Mid Back Pain

Mid back pain is pain that is felt in the mid to upper back as a result with abnormal functioning in the thoracic spine or chest cavity. The chest cavity is bordered on its posterior (back) side by the structures of the thoracic spine as well as the back of the ribs and their articulations with the thoracic vertebrae. The chest cavity is bordered on its anterior side by the front of the ribs, the sternum, manubrium, and xiphoid process.

Between these borders are the sides of the ribs on the lateral sides, and the heart and lungs. Other anatomical structures that pass through the midline if the chest cavity include the trachea and esophagus. We may experience mid back pain for several reasons, though it should be noted tight away that the cause of mid back pain is often different than the cause of neck pain and lower back pain. Neck pain and low back pain is often caused by degenerative disc disease or herniated discs. It should be noted that thoracic herniated discs are less common, and they are less likely to cause back pain when they do occur. It is more likely that mid back pain is caused by joint dysfunction and myofascial pain (muscular irritation). Mid back pain is also known as middle back pain or upper back pain.

Before we discuss symptoms, diagnosis, and treatment options for this condition, let's first establish what the upper back is, and how it functions in relation to the other structures in the chest cavity.

The mid back and upper back are located in a section of the spine known as the thoracic spine (T-Spine). The thoracic spine is concave anteriorly and convex posteriorly. A healthy thoracic spine has is curved 20 to 40 degrees. When viewing this part of the spine from an X-Ray/MRI/CT Scan side view, you can see it curving towards the front of the patient's body. The vertebral bodies of the thoracic vertebra, as well as their transverse processes, provide for the attachment of the heads and tubercles of all 12 ribs.



The ribs move upwards and outwards as we breathe in, and in the opposite directions as we breathe out. Synovial joints are located where the ribs and thoracic vertebrae joint, and they allow for the ribs to slide during respirations. Injuries to the ribs may cause mid back pain. Conversely, joint dysfunction to these articulations and injuries to the structures around the T-Spine may affect respiration.

The Thoracic spine is the largest section of the spine with 12 vertebrae. Each vertebra in the spine is connected to the back of the rib on both sides. The ribs connect to the thoracic vertebrae at facets and demi-facets on the vertebral bodies, and their transverse processes. These ribs attach to the front of the chest (thoracic) cavity at the manubrium, sternum, and Xiphoid process.

The last four thoracic vertebrae make up a section known as the thoracolumbar junction. Below this junction are the T12-L1 intervertebral disc and first lumbar vertebra (top of the lumbar spine). Degenerative disc disease and thoracic herniated discs usually occur in this thoracolumbar junction. Perhaps there is more disc disease in the junction because the lower three ribs do not attach in the front, allowing that part of the mid back to have more rotation and movement.

Back conditions such as spinal instability, degenerative disc disease, spinal stenosis, and herniated discs are much less common in the mid back than in other sections of the spine. It is more likely that the muscles that move the back become strained due to repetitive use or that the ligaments of the mid back become overstretched due to the long term effects of poor posture, causing mid back pain.

Mid back pain associated with muscular irritation is not a problem that is restricted to heavy lifters and sports athletes. Just sitting at a desk day in and day out with bad posture may have cause poor posture and related structural problems. Other cause of muscle strain includes auto accidents, and repetitive motion movements that irritate the muscles as well as the fascia (connective tissue coverings of the muscles). Irritation of the fascia is known as myofascial pain.

When the cause of mid back pain is diagnosed as muscle strain or myofascial pain, conservative treatment programs will include passive and active muscle stretching and strengthening exercises. Before the strength building exercises can commence, however, the muscles and fascia must be treated for any muscle tension or trigger points that are causing muscle spasms or continued tightness. Treatments to release muscle spasms and trigger points include trigger point injections, acupuncture, and massage therapy.