When we talk about back pain, low back pain usually hogs the spotlight since it’s so common. But your low back isn’t the only place you may have discomfort. You can also experience it in the middle of your back.

Your thoracic spine — the middle of your back — lies between the vertebrae in your low back and your neck. You need your middle back to be strong and flexible in order to perform lots of daily activities, from washing your hair to reaching a high shelf to sitting and lying down comfortably. 

On the flipside, 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.

Depending on the cause of your middle back pain, it’s usually possible to manage your symptoms on your own with conservative, at-home measures. 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.

Middle Back Pain: A Hinge Health Perspective

Back pain can feel frustrating, upsetting, or even a little hopeless, especially when it persists or interferes with your daily activities. No matter how bad your 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. 

Although moving through back pain can seem scary and uncomfortable, small changes to your habits can yield huge benefits. And no matter what might be contributing to your back pain (which we’ll discuss below), you're in the right place to get support for dealing with it.

Causes of Middle Back Pain 

Lots of factors can contribute to middle back pain. Some of the most common 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 posture with an object not close to your body, or lift more weight than you are ready for, you can increase the risk for a new episode of back pain.

• 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 the 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.

• 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 use 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 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, Dr. Kemp recommends talking to your medical provider. 

Treatment Options for Middle Back Pain 

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: 

• Gentle movement. Exercises that stretch and strengthen your middle back muscles can help relieve muscle tension and promote better spine support.

• Adjusting 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.

Work with a physical therapist. A physical therapist can help you understand what may be contributing to your middle back pain and manage it with exercises, like the ones below, to improve your flexibility and strength. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

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.

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, your sleep position could be playing a role. If you lie on your side in the fetal position, Dr. Kemp suggests putting a pillow between your legs, or sleeping on your back. You can also open your chest by leaning on a pillow behind your back when you’re sleeping on your side. 

• 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 feel like it hurts more,” Dr. Kemp says. To reduce your stress levels, try incorporating more exercise into your routine. Meditation and breathing activities can also help relieve tension around your ribs and middle back, which help support your lung function. 

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

1. Casiano, V., & De, N. February 20, 2023. Back Pain. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538173/ 

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/