- It usually feels like a sharp pain, stiffness, and/or tightness in the middle back, either during certain movements or when standing still.
- In functional disorders, the pain is most commonly caused by restricted movement in the facet joints and/or, less commonly, in the costovertebral joints, commonly referred to as ”facet or joint lock.”
- Continuous and/or recurring thoracic spine symptoms are usually associated with functional disorders in the neck and shoulder area, breathing, chest, and shoulder blades.
Pain in the middle back / thoracic spine
The thoracic spine is located between the cervical and lumbar spine. The middle back has a smaller range of motion than the neck and lumbar spine. Movement is restricted by the attachment of the ribs and internal organs. Due to the smaller range of motion, disc herniations in the middle back are extremely rare. Naturally, middle back problems directly affect the function of the ribs and breathing, so different kind of dysfunctional breathing patters related to middle back promblems are quite common.
The most common cause of thoracic spine pain is found in the facet joints. The facet joints are located between the vertebrae, with one bone coming from the lower vertebra and the other from the upper vertebra. These are attached to connective tissue, deep muscles, and the joint capsule to form a functional joint. Many factors affect the range of motion of the joint, such as the congenital structure of the skeleton, factors related to natural aging, the structure of the joint capsule, and the condition of the surrounding muscles and connective tissue. The colloquial term for this type of pain is a blocked vertebral or facet, which describes the sensation of local pain and restricted movement when moving and/or standing still quite well.
Symptoms of thoracic spine pain
- People usually describe thoracic spine pain as either a sharp pain or pain in a specific area.
- The pain may feel like a stabbing, aching, or sharp pain.
- The area is usually tender to pressure and/or movement.
- The pain may be felt during certain movements, when standing, sitting, or lying down.
- Pain in the thoracic spine area may also be felt at the attachment points of the back and ribs, in the shoulder blade or rib area.
- The pain is usually more pronounced on one side.
- Occasionally, it affects breathing in such a way that natural breathing movements cause pain.
- It can also cause feeling of shortness of breath, typically with inhalation.
- Pain in the middle back is also usually associated with various other back symptoms, such as symptoms in the neck, shoulder, and/or lower back, such as unusual fatigue and aching.
Causes of prolonged symptoms
Prolonged symptoms are usually caused by a combination of several factors rather than just one of the factors listed below.
- Physiological strain due to functional disorders, particularly in the neck and shoulder area, chest, shoulder blades, shoulders, lower back, and pelvis.
- Congenital posture abnormalities, such as kyphosis, scoliosis, and/or pronounced kyphosis.
- Excessive physical and unilateral strain.
- Congenital hypomobility or hypermobility.
- Psychological factors, such as anxiety, depression, and/or excessive mental strain, commonly known as stress.
- Lifestyle factors, such as overly one-sided and insufficient exercise, inadequate or poor-quality sleep.
- Local or central nervous system sensitization of the pain system.
- Various diseases affecting the lungs and/or heart function.
Treatment of middle back pain
In cases of functional joint disorder, commonly known as blocked facet joint, spinal manipulation therapy is guaranteed to work. Sometimes a cavitation sound can be heard and sometimes not, but the response to treatment is always immediate in cases of functional joint disorder. If manipulation therapy is only partially effective or not effective at all, the problem may be more related to soft tissues, such as connective tissue and muscle structures. If manual therapy targeting all of these tissues do not help much, the problem is most likely caused by structural factors in the back or, even more rarely, the symptom is not caused by the structures of the musculoskeletal system like on certain internal organ origin pain. Naturally, there is rarely a silver bullet treatment for prolonged pain that would eliminate it completely and permanently, as there are many reasons for prolonged pain. Very rarely, the persisten pain in middle back area is caused solely by single mechanical joint dysfunction.
Read more about related pain syndromes:
Cervicogenic (Neck-related) headache
Jaw pain and masticatory muscle pain
Cervical intervertebral disc prolapse
Viimeksi päivitetty 13.10.2025
