Causes of Mid Back Pain & Treatment Options
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Having mid back pain is a common condition that can also feel like tightness or tension in the center of your back. Middle back pain can be caused by strain from daily activities and poor posture, a past or recent injury, or muscle inflammation. Read below for more information on why you may be having prolonged or sudden pain in the middle of your back, related symptoms, and treatment options.
Your mid back pain symptoms explained
Pain in the middle of the back can make sitting, walking, driving, and other activities difficult. The most common cause of mid-back pain is chronic muscle tension or irritation, often due to poor posture or working a desk job. There's a good chance minor pain or injuries can be treated at home; however, anyone over the age of 50 with new severe mid-back pain should seek prompt medical attention.
Common accompanying symptoms of mid-back pain
If you're experiencing mid-back pain, it's also likely to experience:
What causes mid back pain?
The most common cause of mid-back pain in adults is chronic irritation to the muscles and soft tissue. The following details may help you better understand your symptoms. If your mid-back pain becomes severe, worsens, or persists, you should see a physician for a proper diagnosis.
Trauma or injury-related causes of mid-back pain may be due to the following.
- Acute muscle strain: Common causes of a muscle strain are car accidents, sports injuries, or heavy lifting. This pain is sharp, and you can usually pinpoint the exact moment of injury.
- Fracture: A fracture to one of the vertebrae in the thoracic (middle) spine can cause mid-back pain. Fractures to the spine typically only occur with significant trauma, such as a fall from a substantial height or a car accident at high speed. Elderly people with brittle bones (osteoporosis) are more likely to fracture the spine without being involved in significant trauma.
- Spinal cord injury: The spinal cord consists of nerves traveling from the brain to the rest of the body. Injury or irritation to the spinal cord in the mid-back can cause pain as well as numbness, weakness, or tingling in the trunk and legs. Severe injuries can also cause a loss of control of urination and defecation. Spinal cord injury typically occurs in the setting of trauma, often in combination with a spinal fracture.
Chronic causes of mid-back pain may be related to the following.
- Chronic tension: The most common cause of mid-back pain is due to irritation or tension to the muscle and other soft tissue. Commonly, this occurs due to weakness, prolonged sitting, poor posture, or wearing a backpack. This can also be a chronic overuse injury from repetitive motion. This pain is aching or dull and typically develops over time. You may feel as though your back pain is worse when you are stressed or anxious.
- Joint inflammation: There are several conditions that lead to joint inflammation in the spine. Arthritis, common in older adults, is the most common. Other inherited conditions can also cause joint inflammation and pain in younger people, such as ankylosing spondylitis.
- Spinal cord irritation: Irritation of the spinal cord is often accompanied by symptoms of nerve compression like numbness, weakness, or tingling in the trunk or legs.
Other causes of mid-back pain may include the following.
- Injury to aorta: One of the most serious causes of mid-back pain is a problem with the aorta, the large artery that carries blood from the heart to the rest of the body. The lining of the artery can tear, resulting in aortic dissection, which is a medical emergency. A severe, sharp pain to the mid-back is a symptom of aortic dissection. People with high blood pressure are at a higher risk.
- Spinal cord infection: The spine can become infected with bacteria, which can cause localized pain in any part of the back. The infection typically spreads from another site in the body via the blood. These infections typically develop over a long period of time.
- Cancer: Various types of cancer can spread to the spine, causing localized mid-back pain. New mid-back pain in an older adult with symptoms like fatigue, weight loss, or fevers is suggestive of cancer.
10 mid back pain conditions
Low back strain
A strain is defined as a twisting, pulling, or tearing injury to a muscle, or to the tendon that connects the muscle to the bone. (A sprain is an injury to a ligament, which connects two bones together.)
Strains may be acute (happen suddenly) or chronic (show up gradually.) They are usually caused by overuse, improper lifting of heavy objects, or sports. Being overweight or having weak back muscles are both risk factors for back injury.
Symptoms may include a pop or tear at the time of injury; pain that is worse when moving; and sudden muscle cramping or spasm at the site of the injury.
Diagnosis is made through patient history, physical examination, and sometimes x-ray.
Treatment involves rest; ice packs; and over-the-counter pain relievers, followed by a gradual return to normal activities within two weeks. Prolonged immobility actually weakens the back and causes loss of bone density.
