When we injure our middle back, it is normal for there to be pain, - just like if we cut ourselves badly we expect it to be sore. This pain serves as a reminder for us to rest, avoid certain movements and allow healing to begin, and some degree of pain may be present for a few months. The difference with our back is that it has a complex anatomy and it is hard for our brain to localize a source of pain in our spine and the surrounding muscles. Furthermore, we cannot rest our back like an injured limb, so we tend to feel more discomfort. This makes back pain more worrying and hard to interpret without appropriate knowledge.


'Pain serves as a reminder for us to rest, avoid certain movements and allow healing to begin, and some degree of pain may be present for a few months.'


A feature of middle back pain, especially when acute, is sharp grabbing sensations, particularly with movement. The majority of this is due to muscle spasms. When our back is sore the surrounding muscles go into ‘lock down’ to restrict movement to try to promote healing. This response is normal and part of acute back pain. Sometimes muscle spasm produces altered postures or curves in the spine as the body attempts to stay in a position of comfort, and focal areas of muscle tension or ‘knots’ can be felt. Whilst muscle spasms are alarming, their bark is worse than their bite, and the actual pain related to the underlying injury may be minimal.  With return to normal movement as healing occurs muscle spasms generally subside.

In addition to spasms, middle back pain usually involves some sort of aches and pains, sometimes felt in body areas away from the spine – called ‘referred pain’. These aches and pains usually relate to damaged tissues or inflammation. Often this pain is felt between or around the shoulder blades, and it may be central, on one side or on both sides. Because our spine is a deep structure in our body (not like our skin, which is very sensitive), it can be hard for our brain to localize the source of a pain message. As a result, middle back pain can also present as bands of pain, generalized aches, fluctuating pain, or pain that radiates or refers into the ribs, chest or arms. Sometimes you may only feel this referred pain and have no apparent back pain at all! Where a specific portion of the spine has been injured pain can be more localized and symptoms more characteristic. For instance, pain relating to joints between the ribs and the vertebrae/sternum tends to be worse with twisting movements, deep breathing and coughing. Where connections between the vertebrae are injured, lifting arms overhead is often uncomfortable and focal stiffness may be felt between the shoulder blades. Because the back is a mechanical structure, pain will usually vary with movement and positions depending on which structures are involved.  

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Pain from the mid back can sometimes refer to the ribs, chest and arms

In rare cases, an injury to the middle back may involve nerve tissues that exit from the spinal cord between vertebrae. If these nerves become irritated by inflammation, or physically disrupted by an injured or thickened structure such as a disc, arthritic facet joint or ligament, they can cause some other symptoms. Typically, an irritated or compressed nerve will cause sharp, shooting or burning type pain to be felt into your arms, chest wall or flank, sometimes accompanied by pins and needles or numbness. These symptoms are sometimes referred to as ‘radicular pain’, and they may vary with certain movements and positions. 

Where middle back pain has become chronic in nature, the pattern of symptoms can be less clear, and when we are stressed or anxious about back pain it often feels worse. With persistent pain our nervous system (brain, spinal cord, nerves) starts to undergo changes that can make pain more variable and more sensitive, even after tissues of the spine have healed. Furthermore, back pain, much like an ulcer, is sensitive to our emotional state - flaring up when we are stressed or worried. Therefore, with long term pain, stress and anxiety, chronic or recurrent middle back pain can occur. It's not all a mind game but understanding that chronic pain has a physiological basis and that stress and anxiety can exacerbate your symptoms is important to know.