Middle Back Pain

Middle back pain is back pain that is experienced below the neck and above the small of the back. Middle back pain may be associated with injury or degenerative changes to the structures of the spine at that level of the back, or the pain may be referred to that area from damage elsewhere in the body. Anatomically, the thoracic spine is at the level of the spine, in the region of what many refer to as the middle back. The thoracic spine begins at the base of the spine, and ends at the beginning of the lower back. Superiorly, the thoracic spine is bordered by the cervical spine, and these two sections of the back are bordered by the C7-T1 intervertebral disc. Inferiorly, the thoracic spine is bordered by the lumbar spine, and these two sections of the back are bordered by the T12-L1 intervertebral disc. The thoracic spine forms the posterior border of the ribcage, and is located in the midline of the back of the thoracic cavity. Conditions and injuries that affect the ribs and cardiovascular symptoms may be experienced as middle back pain. Conversely, injuries and anatomical problems with the thoracic spine may affect the other structures of the thoracic cavity, causing difficulty breathing and other cardiovascular problems. People may refer to symptoms experienced between the base of the neck and above the lower back as middle back pain. In some cases, people may also refer more specifically to the top area of the back as upper back pain to describe painful symptoms in the upper region of the back. What is upper and middle back pain? The upper and middle back is the area around the spine between the base of the neck and the bottom of the rib cage.



The rib case is comprised of 12 ribs, all of which attach to the thoracic vertebrae at the back of the spine. These ribs curve around the organs of the thoracic cavity and move along with inspiration and expiration. The first seven of these ribs are known as true ribs, and attach directly to the sternum. Ribs 8-12 are also known as false ribs and attach indirectly to the sternum by sections of rib cartilage. Ribs 11 and 12 are floating ribs and have no point of attachment at the front of the chest cavity. Between the spinal bones of the thoracic cavity, are spinal nerves that exit the spine through the intervertebral foramina. If one of these nerves is injured, irritated, or compressed (constricted) you may feel pain near the affected nerve root, or at any part of the body supplied by that nerve. The nerve roots of the thoracic spine (T-Spine) supply the internal organs, arms, legs, chest, and abdomen.

The elements of the thoracic spine include the top thoracic vertebra (T1) and down through the last thoracic vertebra (T12). The intervertebral discs separate the vertebra and are labeled according to the spinal bones they are sandwiched between. For example the disc that is between the fifth and sixth thoracic vertebra is known as the T5-T6 intervertebral disc. The muscles and ligaments hold this section of the spine together. Middle back pain and upper back pain is less common than neck pain and lower back pain, because this region of the spine is less weight bearing and more stable. This part of the spine is more stable because it doesn't move as much as the elements of the neck and lower back. The main purpose of this section of the back is to keep the back stable, and to protect the heart, lungs, and other vital organs in the chest cavity.

What causes upper and middle back pain? Like all spinal structures and joints of the body, the structures of the spine may be affected by inflammatory diseases and wear and wear forms of osteoarthritis. Out body mechanics may put prolonged strain on the middle and upper back, eventually changing its shape. The way we nourish ourselves may affect the health of these weight-bearing bones. Let's take a look at some specific causes of upper and middle back pain.
  • Poor posture.
  • Injury, muscle strain, overuse to the discs, ligaments, and muscles which support our spine.
  • Pressure on the nerves that exit through the side of this region of the spine. Conditions such as scoliosis and herniated discs may lead to pressure on the nerve roots.
  • Fracture of one or more of the vertebrae.
  • Osteoarthritis of the facet joints.
  • Myofascial pain that affects the connective tissue coverings of muscles and other connective tissues.
Rare causes of upper and middle back pain include
  • Vertebral tumors and spine cancer
  • Infection
  • Diseases of digestive and filtration organs such as the liver and gallbladder.
Symptoms: Symptoms of this type of back pain include muscle tightness, muscle stiffness, and a sharp, burning, or dull pain in the middle or upper back. Emergency symptoms that require immediate medical attention include the loss of bladder or bowel control, tingling/weakness in the stomach, chest, arms or legs, and weakness in the arms or legs.