In short
Middle back pain usually comes from strained muscles or irritated joints in the thoracic spine and settles with movement and time. Because it’s less common than lower back pain, constant middle back pain, pain that wakes you at night, or pain with fever, weight loss or chest symptoms should be checked.
On this page
Where is the middle back?
The middle back sits between the bottom of the neck and the top of the lower back, roughly behind the ribcage and below the shoulder blades. It is part of the thoracic spine. The ribcage makes this part of the spine more stable than the neck or lower back, which is one reason pain here is less common.
Common causes
- Muscle strain, from lifting, twisting, sport or a sudden movement.
- Sustained postures, such as long hours at a desk, driving or looking down at a phone.
- Joint irritation, where the ribs meet the spine. This can cause sharp pain that catches on deep breaths or twisting.
- Disc problems, which are much less common in the middle back than in the neck or lower back.
- Bone thinning. In people with osteoporosis, a small fracture of a vertebra can cause sudden middle back pain after little or no injury.
Pain that isn’t settling?
Talk it through with an Australian doctor online. No referral needed.
Pain that might be coming from somewhere else
Organs in the chest and upper abdomen can refer pain to the middle back, including the heart, lungs, stomach, pancreas, gallbladder and kidneys. Shingles can also start with burning pain in a band around one side before a rash appears. See upper back pain for more on these.
What helps
- Stay active and keep moving within comfort.
- Gentle rotations and stretches for the upper and middle back.
- Heat for muscle tension.
- Breaks from sitting, and a look at your work set-up.
- A physiotherapist can help if pain keeps coming back.
When to see a doctor
Most middle back pain settles within a few weeks. See a GP if it doesn’t, or if you have:
- constant pain that doesn’t change with movement or position, or wakes you at night
- fever, sweats or unexplained weight loss
- a history of cancer or osteoporosis
- pain after a fall or accident
- numbness, weakness or changes in walking
Call 000 if middle back pain comes with chest pain, breathlessness, sweating or collapse, or starts suddenly and severely.
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- Briggs AM, Smith AJ, Straker LM, et al. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77.
- Finucane LM, Downie A, Mercer C, et al. International Framework for Red Flags for Potential Serious Spinal Pathologies. J Orthop Sports Phys Ther. 2020;50(7):350-372.
- Downie A, Williams CM, Henschke N, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ. 2013;347:f7095.
- healthdirect. Back pain.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.