Upper and Middle Back Pain

Upper and middle back pain includes pain and related neurologic symptoms between the base of the neck and the bottom of the rib cage. The symptoms in this part of the body may be related to an injury near the spine, or it may be referred pain experienced there from an injury outside that part of the spine. These types of pain may be due to a compression of the nerves that leave this part of the spine, or other structures may be inflamed or traumatized, such as the ligaments, muscle, fascia, or vertebral bones. The affected structures may have become damaged or dislocated due to various injuries or diseases, or as a result of the way we move our bodies in real life. Posture and lifting body mechanics may cause long term stress to the structures within the spine, and among the structures that support the spine. These changes may be reversed by using good posture, weight loss, and changes in diet. In other cases, anatomical changes that negatively affect the structures of the mid and upper back may be reversed through treatments such as spinal adjustments, chiropractic adjustments, and back bracing (a treatment for scoliosis). In this article, we will discuss what upper and middle back pain is, how it is diagnosed, and the various forms of treatment for this condition.

What is upper and middle back pain? Most cases of pain and related disability involve neck pain and lower back pain, which are the two sections of the spine that are the most vulnerable to injury due to their mobility and range of motion. Unlike the sacral portion of the spine, and middle part of the back, the neck and lower back have a relatively high degree of mobility for flexion, extension, and rotation. The upper and middle part of the back, on the other hand, is capable of relatively little motion, and its main purpose is to keep the back stable and protect the heart, lungs, and other thoracic organs.



The upper and middle back begins at the base of the neck, where the last cervical vertebra (C7) and the first thoracic vertebra (T1) meet. The disc that separates this vertebra is labeled according to the vertebra it lays between, the C7-T1 intervertebral discs. The Thoracic spine (aka T-Spine) has 12 vertebrae, labeled according to the number from the top of that section. For example, the fifth thoracic vertebra from the top of the T-Spine is labeled T5. The last thoracic vertebra, T12, is located in the middle of the torso, just above the level of the spine where the spinal cord ends. The spinal cord ends at about the level of L1, though the cauda equine continues below it, as does the spinal nerves.

Pathology: We may experience pain when age related degenerative changes occur in the vertebrae, discs, and spinal nerves in the thoracic vertebra. Dislocations may occur in this area of the spine, as one vertebra slips forwards or backwards, relative to the spinal bone above or below it. The spinal nerves may become constricted when inflammation or herniated discs cause anatomical structures to expand or press into these nerve structures. Constriction of these nerve roots is known as compression, and decompression of the nerves refers to surgical and non-surgical treatments designed to eliminate the cause of the nerve root compression.

Some of the spinal nerve roots leave the spine and travel more than half the lengths of our bodies - and all the way to the superficial layers of the skin and the tips of our fingers and toes. Due to nerve root compression, and portion of the body supplied by that nerve may be affected. Symptoms related to the nerve root compression include pain, muscle tightness or stiffness, weakness, and numbness. The compression of the nerve may also affect the organs of our excretory systems, affecting control over bladder and bowels. Here is a brief overview of the spinal nerves of the upper and middle back, as well as the regions of our body that they supply.

The First Thoracic Spinal Nerve: The first thoracic spinal nerve exits the spine through side openings known as the intervertebral foramina. This nerve combines with a bundle of nerves known as the brachial plexus, which supplies the upper back and arms. The skin and muscle of the upper back and arms are affected by the health or disease of the first thoracic spinal nerve.

The next five thoracic nerves are known as the upper thoracic nerves. These nerves supply the intercostals muscles of the chest. The skin and muscles of the upper chest and back are also supplied by this set of nerves.

The thoracic nerves 7 through 11 are also known as the lower thoracic nerves. These nerves supply the skin and intercostals muscles of the abdomen and lower back.

The 12th thoracic nerve combines with the iliohypogastric nerve (a branch from the 1st lumbar nerve) to supply the skin and gluteus muscles of the buttocks.