Middle back pain: Causes, treatment, and exercises

Middle back pain refers to pain or discomfort in the thoracic spine — the region of the back between the rib cage and the base of the neck.

In this region, there are 12 spinal disks, several vertebrae, and many muscles and ligaments. Any of these structures can become irritated or damaged, leading to middle back pain.

Read on to learn more about the causes of middle back pain and discover techniques to find relief.

Causes of middle back pain

There are many possible causes of middle back pain, ranging from injury to poor posture.

Potential causes include:

1. Aging

Back pain is a common experience for many people over the age of 30.

Pain in any part of the back becomes more likely as a person ages. Back pain is typical in people aged 30 to 60, but it can affect people of any age.

Natural causes of back pain in older adults include:

  • less fluid between spinal joints
  • reduced muscle mass
  • thinning bones

2. Arthritis

There are a number of different forms of arthritis, some of which can affect the back.

Osteoarthritis (OA) is a common degenerative joint disease that affects 30 million adults in the United States. OA causes the ends of bones to rub together, leading to pain, swelling, and stiffness.

Ankylosing spondylitis is a type of arthritis that affects the spine. Symptoms include pain and stiffness in the back. Over time, it causes the vertebrae to fuse together, which can impact posture and mobility.

3. Fractured vertebrae

A fracture or broken bone can occur in any of the vertebrae in the middle back as a result of a sports injury, automobile crash, or fall.

Extreme deterioration of the spine over time, such as from osteoarthritis, can also cause a fractured vertebra.

Symptoms include intense pain that gets worse with movement. If the injury affects the spinal cord, it can lead to tingling, numbness, and incontinence. Fractures require immediate medical treatment.

4. Herniated disks

Disks are located between the vertebrae, where they act as shock-absorbing cushions. They also help a person move.

The disks are filled with liquid and can rupture or bulge outward. This is known as a herniated disk, slipped disk, or ruptured disk, and it puts pressure on the surrounding nerves.

A herniated disk in the middle back does not always cause symptoms, but it may result in pain, tingling, or numbness.

5. Kidney problems

Kidney problems can cause pain in the middle back, just underneath the ribcage on either side of the spine.

The most common causes of kidney pain are infections and kidney stones. Additional symptoms include:

  • fever
  • difficulty urinating
  • pain while urinating
  • chills
  • nausea and vomiting

6. Lifestyle factors

A lack of exercise leads to weak muscles, which can contribute to pain. People who exercise using improper lifting techniques can also experience pain in the back.

Research suggests that people who smoke tobacco also have an increased risk of developing chronic back pain. Smoking is also thought to reduce the nutrient supply to the spinal disks, which increases the risk of pain, degeneration, and injury.

7. Muscle strain or sprain

Repeatedly lifting heavy objects or carrying items improperly can cause the muscles and ligaments in the back to stretch or tear.

8. Obesity

Being overweight or obese puts additional strain on the muscles, bones, and other structures in the back.

In a meta-analysis of almost 100 studies, obesity was found to increase the risk of back pain.

9. Osteoporosis

Osteoporosis is a type of bone disease that results in brittle bones. It occurs when the body does not make enough new bone to replace natural bone loss.

Approximately 54 million people in the U.S. have osteoporosis or are at risk of developing it.

People with osteoporosis in the back can experience middle back pain due to strains or compression fractures.

10. Poor posture

Incorrect posture while sitting or standing is a leading cause of back pain. Slouching increases pressure on the spine and leads to strained muscles as they try to maintain balance.

11. Mental health conditions

People who experience depression or anxiety tend to be at increased risk of developing back pain.

Research suggests that people with depression are 60 percent more likely to develop back pain than people who do not have depression.

12. Scoliosis

Scoliosis causes the spine to curve sideways. It leads to an uneven distribution of weight throughout the back and may cause middle back pain.

13. Tumor

If a tumor grows in the middle back, it can affect spinal alignment and put pressure on the nearby nerves, muscles, and ligaments.

