Upper and middle back pain is very rare in comparison to lower back pain. When is does occur it is most commonly due to muscular spasm or injury or due to problems with the joints of the spine (see Anatomy). Pain in the middle back or upper back can also be caused by chest and lung problems such as pneumonia or even, rarely, heart problems.
Middle back pain is often a concern for sufferers as it is recognised to be more unusual than lower back pain. It is considered a ‘red flag‘ for doctors as one potential indication of a worrying cause of back pain – although minor, common problems such as muscular pain are the more common. If you do have pain in the middle or upper back you should nevertheless seek review by your doctor.
You may have noticed that the middle spine, or thoracic spine, moves differently to other parts of the spine. It is capable of rotation whereas the lower back is only capable of bending forwards and backwards. The thoracic spine is very stable due to support from the ribs and this is why problems in this region are less common overall but the extra joints make joint pains more likely. The thoracic spine is made up of twelve vertebrae and attached to the twelve ribs.
When considering the middle back and thoracic spine it is important to note that the spinal canal (the space the spinal cord run within) is very narrow in this region – the stability of the spine means less space is required. If, however, damage to the vetebrae occurs or a disc prolapses, spinal cord compression occurs quite easily. Spinal stenosis occurs when the space for the spinal cord is inadequate.
Many of the large muscles of the spine are found in the upper and middle back and pains in this area often respond very well to stretching and exercise. Physiotherapy is often recommended and a chiropractor may be able to help. The important thing is to have a doctor review you to identify the cause of the pain and rule out an unusual form of back pain that requires further investigation. You are more likely to need such investigation if you have other symptoms with your pain such as shortness of breath, weight loss, palpitations, limb weakness, bladder or bowel problems, cough or a history of certain cancers in other parts of the body.
List of causes of middle / upper back pain:
- Muscular spasm or injury
- Joint injury – arthritis, dysfunction, inflammation, irritation
- Spinal stenosis
- Nerve root compression
- Herniated vertebral disc
Rare causes to be excluded by a qualified doctor:
- Chest or Lung problems – eg. pneumonia, pneumothorax
- Heart problems
- Tumours – very rare