Upper to Mid Back Pain – The Thoracic Spine


The upper and mid back is known as the thoracic spine. It is a complex area, a bit like a woven bamboo basket! It consists of twelve vertebrae with discs that separate each one, and these discs act as shock absorbers. There are over two hundred joints in the thoracic spine. These connect one vertebra to another, as well as connecting the ribs to the spine and, in some cases, to one another.


These joints are characteristically stiffer by nature than those of the neck or lower back and each joint is supported by ligaments, known as radiate ligaments. Our first ten vertebrae are connected to a rib on each side and reattached to our sternum bone at the front. The bottom two vertebrae have ‘floating’ ribs. There are many muscles in this region and the main function of the thoracic spine is to allow rotation of the upper trunk.

The thoracic spine contributes to six to twenty-two degrees of rotation per segment and four to six degrees forward bending, extending per segment, unlike the lumbar spine which only has one to three degrees for each segment in the lumbar spine.


If we think of the complexity of the area and the demands placed upon it, it is no wonder that things can go wrong here, resulting in pain and injury.


Where is My Pain Coming From?

Muscle spasms, ligament strains, and/or degeneration of joints and discs may cause pain in the upper to mid back areas. Pain may be a sharp, nasty but brief type of pain or an unremitting ache. Characteristically, pain here exacerbates at night and with sleeping.


Common Causes of Thoracic Pain

There are many causes of pain in this area. The most common ones are:

  • Poor posture while in a prolonged position, like sitting at a desk, driving, or standing. This results in gradual stiffening of the spine and weakening of the muscles.
  • Overuse or strain injury, such as lifting heavy objects, overhead shoulder use, forceful coughing/sneezing, or repetitive movements towards one direction.
  • Osteoarthritis or degenerative changes of joints and discs in the thoracic spine.
  • Direct trauma due to sports, car accidents, or fall, causing a fracture.
  • In some rare cases, there can be spinal nerve problems.


It is important to note that there are some rare but possible conditions that can cause thoracic pain. You should mention all your symptoms to your physiotherapist or GP.


This may include some of these signs and symptoms:

  • New, constant, severe, and progressive pain
  • History of immune system compromise, cancer, and prolonged use of corticosteroids
  • Severe or progressive neurological symptoms in the lower extremities
  • Non-mechanical pain, where there is no relief from bed rest or postural modification
  • Pain remains unchanged despite treatment for 2 to 4 weeks, accompanied by severe morning stiffness (rheumatoid arthritis and ankylosing spondylitis)


Do You Need a Scan?

An investigation scan is usually recommended if the pain started with trauma, such as a fall or car accident, that directly hit the thoracic spine and also when symptoms mentioned above are present.


What Your Physiotherapist Will Do

Your physiotherapist will obtain a history of injury and assess your movement, muscles, and joints to determine the cause of pain. Then, a treatment plan will be implemented. Treatment may include:

  • Hands on mobilisation and soft tissue techniques
  • Taping
  • Tailored stretches
  • Prescription of progressive strengthening exercises
  • Reassurance and education about possible cause of pain and injury


It is best to continue with your exercise program for at least three months after the pain has gone, even when the pain has reduced, as prevention and management are the most important aspects of recovery form injury. Remember that our core purpose at Excel Physiotherapy and Wellness is to empower you to manage your injury successfully. If you have been experiencing upper or mid-back pain, call us on 1300 650 510 to book an appointment with one of our physios and get the treatment that you need to be pain-free and able to perform your regular routines with ease. You may also book online by clicking here.