Proper lifting techniques, strengthening exercises, and good nutrition can be very helpful in preventing further injury.
Top Symptoms: lower back pain, back pain that gets worse when sitting, back pain that gets worse when straightening it, lower left back pain, lower right back pain
Symptoms that always occur with low back strain: lower back pain
Symptoms that never occur with low back strain: involuntary defecation, first time leaking urine, back numbness, toe numbness, foot numbness
Kidney infection (pyelonephritis)
A kidney infection, or pyelonephritis, is actually a type of urinary tract infection (UTI) that begins in the urethra or bladder and spreads to the kidneys.
The infection is caused by bacteria that either travel into the urethra or spread from an infection elsewhere in the body.
Women, especially pregnant women, are most susceptible. Anyone who has had a urinary tract blockage, or uses a catheter, or has a weakened immune system is also at risk for a kidney infection.
Symptoms include fever; chills; back and abdominal pain; and frequent, painful urination. If there is also nausea and vomiting and discolored, foul-smelling urine, take the patient to the emergency room or call 9-1-1.
Left untreated, pyelonephritis can cause permanent damage to the kidneys. Bacteria can also enter the bloodstream and cause a life-threatening infection elsewhere in the body.
Diagnosis is made through urine test, blood test, and sometimes imaging such as ultrasound, CT scan, or x-ray.
Treatment includes antibiotics and sometimes hospitalization.
Top Symptoms: abdominal pain (stomach ache), nausea, pelvis pain, back pain, vomiting
Symptoms that never occur with kidney infection (pyelonephritis): mid back pain from an injury
Urgency: Hospital emergency room
Metastasis is the term meaning the spread of cancer cells from tumors in other parts of the body. The spine is a common location for new tumors, or metastases, to form.
Some types of cancers, especially those of the breast, prostate, lung, thyroid, and kidney, are likely to spread to the spine. Exactly why this happens is not known.
Symptoms of spine metastases include back pain; bowel and urinary incontinence; arm or leg weakness; and hypercalcemia, or high levels of calcium in the blood.
Hypercalcemia can cause nausea and vomiting, constipation, and mental confusion.
These metastasized tumors can cause pain and fractures in the spine.
Diagnosis is made through various types of imaging, including x-ray, bone scintigraphy (bone scan,) CT scan, PET scan, and/or MRI.
Treatment is varied and is designed for each individual case. It may include IV osteoporosis medications to strengthen bones; chemotherapy to fight cancer cells; and steroids to reduce inflammation. All of these help to reduce pain, as well. Radiation therapy and surgery may also be used.
Rarity: Ultra rare
Top Symptoms: back pain, lower back pain, fatigue, mid back pain, urinary changes
Symptoms that always occur with spine metastases: back pain
Symptoms that never occur with spine metastases: back pain from overuse, lower back pain from an injury, mid back pain from an injury, mid back pain from overuse
Urgency: Primary care doctor
Osteoporotic spinal fracture
Osteoporosis is a condition in which the density and quality of bone are reduced. Cracks can appear in the boney structures of the back (vertebrae) which can lead to back pain, back deformities and loss of height.
Top Symptoms: mid back pain, spontaneous mid back pain, unintentional weight loss, back pain affecting the spine, back deformity
Urgency: In-person visit
Vertebral osteomyelitis, or spinal osteomyelitis, is an infection in the bones of the spine. It usually affects the lumbar, or lower, back, and may be either acute or chronic.
The infection is caused by bacteria, most commonly Staphylococcus aureus and Pseudomonas aeruginosa, and by some types of fungi. These agents can travel through the bloodstream from an infected wound elsewhere in the body and reach the bones of the spine.
Most susceptible are those with weakened immune systems; poor circulation; recent injury; or undergoing hemodialysis. Osteomyelitis of the spine is the most common form of osteomyelitis in adults, though children can also be affected.
Symptoms include swelling, redness, and pain at the site of the infection, along with fever, chills, and fatigue.
A medical provider should be seen for these symptoms, as vertebral osteomyelitis can progress to abscess and cause further complications if not treated.
Diagnosis is made through blood tests, imaging of the spine, and sometimes biopsy.
Treatment involves several weeks of intravenous antibiotic or antifungal medication, which can be given as an outpatient.
