Mid back or thoracic back pain is less common that neck or low back pain, but can be just as uncomfortable or troublesome.

It is the area of the spine between your neck and lower back and generally has less movement. It can often be linked to a simple muscle strain, lifting or twisting awkwardly, ageing, tension through poor posture or sustained postures.

At times, there will be no obvious direct cause. Often it is not necessary to seek input from a health professional. Symptoms will usually be starting to feel better within 6 weeks.

  • Mid back pain is rarely linked to serious disease or tissue damage.
  • Clicking and creaking of the back is common and is rarely a sign of harm or damage.
  • Backs do not ‘go out of place’ and discs do not slip out, your back is very strong and resilient!
  • There is no one ideal posture, changing posture regularly will help symptoms.
  • Your back can become healthier and stronger with regular movement and exercise.
  • Treatments such as surgery, injections or strong pain medications and not very effective for most mid back pain in the long term. They can also often have negative side effects.
  • Even if you have had back pain for a long time, it can often improve with the right management – consistency is key!
  • X-ray and scans are not usually needed to diagnose mid back pain.
  • X-ray and scans are not able to tell us how much pain you are experiencing.
  • X-rays and scans often will identify normal age related changes which are common finding, even in those that do not have mid back pain and this will often not change the management of the condition.
  • X-rays and scans are best used when there is suspicion of serious injury ie broken bone, or conditions such as cancer or infections.

  • Generally, keeping moving is the best thing to do to aid recovery and return to usual function.
  • Within the first 48 hours, it may be necessary to ease back a little on usual activities and ‘relatively rest’ the painful areas.
  • Try not to stop using the area and to carry out a few movements every hour to prevent stiffness.
  • After 48 hours, you may wish to increase the use of your mid back gradually.
  • Most people will find keeping mobile ‘little and often’ is beneficial, as our muscles, nerves and joints respond well to movement. This is needed to keep them healthy. 
  • Improving your sleep and general health is also important for back pain.

  • It is very important that you are coping well with your pain.
  • It is important to manage your pain so that you are able to move more comfortably. Taking regular pain relief will maximise its effect.
  • You may wish to speak with your community pharmacist, allied health prescriber or GP about pain relief.

  • Usually, keeping time off work to a minimum has been shown to have better outcomes for recovery. It is not always necessary to be pain-free before returning to work.
  • You may wish to avoid recreational activities or sports which involve significant demand until your pain has reduced and your movement has returned.

  • Seek advice if there has been significant trauma (fall from height) or a direct injury to the mid back.
  • If you have severe pain and are unable to move your mid back at all due to pain
  • If you have persisting thoracic pain and any of the following, you should speak with your GP urgently:
    • a history of cancer,
    • unexplained weight loss over the previous 3 months,
    • you have severe pain at night preventing you from sleep
    • feel generally unwell,
    • have a fever or night sweats

Most thoracic pain is not serious and will improve with time and keeping mobile. A rare but serious spinal condition, myelopathy, can lead to permanent damage or disability . It will need to be seen by an emergency specialist spinal team. It is the medical term for spinal cord compression at the neck or chest level (thoracic) of the spine. Symptoms usually start slowly over time, more rarely they can progress suddenly.  Pain is not always the primary concern for this condition. Please see below some of the symptoms that can be experienced with myelopathy. Should you have any combination of these symptoms, seek care urgently through your GP. 

  • Clumsiness and loss of finger dexterity, including difficulty doing buttons up, writing, using cutlery
  • Pins and needles and numbness affecting both arms or both legs
  • Loss of co-ordination in your legs, such as tripping, falling or feeling unsteady
  • Difficulty walking
  • Your legs may become weak or feel stiff
  • Altered sensations such as trickling water
  • Muscle weakness

In some cases of myelopathy, patients may deteriorate very quickly (over 4 weeks) and may require immediate medical attention. If this happens, you may experience symptoms detailed below. Should you have any combination of these symptoms in addition to any of those above, seek emergency attention via A&E:

  • Loss of feeling/pins and needles between your inner thighs or genitals
  • Numbness in or around your back passage or buttocks
  • Altered feeling when using toilet paper to wipe yourself
  • Increasing difficulty when you try to urinate or loss of sensation when you pass urine
  • Leaking urine or recent need to use pads
  • Not knowing when your bladder is either full or empty
  • Inability to stop a bowel movement or leaking
  • Loss of sensation when you pass a bowel motion
  • Change in ability to achieve an erection or ejaculate
  • Loss of sensation in genitals during intercourse

Useful advice and exercise on the self-management of thoracic pain from the Tyneside Musculoskeletal Service - https://www.tims.nhs.uk/wp-content/uploads/2020/07/TIMS-Managing-Thoracic-Back-Pain-New.pdf

 

Help and support

  • If after six weeks you have tried the advice and exercise suggested and your symptoms haven’t improved, a self-referral to NTIMS may be beneficial.
  • Click here for self-referral