How to Prevent and Treat Middle Back Pain, According to Physical Therapists

When we talk about back pain, low back pain usually hogs the spotlight. But your low back isn’t the only place you may have discomfort. You can also experience middle back pain, caused by many common issues, including injury, arthritis, or other spine-related changes.

Your thoracic spine — the middle of your back — lies between the vertebrae in your low back and your upper back. You need your middle back to be strong and flexible in order to perform lots of daily activities, from washing your hair and reaching a high shelf to sitting and lying down comfortably. If you have middle back pain, you may notice that doing these things is more difficult. 

“Moving and putting force through your postural muscles, the area around your shoulder blades, can be hard if the middle back is irritated,” says Courteney Kemp, PT, DPT, a physical therapist at Hinge Health.

Read on to learn more about what causes middle back pain, along with how to prevent and treat it — especially with exercises recommended by our Hinge Health physical therapists.

Causes of Middle Back Pain 

Lots of factors can contribute to middle back pain. Some of the most common causes are: 

• Muscle strain or sprain. Your back is strong and designed to lift things. But if you lift when you are tired, lift with an awkward position, or lift more weight than you are ready for, you can increase the risk for a new episode of middle back pain.

• Falls. Falling or losing your balance can cause injuries throughout the body, including your back depending on how you land.

• Osteoarthritis. It’s very normal for your spine to change as you get older, resulting in osteoarthritis. Forms of inflammatory arthritis, such as rheumatoid arthritis or ankylosing spondylitis, can also cause pain and stiffness in your middle back. 

• Herniated disc. This occurs when the center of one (or more) of the flat, round discs — which are located between vertebrae in the spine and act as shock absorbers — pushes against its outer ring. This can sometimes cause pain anywhere along the spine, including in your middle back.

• Scoliosis. This condition causes the spine to curve sideways. When weight is distributed unevenly in your back, it’s possible to have pain throughout the back, including the thoracic spine. 

• Postural issues. While there's no such thing as the perfect posture, lack of postural variety can make you achy. When you stay in the same position for a long time — whether you’re standing, sitting straight as a pin, or slumped over your laptop — it can make you uncomfortable, which can contribute to middle back pain.

• Spinal stenosis. With spinal stenosis, your spinal canal narrows, which can create pressure on the spinal cord or surrounding nerves. This can result in pain and weakness.

• Everyday activities. It’s very common, Dr. Kemp says, for everyday routines to impact the middle back. “Staying in the same position too long, repetitive activities like bending over a lot, or basic loss of strength in the middle back can result in pain and stiffness,” she says.

Symptoms of Middle Back Pain 

Middle back pain can cause several uncomfortable symptoms, such as: 

• Pain 

• Tenderness

• Tension

• Limited mobility 

• Stiffness 

You may notice that these symptoms bother you more when you’re standing or sitting for a long period of time, when you’re performing reaching motions with your arms, or you’re carrying something heavy, such as a backpack or groceries.

In rare cases, middle back pain can stem from other medical conditions. If you experience numbness or tingling going down your legs, chest pain, or changes in your bowel or bladder control, talk to your medical provider.

While many different remedies can help middle back pain, Dr. Kemp says movement, especially exercises that focus on stretching and strengthening, is one of the best ways to relieve — and prevent — middle back pain. The above exercises recommended by Hinge Health physical therapists are a great place to start. “Mobility is an important part of relieving middle back pain, but you also need to strengthen your muscles to better support your posture in the long term,” says Dr. Kemp.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Middle Back Pain Treatment Options

In most cases, mild to moderate symptoms of middle back pain can be treated at home, or without medical intervention. Depending on the cause, the following remedies may help improve your pain: 

• Physical therapy. Keeping up with regular, gentle exercise can help ease pain relief. A physical therapist (PT) can recommend exercises that stretch and strengthen middle back muscles, like the ones above, to help relieve muscle tension and promote better spine support. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Adjust your position. Staying in the same position for too long can cause tension and stiffness. Dr. Kemp recommends changing positions frequently if you sit at a desk. “Set an alarm for every 45 minutes to take a minute to do stretches that feel good, so you reset your postural muscles,” she says.

• Over-the-counter pain medications. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for middle back pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Heat or ice. While ice can help with swelling from a back injury, heat can help to loosen tight muscles in your middle back. Either heat or ice can be a good option if you’re experiencing discomfort in your middle back. 

• Massage therapy. Getting a massage from a licensed massage therapist can help soothe the tense muscles in your middle back, potentially reducing pain, which may make it easier to engage in strengthening exercises. 

Although moving through back pain can seem scary and uncomfortable, small changes to your habits can yield huge benefits. No matter how bad your middle back pain is, or how long it’s been going on, you can always do something to help improve it. And that usually starts with moving more. Mobility and strengthening exercises, as well as regular exercise, can help with back pain long term so you can keep up with all the activities you enjoy. 

How to Prevent Middle Back Pain

When it comes to middle back pain, you can take steps to prevent it from interfering with your life. 

• Change up your sleeping position. If you are waking in the middle of the night with back pain or you have more pain in the morning than later in the day, try lying on your side in the fetal position. Dr. Kemp suggests putting a pillow between your legs. You can also try sleeping on your back. 

• Optimize your workspace. Try to set up your workspace so it’s comfortable for you and allows you to change positions frequently, whether you invest in a standing desk or a chair you like. 

• Manage your stress levels. Stress can increase our perception of pain. “If you’re stressed and your back already hurts, it could hurt more,” Dr. Kemp says. To reduce your stress levels, try incorporating more exercise and mindfulness practices — like diaphragmatic breathing — into your routine. 

• Practice safe lifting techniques. While lifting heavy objects is rarely the primary cause of back pain, there are things you can do that may help prevent pain flares, like warming up first, keeping heavy objects close to your body when you pick them up, being intentional about body position, and carrying items at hip height to minimize stress on the body.

• Strengthen your core. Research that shows increased core strength improves back pain. Combining core-strengthening exercises with total body and endurance exercises can help prevent middle back pain from occurring or worsening.  

• Try foam rolling. Foam rolling uses a foam tube to help relieve back muscle tightness and soreness in the middle back. It applies pressure to areas that are tight, helping to release them.

• Take breaks from sitting. Sitting for a long time without changing positions can contribute to muscle fatigue, which can cause pain in your middle back. Adding simple movement snacks into your day if you sit a lot can help reduce stiffness and tension. 

PT Tip: Try a Towel for More Support 

Supporting your lumbar spine, or the base of your back, can help with pain throughout the back. Dr. Kemp recommends rolling a hand towel and putting it sideways across your low back when you sit to support the natural curve of your spine. “Then, the rest of your spine will stack nicely, which can help reduce pain in your middle back and neck,” she says. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Johansson, M. S., Jensen Stochkendahl, M., Hartvigsen, J., Boyle, E., & Cassidy, J. D. (2016). Incidence and prognosis of mid-back pain in the general population: A systematic review. European Journal of Pain, 21(1), 20–28. doi:10.1002/ejp.884

3. Hey, L.A. July 14, 2023. Scoliosis in the adult. UpToDate. https://www.uptodate.com/contents/scoliosis-in-the-adult

4. El Sayed, M., & Callahan, A. L. August 8, 2023. Mechanical Back Strain. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542314/ 

5. Cho, H., Kim, E., & Kim, J. (2014). Effects of the CORE Exercise Program on Pain and Active Range of Motion in Patients with Chronic Low Back Pain. Journal of Physical Therapy Science, 26(8), 1237–1240. doi:10.1589/jpts.26.1237