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The treatment for middle back pain will depend on the underlying cause. Doctors usually suggest home remedies first but may recommend medical and surgical interventions if needed.

Home remedies

Beneficial exercises include certain stretches, such as the cobra pose.
At-home methods to treat middle back pain include:

Contrast therapy

Alternating hot and cold compresses, or ice and heat, can provide relief from many types of middle back pain. Heating pads and cold compresses are available for purchase online.

Over-the-counter pain relief

Ibuprofen (Advil) or naproxen (Aleve) may relieve pain and swelling. These medications are also available for purchase online.

Improvements to posture

Poor posture should be corrected to alleviate back pain. Practice correct posture by:

  • standing tall with the shoulders back
  • not slouching
  • taking regular breaks from sitting or using a computer

Workstations should be ergonomically optimized for back health. People should adjust the height and positioning of the chair, desk, computer screen, keyboard, and mouse for their needs.


Several exercises may help to stretch and strengthen the muscles in the middle back to treat and prevent pain.

Beneficial stretches include:

  • Cat-Cow Pose: Position yourself on your hands and knees. Then, arch your back as far as comfortable (like a cat) before sinking your back toward the ground in a U-shape (like a cow).
  • Cobra Pose: Lying flat on the ground, use your arms to prop up the upper body, stretching the back.
  • Seated twist: Sitting cross-legged, twist your upper body to the right, placing your left hand on the right knee for support. Repeat on the other side.

Beneficial exercises include:

  • Low-impact activities. Good options include yoga, swimming, and walking.
  • Core-strengthening exercises. Working the abdominal and back muscles using bridges and planks helps to support the back.

People should speak with a doctor or physical therapist before beginning any new exercise regimen.

Medical treatments

A person should see a doctor for back pain that persists for several days or does not respond to home remedies.

Possible medical treatments for middle back pain include:

  • prescription medications, including painkillers, muscle relaxants, or steroid injections
  • physical therapy, such as exercises and massage


If medication or physical therapy do not alleviate middle back pain, surgery may be necessary. Types of surgery for the middle back include:

  • Discectomy. People with a herniated disk may need a discectomy to remove the injured part of the disk and prevent further damage.
  • Fusion. A fusion procedure involves joining two vertebrae and using a spacer to replace damaged disks.
  • Laminectomy. Used to decompress the spinal cord, a laminectomy removes the back wall of a vertebra (the lamina).
  • Laminotomy. In this surgery, a portion of the lamina is removed to treat a pinched nerve.

Not all cases of middle back pain are preventable, but the following steps may reduce the risk of injury:

  • Maintain a healthful weight. Being overweight or obese puts extra stress on the back muscles.
  • Sleep on one side or on the back. People who sleep on their stomach may experience spinal misalignment. It is best to sleep on the back, or one side with a pillow between the knees.
  • Practice proper posture. Stand tall with the shoulders back and keep the pelvis in a neutral position.
  • Ergonomically optimize all workspaces. Make sure computers are at eye level, look for a seat with armrests and lower back supports, and wear supportive shoes.
  • Lift with caution. Where possible, avoid heavy lifting or find someone to help. When lifting, keep the back straight and bend at the knees.
  • Try physical therapy. Ask the therapist for a personalized program to improve posture, core strength, and mobility.

Middle back pain may cause numbness, stiff muscles, or burning sensations.

Middle back pain symptoms vary depending on the underlying cause of the pain.

Some common symptoms include:

  • burning sensations
  • dull or aching pain
  • sharp or stabbing pain
  • tight or stiff muscles

More severe symptoms include:

  • a tingling sensation in the arms, chest, or legs
  • chest pain
  • incontinence
  • numbness
  • weakness
When to see a doctor

A person should see a doctor if they experience any of the symptoms for more than 3 days, especially if they do not respond to home remedies.

Symptoms of severe back pain that require prompt medical treatment include:

  • a tingling sensation in the arms, chest, or legs
  • chest pain
  • incontinence
  • numbness
  • weakness

People should seek immediate medical treatment for back symptoms following a fall, collision, or another injury.

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