Middle Back Pain: Causes, Symptoms and When to See a Doctor
Middle back pain is one of those problems that tends to creep up on you. One day you’re fine, and the next you’re wincing every time you twist, reach for something on a shelf or sit at your desk for too long. It’s incredibly common, yet many people put up with it for weeks — sometimes months — before seeking help.
At OneMedicine in Edgbaston, Birmingham, Dr Ibrar Ahmed (MBChB, MRCP, MRCGP, PhD, Dip. Cardiology) regularly sees patients who have been living with middle back pain unnecessarily. With over 20 years of experience in medicine, Dr Ahmed takes a thorough, evidence-based approach to identifying the root cause and getting you on the right path to recovery.
In this guide, we’ll cover what middle back pain actually is, what causes it, when you should be concerned and what you can do about it.
What is middle back pain?
Your back is divided into three main regions: the cervical spine (neck), the thoracic spine (middle back) and the lumbar spine (lower back). When we talk about middle back pain, we’re referring to discomfort or pain in the thoracic region — the area between the base of your neck and the bottom of your rib cage.
This part of your spine is made up of 12 vertebrae (T1 to T12), and it’s designed to be more stable than your neck or lower back because it’s attached to your rib cage. That stability is a good thing in many ways, but it also means that when something does go wrong in this area, it can be particularly uncomfortable and sometimes tricky to pin down.
Upper middle back pain — felt between the shoulder blades and across the upper thoracic area — is especially common among people who spend long hours at a computer or who carry tension in their shoulders and neck.
Common causes of middle back pain
Understanding the causes of pain in upper middle back and the broader thoracic region is the first step towards effective treatment. Here are the most frequent reasons people experience this type of discomfort.
Poor Posture
This is by far the most common culprit. Slouching at a desk, hunching over a phone or sitting in a poorly supported chair for hours puts significant strain on the muscles and ligaments of the thoracic spine. Over time, this leads to muscle fatigue, stiffness and pain.
Upper middle back pain caused by posture tends to build gradually. You might notice it worsens towards the end of the working day or after long periods of sitting. The good news is that postural middle back pain usually responds well to lifestyle changes, stretching and strengthening exercises.
Muscle Strain and Overuse
Lifting something heavy, twisting awkwardly, starting a new exercise routine or even carrying a heavy bag on one shoulder can strain the muscles in your middle back. This type of pain usually comes on suddenly and is often accompanied by stiffness and tenderness in the affected area.
Most muscle strains heal within a few weeks with rest, gentle movement and over-the-counter pain relief. However, if the pain persists or keeps coming back, it’s worth having it assessed. A private GP appointment can help identify whether something more is going on.
Stress and Tension
It might surprise you, but emotional stress is one of the overlooked causes of pain in upper middle back. When you’re stressed or anxious, your body’s natural response is to tense up — particularly across the shoulders, neck and upper back. Over time, this chronic muscle tension can lead to persistent pain, headaches and restricted movement.
Addressing the underlying stress is just as important as treating the physical symptoms. Techniques such as mindfulness, regular exercise, good sleep habits and, where needed, professional support can all make a real difference.
Joint Dysfunction
The joints in your thoracic spine (called facet joints) and the joints where your ribs connect to your spine (costovertebral joints) can become stiff, inflamed or irritated. This can cause localised pain that may feel sharp when you move in certain directions, take a deep breath or twist your torso.
Joint-related middle back pain is often linked to age-related wear and tear, previous injury or prolonged poor posture. A thorough clinical examination can usually distinguish joint dysfunction from muscular pain.
Herniated or Bulging Disc
Although disc problems are more common in the lower back and neck, they can occur in the thoracic spine too. A herniated disc happens when the soft inner material of a spinal disc pushes through the tougher outer layer, potentially pressing on nearby nerves. Symptoms can include localised pain, numbness, tingling or, in some cases, pain that radiates around the rib cage.
Thoracic disc herniations are relatively uncommon, but when they do happen, they need proper assessment. If you’re experiencing upper middle back pain alongside any neurological symptoms — such as numbness in the arms or legs, weakness or changes in bladder or bowel function — you should seek medical attention promptly.
Osteoarthritis
Osteoarthritis is a degenerative condition where the cartilage that cushions your joints gradually wears down. It can affect the thoracic spine, leading to stiffness, aching and reduced mobility. This is more common in people over 50, though it can develop earlier, particularly after previous injury.
If you’re concerned about joint health or have a family history of arthritis, a bone health assessment can provide valuable information about the condition of your bones and joints and help you take proactive steps.
Osteoporosis
Osteoporosis is a condition where bones become weak and brittle, making them more susceptible to fractures. Compression fractures in the thoracic vertebrae are a well-known complication of osteoporosis and can cause significant middle back pain, loss of height and a hunched posture (kyphosis).
Women are more commonly affected, particularly after the menopause, but men can develop osteoporosis too. Early detection through a bone health screening is important because treatment can slow bone loss and reduce the risk of fractures.
Less Common but Serious Causes
In rare cases, middle back pain can be a symptom of something more serious. These include spinal infections, tumours, inflammatory conditions such as ankylosing spondylitis, or referred pain from organs like the heart, lungs, kidneys or pancreas.
This is why persistent or unexplained back pain should never be ignored. While the vast majority of cases have a straightforward explanation, ruling out anything serious gives you peace of mind and ensures you get the right treatment.
When should you see a doctor about middle back pain?
