Upper & Middle Back Pain

Upper & Middle Back Pain

Upper back pain or middle back pain—also known as thoracic pain—is much less common than neck pain or low back pain. While the cervical spine (neck) and lumbar spine (lower back) are designed to provide mobility, the thoracic spine is designed for stability. It provides the strength to let us stand upright, and it protects the vital organs in the chest. Because there is only limited movement in this part of the spine, it is less likely to be injured or to experience degeneration over time.

Common Causes of Upper & Middle Back Pain

Most cases of upper and middle back pain are caused by:

  • overuse injuries either from repetitive motions (e.g., performing the same task on an assembly line) or from remaining in an improper position for too long (e.g., bending over to work on something close to the ground)
  • muscle strain
  • injury to the muscles, ligaments, and discs that support the spine
  • poor posture
  • prolonged sitting at a computer
  • using a backpack
  • myofascial pain that affects connective tissues within muscle groups
  • conditions that put pressure on the spinal nerves in the upper and middle back (such as thoracic outlet syndrome)

Thoracic Outlet Syndrome

Thoracic outlet syndrome is a condition caused by the compression (squeezing) of nerves or blood vessels—or both—because the passageway they travel through between the base of the neck and the armpit (known as the thoracic outlet) is too narrow.

The thoracic outlet is surrounded by muscle, bone, and other tissues. Conditions that cause the structures around the thoracic outlet to move or to become enlarged can cause the passageway to narrow, compressing the nerves and blood vessels and causing pain. This can result from a number of situations including weight gain, muscle enlargement due to weight lifting, or a tumour at the top of the lung (rare). Often no specific cause is found.

Risk Factors for Upper & Middle Back Pain

While thoracic back pain can affect anyone, some people are more likely to suffer from it than others. Among the factors that increase the risk are:

  • age 40 years and over
  • poor posture
  • poor physical condition
  • lack of exercise, excessive sitting
  • physical deformities such as scoliosis (a sideways curvature of the spine) or kyphosis (a backward curve of the spine that forms a hunchback)
  • doing heavy physical labour
  • history of prior injury

Treating Upper & Middle Back Pain

About 90% of the time upper and middle back pain will start to get better within two weeks of keeping the area mobile (avoiding excessive rest), doing special exercises, and taking a pain reliever.

Even though most upper and middle back pain is due to a minor problem, there are some signs that point to the possibility of a more serious underlying cause. Medical attention should be sought if:

  • the pain follows a recent infection
  • the pain is accompanied by a fever of 37.8° C (100° F) or higher
  • the pain occurs after unexplained weight loss
  • the pain sufferer is an IV drug user

The following conditions signal the need for emergency care:

  • weakness or paralysis
  • loss of bowel or bladder control
  • prior history of cancer
  • recent trauma (for example, a car accident or a fall from a significant height)

If conservative measures (exercising and taking a pain reliever) don't relieve your upper or middle back pain within a couple of weeks, see your doctor to rule out a more serious underlying cause of your pain.