Mid Back and Upper Back Pain Overview
Mid back pain (thoracic pain) is very common throughout life. Most of us can expect to experience mid back pain at some point during our lives. Pain in the mid back, also known as the thoracic spine, is typically from a joint or muscle problem; however, it can be associated with more serious problems. For this reason, just like neck or low back, intense or persistent thoracic pain should be investigated by a chiropractor or physiotherapist. Furthermore, thoracic pain is prevalent amongst healthy individuals without any underlying serious issue.
Mid back epidemiology
In general terms, it is estimated that about 2-25% of the population will experience thoracic pain in their lifetime. In children, the risk of developing thoracic pain seems to be determined by the amount of sitting the child is doing, weight of backpacks when carried with poor technique and certain sport participation. Girls are more likely to get thoracic pain as opposed to boys. In adults, having thoracic pain seems to increase the likelihood of other musculoskeletal conditions (muscle and joints issues).
Mid back pain symptoms
The most common symptoms of thoracic pain is dull pain located between the shoulder blades that is usually worse on bending movements and twisting movements. Sometimes the pain will be worse on deep breathing; however, if this is the case, it is important to see a chiropractor or physiotherapist to make sure the pain is mechanical and not coming from structures like your lungs, gallbladder or stomach. The presentation of symptoms really does depend on the underlying cause.
Mid back pain causes
The mid and upper back comprise many anatomical structures such as muscles, bones, joints, nerves, intervertebral discs and even our internal organs. Therefore, pain arising from these areas can be caused by a multitude of conditions. The term mid and upper back pain is very unspecific. Broadly speaking, mid and upper back pain can be caused by the following categories:
- Musculoskeletal. Overuse, muscle strain, or injury to the muscles, ligaments, intervertebral discs (i.e., disc herniation) and other soft tissue structures that support your spine.
- Postural loading. This also fits into the musculoskeletal group and is explained by sustained poor posture, including forward head carriage and increased thoracic kyphosis, which can fatigue muscles overtime leading to pain and stiffness.
- Fracture and dislocations. A fracture or dislocation of one of the spinal bones called vertebrae.
- Degenerative and autoimmune diseases. These include osteoarthritis, osteoporosis, psoriatic arthritis, ankylosing spondylitis and rheumatoid arthritis.
- Myofascial pain. Myofascial pain that affects the connective tissue of a muscle or group of muscles, such as fibromyalgia and chronic fatigue syndrome.
- Red flags. These are conditions which raise alarms in clinicians and often require immediate medical intervention. These are quite rare affecting approximately 1% of the population. They include visceral referral from for example gallbladder or stomach disease, cancers, or infections.
The following conditions are the most common causes of mid and upper back pain:
- Muscle pain
- Joint pain
- Thoracic myelopathy
- Thoracic spine trauma
- Thoracic osteophytes
- Thoracic bone Spurs
- Thoracic spine stenosis
- Thoracic degenerative disc disease
- Thoracic disc herniation
- Thoracic arthritis
- Thoracic foraminal stenosis
- Thoracic pinched nerve
- Thoracic facet syndrome
- Thoracic facet joint pain
- Thoracic disc bulge
- Thoracic disc protrusion
- Thoracic spondylosis
- Thoracic spondyloarthropathies
- Thoracic radiculopathy
- Thoracic discogenic pain
- Acute mid back pain
- Chronic mid back pain
- Stiff mid back
- Thoracic spine tumour
- Upper back arthritis
What you should expect from your consultation
It is worth having any thoracic pain looked at by an experienced chiropractor or physiotherapist. To identify the cause of thoracic pain we typically will go through the following questions on the initial consultation to successfully identify the cause of the thoracic pain.
- Medical profile. Here we look at your medical history for conditions or factors that may have contributed to your thoracic pain
- Pain profile. We will ask you about the location of your pain, radiation of pain, and factors or activities that increase or reduce your pain
- Joint profile. We will ask questions regarding how your thoracic moves into different directions such as bending, twisting, sitting and crouching.
- Activity profile. We will ask you questions about what activities make the thoracic condition worse such as walking, running, going to the toilet or throwing a ball, amongst others.