignment, arthritis, fracture, kyphosis, scoliosis, disc space narrowing, or degenerative change
• Flexion-extension X-rays in selected cases when abnormal motion or instability is suspected
• MRI of the thoracic spine when disc herniation, spinal cord compression, nerve compression, tumor, infection, fracture, or significant neurological symptoms are suspected
• CT scan of the thoracic spine when bone detail, fracture, deformity, or surgical planning requires further evaluation
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal cord and nerve roots is needed
• Electromyography and nerve conduction studies, also called EMG/NCS, when symptoms may involve thoracic radiculopathy or another nerve disorder
• Blood tests in selected cases when infection, inflammatory disease, cancer-related concern, or another medical condition is suspected
• Diagnostic injections in selected cases when the pain source may involve the facet joints, rib joints, or a thoracic nerve root

The goal of diagnosis is to identify the likely pain source, determine whether nerve or spinal cord compression is present, and decide whether conservative care, pain management, injections, or surgical evaluation may be appropriate.

Treatment Options

Mid back pain treatment depends on the cause, severity, duration, neurological examination, imaging findings, prior treatment, activity limitations, and overall health. Many patients begin with non-surgical care when there is no progressive neurological deficit, spinal cord compression, fracture, infection, tumor, or other urgent concern.

Treatment options may include:

• Activity modification to reduce movements, positions, lifting, or twisting that worsen symptoms
• Physical therapy to improve posture, thoracic mobility, shoulder mechanics, core strength, flexibility, and spinal stability
• Home exercise and stretching when recommended by a clinician or therapist
• Heat, ice, or other comfort measures for short-term symptom relief
• Anti-inflammatory medication, acetaminophen, muscle relaxants, or nerve pain medication when medically appropriate
• Treatment of posture, ergonomic, or activity-related contributors
• Trigger point injections or myofascial pain treatment when muscle-related pain is a major contributor
• Thoracic facet joint injection, medial branch block, or radiofrequency ablation in selected cases when facet-mediated pain is suspected
• Thoracic epidural steroid injection in selected cases involving thoracic radiculopathy or nerve irritation
• Treatment of vertebral compression fracture in selected cases, which may include bracing, osteoporosis management, pain control, or procedural treatment when appropriate
• Evaluation for thoracic spine surgery when symptoms are related to significant spinal cord compression, nerve compression, instability, fracture, tumor, infection, or persistent structural pain that does not improve with appropriate non-surgical care
• Thoracic decompression in selected cases involving spinal cord or nerve compression
• Spinal fusion or stabilization in selected cases involving instability, deformity, trauma, tumor, or certain fractures
• Rehabilitation and follow-up care to support strength, mobility, function, posture, and symptom monitoring

Surgery is not appropriate for every patient with mid back pain. Neurosurgical treatment may be considered when mid back pain is associated with thoracic radiculopathy, spinal cord compression, progressive neurological symptoms, fracture, instability, tumor, infection, deformity, or structural compression that has not improved with appropriate non-surgical care.