Top Symptoms: upper back pain, spontaneous neck or back pain, fever, foot numbness, upper leg numbness
Urgency: Hospital emergency room
Traumatic vertebral fracture
Vertebrae are the individual small bones that fit together, one above the other, to form the spine. If a vertebra is broken and/or dislocated due to sudden forceful injury (trauma,) this is a traumatic vertebral fracture.
The term includes fracture of the transverse processes, the "wings" of bone on either side of each vertebra. This is a less serious injury.
Automobile accidents, sports injuries, and falls from heights are common causes, as are gunshot wounds.
Symptoms include severe back pain that is worse with movement. Damage to the spinal cord causes limb numbness and weakness, with bowel and bladder dysfunction.
This is a medical emergency. One vertebra has been partially or entirely torn away from the vertebra directly below it and damaged the spinal cord. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through physical examination, neurologic tests to assess ability to move, and imaging.
Surgery stabilizes and realigns the spine, which removes pressure from the spinal cord. Rehabilitation will help the patient regain normal function.
Top Symptoms: back pain, constant back pain, severe back pain, back pain that shoots down the leg, back pain affecting the spine
Symptoms that always occur with traumatic vertebral fracture: back pain
Symptoms that never occur with traumatic vertebral fracture: mild back pain
Urgency: Emergency medical service
Herniated (slipped) disk in the upper back
The backbone, or spine, is made up of 26 bones called vertebrae. In between the bones are soft disks filled with a jelly-like substance. These disks cushion the vertebrae and keep them in place. Although people talk about a slipped disk, nothing actually slips out of place. The outer shell of the disk ruptures, and the jelly-like substance bulges out. It may be pressing on a nerve, which is what causes the pain.A slipped disk is more likely to happen due to strain on the back, such as during heavy lifting, and older individuals are at higher risk.
Top Symptoms: upper back pain, neck pain, arm weakness, back pain that gets worse when sitting, upper spine pain
Symptoms that always occur with herniated (slipped) disk in the upper back: upper back pain
Urgency: Primary care doctor
A bruise is the damage of the blood vessels that return blood to the heart (the capillaries and veins), which causes pooling of the blood. This explains the blue/purple color of most bruises. Bruises of the back are common, given how exposed this area of the body is.
Top Symptoms: back pain, constant back pain, mid back pain from an injury, swollen back, bruised back
Symptoms that always occur with mid-back bruise: mid back pain from an injury, constant back pain
A kidney stone is a stone made up of various possible materials that forms in the kidneys. Factors that increase the risk of forming kidney stones include high levels of calcium, uric acid, and oxalate in the urine, low levels of citrate in the urine, abnormal urine pH, low urine volume, certain urin...
Acute pancreatitis is the inflammation of the pancreas, which creates and releases insulin and glucagon to keep the sugar levels in your blood stable. It also creates the enzymes that digest your food in the small intestine. When these enzymes accidentally get activated in the pancreas, they digest the pancreas itself, causing pain and inflammation.
Top Symptoms: constant abdominal pain, nausea or vomiting, being severely ill, severe abdominal pain, fever
Symptoms that always occur with acute pancreatitis: constant abdominal pain
Urgency: Hospital emergency room
Treatments for your middle back ache
Mild mid-back pain due to chronic irritation or strain can often be treated at home. However, there are more serious causes of mid-back pain that require evaluation and treatment by a physician.
When mid-back pain is an emergency
Seek emergency treatment if:
- You experience new, sharp chest pain that moves to the mid or upper back, especially if accompanied by lightheadedness or nausea: This may be a sign of injury to the aorta, which is a medical emergency.
- You experience a sudden loss of control of your bowels or bladder with or without back pain: This may be a sign of serious injury to the spinal cord.
- You experience sudden numbness, weakness, or tingling in the legs with or without back pain: This may be a sign of serious injury to the spinal cord.
You can try the following remedies for mid-back pain at home.
- Rest: If your mid-back pain is due to a muscle strain from an injury, several days of rest may help relieve your symptoms. You should also avoid activities that exacerbate the pain.
- Lifestyle modification: If your mid-back pain is related to poor posture, sitting for prolonged periods of time, or overuse due to repetitive motion, modifying your lifestyle may help. Avoid repetitive motion, strengthen your core to improve posture, or try a standing desk.
