Middle back muscle pain

Middle back muscle pain is defined as pain of muscular origin, located in the thoracic spine territory. This territory extends from the base of the neck to the lower border of the rib cage and includes 12 spinal discs, T1-T12.

Vertebrae, ligaments and muscles are also present. The ligaments are the structures connecting the muscles to the bone and are of a different consistency than the latter.

The muscles located at the middle back are the rhomboids, lower trapezius, and middle trapezius. Injury at any of the aforementioned structures can lead to middle back pain.

Causes of middle back muscle pain

Middle back muscle pain can be the result of many and heterogeneous causes. It is usually a condition affecting older adults but can also appear in younger people in high risk, such as athletes. 

Potentially, middle back muscle pain can be due to the following:

Old Age

Old people are prone to pain, especially in the back. Potential causes include reduction of the fluid located in between the spinal joints, reduction of the bone density and muscle mass reduction.

These elements can appear naturally, in a degenerative manner without the presence of a profound disease. Less fluid between the spinal joints means less lubrication which leads to wearing of the bones when movement occurs.

Reduction of the muscle mass and bone density is mainly associated to the natural processes taking place in the aging human body. Bone loss, for example, is the result of calcium and phosphate reabsorption which an progressively lead to osteoporosis.

Calcium and phosphate reabsorption means that the bone loses its minerals instead of keeping them in its property. Osteoporosis is the condition resulting from excessive bone loss.

It is a quite common condition in the aging population and can affect the bone density of the middle back, leading to middle back pain. Muscle loss, or sarcopenia with aging, is closely related to the metabolic disturbances and nerve loss taking place in the aging human body.


Arthritis is a group of heterogeneous diseases affecting the joints. Some forms of arthritis can affect the back while others are related to the joints of the limbs.

The most common degenerative type of arthritis is Osteoarthritis. Osteoarthritis leads to bone wearing at the level of the joints, combined with swelling and stiffness.

A particular type of arthritis affecting the spine is Ankylosing Spondylitis. This condition causes pain and stiffness of the spine, interfering with the individual’s mobility and daily performance.

Fusion of the vertebrae happens later in time and this is when ankylosis begins. Ankylosis leads to severe pain and a fixed position. The pain associated with Ankylosing spondylitis is severe and deliberating. Its course is chronic and there is no definitive treatment.


Sports, car accidents or falls can occasionally lead to fractured vertebrae in the middle back. Except for exogenous forces responsible for bone fracture, degenerative diseases such as Osteoarthritis can lead to pathological fractures of the vertebrae.

Regardless the mechanism of the fracture, severe pain and discomfort are present. Pain is usually exacerbated with movement and needs immediate management.

In severe cases, middle back pain is associated with sensory neurological symptoms such as numbness or tingling, meaning that the spinal cord has also been affected.


Herniated discs area quite common cause of middle back pain. Discs are structures filled with liquid, located between the vertebrae. They have a supportive role and help a person move. When a disc ruptures or bulges outwards, a hernia is created. When pain starts abruptly and in the absence of any other medical reasons, a hernia is usually suspected. Individuals regularly lifting weight are prone to present with a herniated disc, accompanied with middle back pain.

Muscle strain

Muscle strain or sprain, usually affecting the rhomboid muscles, can lead to middle back muscle pain. It is most commonly due to overuse of the arms or shoulders. This condition is quite prevalent among athletes, typically tennis players or those overusing their upper body. It can be prevented by correct and prolonged warm up and treated by resting and stretching. Muscle strain or sprain can result from incorrect posture too, especially in those required to work in a particular position, for example in front of a computer.

Bad posture and Scoliosis

Poor posture is closely related to strained muscles and, therefore, middle back pain. It is a quite common condition that usually results from prolonged posture in an incorrect manner. Poor posture in the long term can lead to a condition called Scoliosis. Scoliosis is the curving of the spine, resulting in imbalanced muscle work load. Thus, some muscles practically work more to balance with the permanent poor posture, finally leading to back pain. Scoliosis, however, is not irreversible. Special bracing are available and can reverse Scoliosis, especially in the young population.

Benign or malignant tumors

Whether benign or malignant, tumors can be the cause of middle back pain. Tumors are usually not painful themselves. What causes pain, is the compression of other structures by the tumor. Nerves, muscles and ligaments compression can lead to severe middle back pain. The solution for this type of middle back pain is the correct management of the tumor which is usually surgical. If malignant, these tumors are usually accompanied by other symptoms and signs, evident by clinical and paraclinical examination.

Middle back pain symptoms

Symptoms of middle back pain are usually relevant to the particular condition causing the pain in the first place. In other words, middle back pain can appear alone or together with symptoms of neurological origin, such as numbness or tingling.

In other occasions, pain can be accompanied by prominent signs such as a tumor. Moreover, the nature of the pain may vary as well, according to the primary condition causing the pain. Some conditions result in dull pain while others in stabbing pain. A burning sensation has been observed as well. Severe symptoms may include chest pain, numbness or weakness of the limbs and bowel or bladder incontinence.

Useful tests

Middle back pain is a subjective symptom. The patient claims to suffer from middle back pain but the physician cannot actively assess the pain.

However, there are some medical tests that could help establish the origin of the pain. These include imaging tests together with neurological clinical examination.

Neurological examination assess the function of the cranial and peripheral nerves. Imaging helps establish what’s going on inside your body, revealing possible fractures or tumors. X-ray, ultrasound, CT and MRI scan are some useful imaging tests, sometimes necessary to establish the correct diagnosis.

Middle back pain treatment

Middle back pain treatment is based on the condition causing the pain. However, most people try to manage middle back pain by home remedies, finally turning to traditional medicine if the pain persists.

The cornerstone of home-managing middle back pain is applying ice to achieve immediate relief. Stretching and back muscles strengthening is also recommended, especially in strains or sprains of the middle-back muscles. If the pain is unbearable, consult your doctor to provide you with pain-relief medication such as Ibuprofen.

Prevention of middle back pain consists in avoiding activities that could result in overuse of the muscles. Respecting the correct instructions regarding driving safety could prevent minor accidents and potential vertebrae fractures. Muscle warm up before any virtuous activity is also recommended. Finally, correct posture while sitting on a chair is mandatory.

Medical treatments are classified as pharmacological and non-pharmacological. The non-pharmacological treatments include physiotherapy and chiropractic care, which is a form of alternative medicine.

Pharmacological treatments are based on pain-relief medication such as Ibuprofen and steroids injection. Surgical treatments are invasive techniques, usually preferred over conservative treatments when the pain is persistent or treatment-resistant.

Surgical treatments vary and your doctor will choose the correct surgery for you depending on the cause of the pain. Laminectomy, laminotomy and diskectomy are some examples of surgery, together with herniotomy in case of herniated disc.

In conclusion, middle back pain is a quite prevalent condition. It is not as common as lower back pain, but it still bothers many and different categories of people, including athletes, people working in front of a desk, or others required to put physical effort and strength to make their work efficient.

What makes middle back pain so common, is the heterogeneity regarding its causes, varying from traumatic, to organic or even cancerous. Preventing middle back muscle pain is an essential procedure.

Treatment, finally, depends on the severity of the pain and the particular condition producing the pain. In some cases, home remedies are sufficient while in other, pharmacological treatment or physiotherapy is mandatory.

When the pain is severe, persistent or treatment-resistant, surgery is recommended. Middle back muscle pain should not be ignored as it may be the only sign of a serious condition such as a malignant tumor.

When the pain is accompanied by other atypical symptoms including different body territories, the cause should be carefully assessed. However, most of the conditions causing middle back pain are manageable and heal completely in time.

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