Many cases of middle back pain are mild and improve on their own with self-care. However, you should consider seeing a doctor if:
- The pain has lasted longer than two to three weeks without improvement
- It’s severe enough to interfere with your daily activities or sleep
- You’ve noticed numbness, tingling or weakness in your arms or legs
- The pain followed an injury, such as a fall or car accident
- You have a history of cancer, osteoporosis or immune system conditions
- You’re experiencing unexplained weight loss alongside the pain
- You have a fever or feel generally unwell
At OneMedicine, Dr Ahmed can carry out a thorough assessment to identify the cause of your pain and recommend the most appropriate next steps. This might include blood tests, imaging, referral to a specialist or a tailored management plan.
If getting to the clinic is difficult — whether because of pain, work commitments or distance — an online or telephone appointment can be an excellent first step. Many cases can be assessed remotely, and Dr Ahmed can advise you on whether an in-person examination is needed.
How is middle back pain diagnosed
Diagnosing the cause of middle back pain starts with a detailed history and physical examination. Dr Ahmed will ask you about the nature of the pain, when it started, what makes it better or worse and whether you have any other symptoms.
The physical examination will assess your range of movement, check for tenderness in specific areas, test your reflexes and look for any neurological signs. In many cases, this is enough to reach a working diagnosis and start treatment.
If further investigation is needed, Dr Ahmed may arrange blood tests to check for inflammatory markers, vitamin deficiencies (such as vitamin D, which plays a key role in bone health), or other underlying conditions. Imaging — such as X-rays, MRI or CT scans — may also be recommended depending on the clinical picture.
What can you do at home?
While you’re waiting for an appointment or if your symptoms are mild, there are several things you can do at home to help manage middle back pain:
- Stay active. It might seem counterintuitive, but gentle movement is usually better than bed rest. Walking, swimming and yoga can all help keep your back mobile and reduce stiffness.
- Improve your posture. If you work at a desk, make sure your screen is at eye level, your feet are flat on the floor and your chair supports your lower back. Take regular breaks to stand, stretch and move around — ideally every 30 to 45 minutes.
- Apply heat or cold. A warm bath, hot water bottle or heat pack can help relax tight muscles. If there’s any swelling, a cold pack wrapped in a towel applied for 10 to 15 minutes can help reduce inflammation.
- Over-the-counter pain relief. Paracetamol and ibuprofen can help manage pain and inflammation in the short term. Always follow the recommended dosage and speak to a pharmacist or doctor if you’re unsure.
- Stretch regularly. Gentle stretches targeting the thoracic spine and shoulders can relieve tension and improve flexibility. Doorway stretches, cat-cow stretches and thoracic rotations are all helpful.
- Manage stress. If tension is contributing to your pain, find ways to decompress. Regular exercise, adequate sleep, breathing exercises and limiting screen time in the evening can all help.
How OneMedicine can help
At OneMedicine, we understand that middle back pain can range from a minor nuisance to something that significantly affects your quality of life. Dr Ibrar Ahmed brings over two decades of clinical experience and a specialist interest in heart health to every consultation, ensuring that nothing is overlooked — including the less obvious causes of pain in upper middle back and thoracic regions.
Whether you need a face-to-face private GP appointment at our Edgbaston clinic or prefer the convenience of an online consultation, we’re here to help you get to the bottom of your symptoms and start feeling better.
We also offer comprehensive health checks, blood tests, cancer screenings and bone health assessments — so if your back pain is part of a bigger picture, we can investigate thoroughly and give you clear, honest answers.
Frequently questions our patients ask
What causes middle back pain between the shoulder blades?
Pain between the shoulder blades is usually caused by muscle tension, poor posture or joint stiffness in the upper thoracic spine. It’s particularly common in people who sit at a desk for long periods or carry stress in their shoulders. In some cases, upper middle back pain in this area can also be related to nerve irritation, disc problems or referred pain from other structures. If it persists, a medical assessment can help identify the exact cause.
Is middle back pain a sign of something serious?
In most cases, no. The majority of middle back pain is caused by muscular strain, poor posture or joint stiffness and improves with time and self-care. However, in rare instances, it can be linked to conditions such as osteoporosis, spinal infections, inflammatory diseases or problems with internal organs. If your pain is severe, persistent, or accompanied by other symptoms like numbness, fever or unexplained weight loss, you should see a doctor.
Can stress really cause upper middle back pain?
Yes, absolutely. Chronic stress triggers a sustained muscle tension response, particularly in the neck, shoulders and upper back. Over time, this can lead to persistent pain, stiffness and headaches. Addressing the stress itself — through lifestyle changes, exercise or professional support — is an important part of resolving the physical symptoms.
When should I book a GP appointment for back pain?
If your middle back pain has lasted longer than two to three weeks, is getting worse, or is accompanied by worrying symptoms like numbness, weakness or unexplained weight loss, it’s time to seek medical advice. You can book a private GP appointment at OneMedicine for a thorough assessment, or arrange an online consultation if that’s more convenient.
How can I prevent middle back pain from coming back?
Prevention is largely about maintaining good habits. Keep active with regular exercise that strengthens your core and back muscles. Pay attention to your posture, especially if you work at a desk. Stretch regularly, manage your stress levels and maintain a healthy weight. If you’re over 50 or have risk factors for bone disease, consider a bone health assessment to check for conditions like osteoporosis that could increase your risk of thoracic spine problems.
This article was reviewed by Dr Ibrar Ahmed (MBChB, MRCP, MRCGP, PhD, Dip. Cardiology), a highly experienced private GP at OneMedicine, Edgbaston, Birmingham. For personalised advice about middle back pain or any other health concern, please get in touch with our team.
