Are You Experiencing
Middle Back Pain?

Not understanding the cause can be unsettling. Middle back pain can come from a number of different sources. Understanding the source is the first step in finding relief. Learn more about what could be causing your pain and most importantly, what to do about it.



Middle Back Anatomy

The region of the middle back is called the thoracic spine. The thoracic spine is located below the cervical spine and above the lumbar spine and is comprised of 12 bony vertebrae. The vertebrae function to protect the spinal cord that runs through the spinal column. Attached to the vertebrae on either side are the ribs. Each vertebra is separated by discs that help to cushion and assist in providing movement throughout the spine.

In addition to the bony components of the mid back, numerous soft tissue components also make up the middle back. Nerve roots exit between the each vertebrae. The nerves in the region of the thoracic spine help supply sensation to the area, assist in providing impulses for muscle activity, and include the sympathetic nervous system that function to help regulate organs including the stomach, heart, lungs and kidneys.

middle back pain


The middle back region also contains numerous muscles. The muscles that are deep are generally short and work to provide spinal stability. The more superficial muscles are generally longer and assist in providing movement of the spine and arms. Muscles also attach from the thoracic spine to the shoulder blade or scapula and assist in providing stability for the shoulder girdle.


Sources of Middle Back Pain

Because of the complexity of the anatomy in the mid back region, the sources of pain can be numerous. Middle back pain can be caused by local structures such as discs, muscles, bones, and nerves but can also be referred pain. Referred pain is when the cause or source of the pain is other than where the pain is felt. A common example of referred pain is with the heart. A person having a heart attack may feel no chest pain at all but could experience left arm pain.

Organs that can cause mid back pain include the kidneys, heart, lungs, or the upper digestive tract. Even people that are suffering from acid reflux can complain of mid back pain.

The good news is that a majority of middle back pain is due to musculoskeletal causes or the bones, discs, muscles, and ligaments. Some of the more common issues associated with the mid back include:


• Degenerative Disc Disease (DDD)
• Bulging Discs
• Facet joint pain
• Pinched nerves
• Muscle spasms
• Compression fractures

Another potential source of mid back pain comes from the neck. The facet joints f the lower cervical spine (C5-C7) will commonly create middle back pain. Specifically pain along the inside aspect of the shoulder blade (scapula) and/or between the shoulder blades can be referred pain from the lower cervical facet joints.


Mid Back Pain Diagnosis

With all these potential different sources of mid back pain, how is the cause of the pain determined? The best doctor for determining the cause of your middle back pain is an orthopedic physician. The first step is to obtain a detailed history of your symptoms. It is important that you provide accurate information to help your doctor determine the nature of your pain. Important things to consider include:

• Is the pain at rest or only with movement?
• Are there certain positions or postures that recreate your pain?
• Does the pain keep you up at night?
• Does it hurt to cough or sneeze?
• Is there pain when taking a deep breath?

After taking a subjective history as to how long, when, and the quality of your symptoms, a physical exam should be performed. A thorough mid back exam should include testing the range of motion of the neck, shoulder, and mid back region. Pain Strength testing of the shoulder may also be part of the exam. with movement of any one of these regions will help your doctor determine the source of your pain.

As part of the physical exam, images may be taken. X-rays are the most common scans performed but only show bone thus an x-ray can only indicate if bone (such as a fracture) is the cause of the pain. The only means of determining if a disc, facet joint, or nerve root is the cause is by obtaining an MRI. Another test that may be indicated is a bone density test. If an x-ray indicates a compression fracture, determining your bone density will be important in determining the best ongoing treatment.


Treatment for Mid Back Pain

The best treatment is of course based on the specific cause of the pain. As most middle back pain is related to muscles/joints/bones, some typical treatment recommendations can be given. As with all musculoskeletal pain, the use of ice (not heat) is an important treatment choice. Apply ice to the region of pain for 10 to 15 minutes a few times a day. If your mid back pain is reproduced by any neck movements, also make sure to ice the lower neck region.

To reduce inflammation that is generally associated with musculoskeletal pain, anti-inflammatory medication can also be helpful. Consult your doctor for what specific type of anti-inflammatory medication would be best for you but common choices include Advil, Aleve, and Celebrex. In some cases, then oral anti-inflammatory medication is not effective, epidural injections can be an effective and appropriate treatment option.

Physical therapy can also be helpful in reducing middle back pain. Modalities including electric stimulation and ultrasound may be helpful in decreasing pain and promoting healing. Soft tissue massage and joint mobilizations can help to restore normal joint and tissue mobility. And exercises including stretching and strengthening can help to restore normal function.


Summary

• Middle back pain can be caused by a number of different sources including: organs, joints, nerves, discs, bones, and muscles.

• Mid back pain can be frequently associated with the lower cervical spine.

• A thorough exam should include a detailed history and physical exam including range of motion testing and possibly scans.

• As most mid back issues are musculoskeletal in nature, treatment generally involves ice, anti-inflammatory medication, and physical therapy.

Middle back pain can have a number of different causes. If your mid back pain last more than a few weeks, consider seeking medical treatment.



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References

Pain Pract. 2010 Jul-Aug;10(4):327-38. Epub 2010 May 12.10. Thoracic pain.van Kleef M, Stolker RJ, Lataster A, Geurts J, Benzon HT, Mekhail N.

Pain Physician. 2008 Sep-Oct;11(5):611-29.Systematic review of diagnostic utility and therapeutic effectiveness of thoracic facet joint interventions.Atluri S, Datta S, Falco FJ, Lee M.

BMC Musculoskelet Disord. 2009 Jun 29;10:77.Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review.Briggs AM, Smith AJ, Straker LM, Bragge P.