Upper Middle Back Pain – Causes, Treatment, and Prevention

Upper Middle Back Pain - Causes, Treatment, and Prevention

Upper middle back pain, also known as thoracic back pain, can be a distressing condition that affects many individuals. It occurs in the area between the cervical spine (neck) and the lumbar spine (lower back) and can be caused by various factors. Understanding the causes, symptoms, and treatment options for upper middle back pain is crucial for finding relief and improving overall spinal health.

Understanding the Anatomy of the Upper Middle Back

Understanding the Anatomy of the Upper Middle Back

The upper middle back, also known as the thoracic region or thoracic spine, is a crucial part of the vertebral column. It is situated between the cervical spine (neck) and the lumbar spine (lower back). The thoracic spine consists of twelve vertebrae, labeled T1 to T12, and plays a vital role in providing structural support, protecting the spinal cord, and facilitating various movements of the upper body.

Let’s explore the anatomy of the upper middle back:

  • Thoracic Vertebrae: The thoracic spine is composed of 12 vertebrae, each numbered T1 to T12. These vertebrae increase in size from T1 to T12 as they go down the spine. The uppermost thoracic vertebra, T1, connects to the last cervical vertebra (C7) while the lowermost thoracic vertebra, T12, connects to the first lumbar vertebra (L1).
  • Intervertebral Discs: Between each pair of thoracic vertebrae, there is an intervertebral disc. These discs act as shock absorbers and allow slight movement between adjacent vertebrae, enabling flexibility and preventing the vertebrae from grinding against each other.

Nerve Connections in the Upper Middle Back

The nerve connections in the upper middle back, also known as the thoracic region or thoracic spine, are integral to transmitting sensory and motor signals between the spinal cord and various structures in the upper body. The nerves in this area are responsible for providing innervation to the muscles, skin, and organs within the thoracic region.

  • Spinal Nerves: At each level of the thoracic spine, a pair of spinal nerves emerge from the spinal cord through spaces between adjacent vertebrae. There are 12 pairs of thoracic spinal nerves, labeled T1 to T12, corresponding to the 12 thoracic vertebrae. These nerves contain both sensory and motor fibers.
  • Sensory Nerves: The sensory fibers of the thoracic spinal nerves carry information from the skin and other structures in the upper middle back to the spinal cord and eventually to the brain. These sensory nerves are responsible for detecting sensations like touch, pain, temperature, and pressure in the thoracic region.
  • Intercostal Nerves: Between each pair of adjacent ribs, there is an intercostal nerve. These nerves run along the spaces between the ribs and are critical for providing sensation to the skin, muscles, and other structures of the chest wall and upper abdomen.
  • Motor Nerves: The motor fibers of the thoracic spinal nerves control the muscles of the upper back, chest, and abdomen. They are responsible for initiating and coordinating muscle contractions, allowing various movements like breathing, trunk rotation, and stabilization of the spine.

Typical Symptoms of Upper Middle Back Pain

Typical Symptoms of Upper Middle Back Pain

Upper middle back pain, also known as thoracic back pain, can manifest with various symptoms that may range in intensity and duration. These symptoms can vary depending on the underlying cause of the pain. Some typical symptoms of upper middle back pain include:

  • Localized Pain: Pain is usually felt in the upper back region between the shoulder blades. It may be described as a dull ache, a sharp stabbing sensation, or a constant discomfort.
  • Tenderness to Touch: The affected area may be sensitive to touch, and pressing on the painful spot can worsen the discomfort.
  • Stiffness: The upper middle back may feel stiff, limiting your ability to move the neck, shoulders, or back freely.
  • Radiating Pain: In some cases, the pain can radiate outward from the upper back to the sides, chest, or abdomen.
  • Muscle Spasms: Muscles in the upper back may go into involuntary spasms, causing additional pain and discomfort.
  • Limited Range of Motion: Pain and stiffness can lead to a reduced range of motion in the neck, shoulders, and upper back.
  • Pain with Movement: Certain movements, such as bending, twisting, or lifting, may exacerbate the pain.
  • Pain with Breathing: Deep breathing or coughing may trigger or worsen the pain, especially if there is an involvement of the ribs or intercostal muscles.

