The upper and middle back, known as the thoracic spine, is composed of 12 vertebrae with discs that separate each and absorb shock, and muscles and ligaments that hold the spine together.
Upper and middle back pain
can occur anywhere from the bottom of your rib cage up to the base of your neck. It is not as common as low back pain or neck pain as the vertebrae don’t flex or move as much as the bones in your lower back or neck. However, like many other types of back pain, upper and middle back pain can range from aching and stiffness to a sharp or burning sensation.
What causes upper and middle back pain?
Upper and middle back pain may be caused by:
Overuse of, or injury to, the muscles, ligaments and discs that make up the thoracic spine. Examples include a fall or jolting from a car accident, being hit hard in the back, lifting or carrying something too heavy, reaching to put objects on a high shelf, carrying a heavy backpack over just one shoulder,repetitive throwing, bending or twisting or even forceful coughing or sneezing can cause back muscle pain.
Poor posture. Slumping or slouching when you sit or stand, especially when using a computer for a long time.
Pressure on the spinal nerves from problems such as a herniated disc.
A fracture of one of the vertebrae.
Osteoarthritis from the breakdown of protective cartilage that cushions your facet joints in the spine. Often caused by the discs degenerating that results in the vertebrae grinding and wearing down.
Myofascial pain or muscular irritation of your connective tissue that protects and covers a muscle or group of muscles. This is often caused by overuse or deconditioning of these muscles.
How can I treat mild to moderate upper and middle back pain?
If you are looking for back pain solution to treat mild to moderate upper and middle back pain, in most cases, you’ll be able to manage it at home:
1. Exercise and stretches
Stretching and an active lifestyle are often recommended to help reduce back pain and speed the recovery process following an injury. Improving flexibility through stretching is also an excellent way to avoid future injuries¹.
As upper back pain is related to large muscles in the shoulder area, exercise to stretch and strengthen the muscles of your back, shoulders, and stomach are largely recommended. These muscles help support your spine. Exercise will also strengthen the muscle groups that support your mid-back to help relieve pain. Both specific exercises and stretches for this region together with general exercise, such as swimming, walking, cycling, are recommended. Strong muscles can help improve your posture, keep your body in better balance, decrease your chance of injury and reduce pain.
Regular yoga or Pilates sessions can also help relieve upper and middle back pain as they incorporate a number of positions and moves that use the upper and middle back muscles. Stretching exercises are best after a workout when your muscles are warmed up. You should take a break from exercise and stretching if your back hurts a lot, but try not to let too much time pass before you get moving again. Instead it’s good to return to your activities slowly.
2. Benefits of Movement
There are many benefits of exercising if you are experiencing upper and middle back pain. These include:
A reduction of muscle spasm and tension
Improved blood flow which will reduce inflammation and provide nutrients to the area in pain
Better soft tissue mobility
Increased confidence to complete everyday activities
A reduction in anxiety and emotional stress
After 10 minutes of exercise, the brain produces ‘happy chemicals’ that have a calming effect on nerves²
It’s best to speak to your doctor or physiotherapist about the kinds of exercises you can do to stretch and strengthen the muscles in your back, shoulders,and stomach.
3. Preventing upper and middle back pain through exercise
Back stretches when done on a regular basis will help prevent back pain. They support you in maintaining back mobility, joint health, sustaining good posture and keeping your discs moving and altering their position to minimise stress.
Exercising regularly will help keep weight gain and obesity at bay which can cause strain on the back and ultimately lead to back pain.
Over-the-counter pain medicines can reduce pain and swelling. Acetaminophen (for example, Tylenol) will provide pain relief. Nonsteroidal anti-inflammatorydrugs (NSAIDs) such as Ibuprofen, Aspirin and Motrin can reduce pain and swelling.
5. Ice or heat
Heat or ice is often used to reduce pain, stiffness and swelling in middle and upper back pain. Heat can reduce pain and stiffness whilst ice can help reduce pain and swelling.
6. Manual and physical therapy
Manual therapy includes massage or spinal manipulation. It helps reduce muscle tension and pain in the back and improve blood flow.
may use specific exercises combined with massage to relieve your upper and middle back pain. They will also advise you on exercises and stretches to do at home to aid relief of your pain and to offer support for this area.
Acupuncture involves putting tiny needles into your skin at certain points on the body to promote healing and pain relief. It can help relieve upper and middle back pain by concentrating on certain points on the back.
8. Practice good posture
Poor posture puts stress on your back
and can cause upper and middle back pain. Try to stand or sit tall, keeping your back as straight as possible and balance your weight evenly on both feet. Don't slump or slouch.
When sitting, keep your shoulders rolled back and be sure to adopt suitable positions when using computers and driving. For example if you spend a lot of time at a computer, at home and at work, make sure the screen is at eye level, never below and not too far away so that you have to reach to it. Again if you spend a long time in the car raise the steering wheel and sit closer to it
An uncomfortable position or uncomfortable bed while sleeping / at night could lead to upper and middle back pain or exacerbate the pain you’re experiencing. Try to find a comfortable sleeping position and use pillows to maintain this position whilst you’re asleep if needed. A relatively firm mattress may also be beneficial as a soft mattress doesn’t give your back proper support. According to the Sleep Council a mattress should be changed every 7 years³.
10. Learn ways to reduce stress
Stress can make your pain feel worse. Learning ways to reduce your stress may result in reduced pain. You could try deep breathing and relaxation exercises or meditation.
11. Stay positive
Although it can be difficult to be cheerful or optimistic if you are in pain, it’s important to stay positive because this can help you recover faster⁴.
How to relieve upper and middle back pain in pregnancy
Pregnancy can cause middle and upper back pain. Between 50 and 70 percent of pregnant women will experience back pain during pregnancy. The American Pregnancy Association (APA) states that back pain can manifest at any point during a pregnancy, although it usually occurs during the third trimester when the weight of the baby is approaching its maximum⁵. An increase in hormones that affect spinal ligaments, an altered centre of gravity that places excessive strain on back tissues, additional body weight, poor posture and increased stress are all factors of pregnancy related back pain.
Middle and upper back pain during pregnancy can interrupt your activities of daily living and cause restless sleep.
Exercise may offer relief if you suffer from middle and upper back pain in pregnancy. It’s advisable to get some advice from an antenatal exercise specialist who can tailor your exercise programme for your specific needs to support and help strengthen your back. You should avoid sleeping on your back.Try to sleep on your left side, and use a support pillow under your knees. A support belt under your abdomen may also help and make sure you get plenty of rest.
What to do if your pain gets worse
If your pain worsens and you’re finding it difficult to do daily activities you should consult your doctor. It may be that you may need to take a prescription pain medicine or have diagnostic tests to determine the cause of your pain. Your doctor may refer you to a Physiotherapist or an upper and middle back pain specialist. If surgery is required it usually involves removing what is causing the pain and then fusing the spine to control movement.
If you would like to read further orthopaedic blogs, don't hesitate to view our orthopaedics posts section
About back and spinal treatments at Ramsay Health Care
Ramsay Health Care offers a comprehensive range of diagnostic assessments and treatments for upper and middle back pain
including radiology services,osteopathy, physiotherapy, pain management clinics, rheumatology, injection therapies and surgery.
Our experienced health professionals including Chartered Physiotherapists
offer one to one advice for your tailored treatment and exercises plan to help relieve your upper and middle back pain.
Some of the highest qualified and experienced orthopaedic
, rheumatology and pain management consultants in the UK work with Ramsay Health Care to provide the best individual healthcare for your needs.
Please contact us
if you would like to discuss back pain solutions in more detail.