- Heat or ice: If your mid-back pain is due to muscle strain or irritation, heating pads or ice packs may help.
- Massage or acupuncture: If your mid-back pain is due to muscle strain or irritation, massage or acupuncture may help, as well as if your back pain seems to be related to stress or anxiety.
- Pain medication: Over-the-counter pain medication such as ibuprofen (Advil, Motrin), other NSAIDs, or acetaminophen (Tylenol) may help.
- Stretching or strengthening: If your mid-back pain is related to muscle tension or strain, stretching and strengthening may help relieve symptoms. Try a yoga class or incorporate a few stretches into your morning routine.
When to see a doctor
If your mid-back pain worsens or persists, you should see a physician. He or she may recommend the following treatment options.
- Physical therapy: If a doctor determines your mid-back pain is due to muscle strain or chronic irritation in the soft tissue, physical therapy can help strengthen the muscles of the back and core, improve posture, and relieve pain.
- Medications: If a doctor suspects your back pain is due to joint inflammation, they may prescribe medication to help with inflammation and pain. If a doctor suspects your back pain is due to infection, they may prescribe antibiotics. A doctor may also recommend prescription pain medication (opioid or non-opioid) to help manage mid-back pain symptoms.
- Imaging: If a doctor is concerned for a fracture, a spinal infection, or a spinal tumor, they may order a CT scan or an MRI to diagnose the cause of your back pain.
- Surgery: In rare cases of mid-back pain, including serious injury to the spinal cord or injury to the aorta, surgery may be recommended. Your doctor will discuss the risks and benefits of surgery in these cases.
FAQs about mid back pain
Why do I have sudden mid-back pain?
Upper and middle back pain is most commonly caused by overuse, muscle strain, muscle spasm, or muscle injury. These often involve a repetitive activity like lifting an object from the ground or stooping to pick up an item. Poor posture can also contribute to pain in the middle back. More serious causes include pressure on a spinal nerve, which can occur following a herniated disk. Fractures of spinal vertebrae can occur following trauma or a disease of the bones or spine. Osteoarthritis may break down cartilage in the back, and myofascial pain may involve inflammation of connective tissue. Treatment depends on the cause, and longstanding back pain should be examined by a physician.
How should I sleep with middle back pain?
This depends on the cause of back pain. Poor posture may necessitate sleeping in a position that takes the stress off the muscles of the spine. If you find that you have a fracture, you should bear as little pressure or force as possible, and this depends on the area fractured and the treatment of the fracture. Myofascial pain can at times be alleviated with anti-inflammatory medications.
Can you have gas pain in your back?
Yes, pain that distends or presses against the lining of the GI tract can cause back pain. To be clear, this does not mean that gas is causing injury to your back. A nerve that supplies both the walls of the abdomen and the spine may be affected by gas, and your brain may interpret signals from that nerve as back pain.
Can poor posture cause middle back pain?
Yes, poor posture can cause middle back pain. Additionally, lifting your shoulders for a long period of time (if a desk is too short) can also cause pain in the middle back. Middle back pain over a long period of time is frequently muscular and can be aggravated by activities that cause further strain of the muscles of the mid-back. Correct ergonomics (our interactions with things such as chairs and desks) is important for those who sit for many hours at work or home, especially when using a computer.
Why does my back hurt suddenly?
Sudden back pain is commonly a sign of back muscle strain, spasm, or injury. If you have engaged in any activity that strains the back, including arm lifting, leaning forward or hunching at a desk, or lifting objects from the ground, you may have this type of injury. If you have osteoporosis — weak bones, most common in elderly women — you may have a spinal fracture from something a simple as stepping down from a curb.
Questions your doctor may ask about mid back pain
- Did you just suffer from a high impact injury (e.g., a fall, collision, accident or sports trauma)?
- Have you noticed a change in your height (since your tallest recorded height)?
- Have you experienced any nausea?
- Any fever today or during the last week?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Martin is an Emergency Medicine resident at the University of Washington in Seattle. She received her undergraduate degree from Stanford University where she majored in Human Biology, and received her MD from the University of Pennsylvania. She’s interested in Emergency Medical Services and Flight Medicine, and is currently a resident flight physician with Airlift Northwest. In her free time, she enjoys playing ultimate frisbee, cycling, rock climbing, and trail running!