Common Causes of Upper Middle Back Pain

Upper middle back pain can be because of various factors, ranging from musculoskeletal issues to underlying medical conditions. Here are some common causes of upper middle back pain:

  • Muscle Strain: Straining or overusing the muscles in the upper back, often due to poor posture, lifting heavy objects, or repetitive movements, can lead to muscle inflammation and pain.
  • Joint Dysfunction: Dysfunction or misalignment of the facet joints that connect the vertebrae in the upper back can cause pain and limited mobility.
  • Intervertebral Disc Problems: Disc-related issues, such as herniated discs or degenerative disc disease, can irritate nearby nerves and cause upper middle back pain.
  • Postural Problems: Poor posture, such as slouching or hunching over a desk or computer for extended periods, can strain the muscles and ligaments in the upper back, leading to pain.
  • Spinal Stenosis: Spinal stenosis is a condition where the spinal canal narrows, potentially compressing the spinal cord or nerve roots and causing pain.
  • Osteoarthritis: Degeneration of the joints and cartilage in the thoracic spine due to aging or wear and tear can result in osteoarthritis, leading to pain and stiffness.

Diagnosis of Upper Middle Back Pain

The goal is to identify the underlying cause of the pain to provide appropriate treatment. Here’s an overview of the diagnostic process for upper middle back pain:

  • Medical History: The healthcare provider will start by asking about your symptoms, the location, duration, and intensity of the pain, any factors that aggravate or alleviate the pain, and any relevant medical history or previous injuries.
  • Physical Examination: A thorough physical examination will help to assess your posture, range of motion, muscle strength, and any areas of tenderness or swelling in the upper back. The doctor may also examine other parts of your body to check for referred pain.
  • Neurological Examination: If there are any indications of nerve involvement, a neurological examination may be conducted to assess reflexes, sensation, and muscle function.

Treatment Options for Upper Middle Back Pain

Treatment Options for Upper Middle Back Pain

The treatment for upper middle back pain depends on the underlying cause of the pain. Here are some common treatment options that healthcare providers may recommend:

  • Rest and Activity Modification: For mild cases of upper middle back pain due to muscle strains or overuse, rest and avoiding activities that exacerbate the pain can be beneficial.
  • Physical Therapy: A physical therapist can design a personalized exercise program to strengthen the muscles in the upper back, improve flexibility, and correct posture. Physical therapy can also include manual techniques and modalities to reduce pain and inflammation.
  • Pain Medications: Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can help alleviate pain and reduce inflammation.
  • Topical Analgesics: Creams or patches containing topical analgesics, such as menthol or capsaicin, can provide localized pain relief.
  • Heat or Ice Therapy: Applying heat or ice packs to the affected area may help reduce pain and muscle spasms. Heat is generally more suitable for chronic pain, while ice is more beneficial for acute injuries.

Myths and Misconceptions about Upper Middle Back Pain

Here are some common myths and misconceptions about upper middle back pain:

Myth: Upper middle back pain is always caused by a serious medical condition.

    • Reality: While upper middle back pain can sometimes be associated with serious conditions, such as spinal fractures or tumors, the majority of cases are caused by more benign factors like muscle strains or poor posture. It’s essential to get a proper evaluation from a healthcare professional to determine the underlying cause.

Myth: Rest is the best treatment for upper middle back pain.

    • Reality: While some rest can be beneficial for acute injuries or muscle strains, prolonged bed rest is generally not recommended for most cases of upper middle back pain. Gentle exercises and movements, as guided by a healthcare professional, can help improve flexibility and strength and promote healing.

Exercises and Stretches for Upper Middle Back Pain Relief

Exercises and stretches can help relieve upper middle back pain and improve flexibility and strength in the area. Here are some exercises and stretches that you can try:

Thoracic Extension Stretch:

    • Sit or stand with your back straight.
    • Place your hands behind your head, interlocking your fingers.
    • Gently arch your upper back backward, looking up towards the ceiling.
    • Hold the stretch for 15-30 seconds, then return to the starting position.
    • Repeat the stretch 5-10 times.

Upper Back Foam Rolling:

    • Lie on your back with a foam roller placed horizontally beneath your upper back.
    • Support your head with your hands, crossing your arms in front of you.
    • Slowly roll your upper back along the foam roller, from the base of your neck to the middle of your back.
    • Pause on any tender spots and apply gentle pressure.
    • Roll back and forth for about 1-2 minutes.


Upper middle back pain is a common issue that can significantly impact one’s quality of life. By understanding its causes, symptoms, and treatment options, individuals can take proactive steps to find relief and enhance their overall spinal health. Seeking medical attention when needed and making lifestyle changes to prevent future pain are essential aspects of managing upper middle back pain effectively.

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