Mid-back pain

Do you have mid-back pain?

Read below for information about the mid back or thoracic spine.

Your thoracic spine is the middle section of your spine. It starts at the base of your neck and ends at the bottom of your ribs.

The thoracic spine is designed to be strong and stable to allow us to stand upright and to protect the vital internal organs in the chest. As this area is very stable, it is less prone to the injuries experienced by the neck and low back, but it is susceptible to pain, particularly when this area becomes stiff.

Pain is often felt when sitting, when twisting the body or
can feel like restriction when taking a deep breath. This is usually when the spine is stiff.

What you can do to help

Read advice on how you can support mid back pain

Avoid staying in one position for long periods of time and keep active throughout the day.
Look at your work position and try seated (desk-based) exercises during the workday.
Adopt good posture throughout the day’s activities.
Regularly carry out seated or movement exercises to reduce stiffness.
To maintain a healthy spine and prevent reoccurrences, progress to strengthening exercises.

When to seek further support

It is rare that spinal pain is actually an indication of a more serious
underlying medical issue (<1%). However, an in-depth assessment by a health care professional (A&E/GP/physiotherapist) is recommended if:

Your mid-back pain started suddenly following significant trauma (such as a vehicle accident or fall from a height).
You felt/feel unwell with the spinal pain (such as fever, chills, unexplained weight loss or have had a recent bacterial infection).
You have a medical history of osteoporosis, cancer, HIV, drug abuse, have an immunosuppressive condition or are on long-term steroid medication.

If your mid back pain is progressively getting worse, is not relieved by lying down and is keeping you constantly awake throughout the night, despite trying the advice and exercises within this leaflet for 1-2 weeks or indeed if the exercises are making your pain significantly worse. Then please seek further advice from your GP.

Mid-back pain and exercise

You may find that the exercises suggested on this page slightly increase your symptoms initially. You should find that with practice, the exercises themselves become easier to do and that you begin to move more comfortably.

How much exercise should I do?

A senior couple on yoga mats outside in a park in a bent knee standing pose with arms outstretched.

Exercise 2 - 3 times a week

Allowing rest days in between to let soft tissues recover and develop.

cropped image of two people, one black and one while in shorts and t-shirts on an exercise bike pedalling. Close crop on their hands on handle bars and their legs moving.

Choose 3 or 4 exercises

Choose exercises that are challenging but manageable.

Young asian man running on the spot wearing a t-shirt and shorts in their living room on a wooden floor.

Repeat the exercise

Perform 3 to 5 sets of 5 repetitions for each exercise.

Rest

Rest for up to 1 to 2 minutes between each set and monitor how you are feeling during and after exercising.

Once an exercise is easy, progress it

If the exercises are feeling easy after a week at this level, try a small increase in difficulty. You can do this by increasing the resistance (tension in band or weight used), depth of the movement, slowing down the return phase of the movement or adding a hold for a few seconds at the end of the movement.

How much pain is too much pain?

Read below for advice and exercises to manage mid-back pain.

Before exercising

Before exercising, rate your pain at the moment on a scale of 0-10, where 0 is no pain and 10 is the worst pain you can imagine.

A maximum pain level

A maximum pain level of 4/10 whilst exercising is fine as long as it eases within 45 minutes of the session and does not interfere with sleep or activities the next day.

If your pain increases

If your pain increases beyond this, simplify the exercise by reducing the range of movement or number of repetitions, or try an easier exercise.

Seated (desk based) exercises

Read about seated (desk-based) exercises to improve mid-back pain symptoms.

Throughout the working day, aim to complete some exercises every 1-2 hours. Perform each exercise until you feel that some of the stiffness has reduced.

Seated upper back stretch

Seated side flexion

Seated extension

Seated rotation

Movement exercises

Read about movement exercises to improve mid-back pain symptoms.

Choose 3 or 4 exercises from the set below that are challenging but manageable. Gradually build your range of movement. Perform each exercise until you feel that some of the stiffness has reduced.

Thoracic spine extension

Cat camel

Quadruped rotation

Wall rotation

Start next to a wall in a half-kneeling position (use a pillow underneath your knee if required), with your raised leg against the wall. Your foot should be flat on the floor, and your hip bent to 90 degrees.

The arm closest to the wall should be raised to shoulder level, with the other arm next to it. Twist your upper back and move your outer arm as far as you can. The arm against the wall should not move.

Extension

For this exercise you can use a foam roller or roll a few towels together.

Start lying on your back with both knees bend and feet flat on the floor. Position the roller horizontally behind your mid-back. Place both bands at the back of your head. Then let your shoulders and head slowly bend backwards. Return to the starting position and repeat.

Aim to move the spine vertebrae-by-vertebrae when moving up and down. Keep your chin tucked in and try not to let your lower back arch.

Open book

Strengthening exercises

Read about strengthening exercises to improve mid-back pain symptoms.

Complete these exercises every other day to allow enough rest for the soft tissues to recover and develop.

Choose 3 or 4 exercises from the set below that are challenging but manageable.

Perform 3 to 5 sets of 5 repetitions of each exercise.

Rest for up to 1 to 2 minutes between each set.

Once an exercise is easy, progress it by increasing the number of repetitions (aim for 10) or by holding the position for longer, or moving to a more challenging exercise.

Extension

Wall squat

Stand tall, facing a wall. Feet slightly wider than hip-width apart, toes point slightly outward. Arms lifted, elbows straight, and hands against the wall. Squat down, keeping your trunk upright and weight in your heels.

Go as low as you can, while still controlling the neutral position of your spine. Aim to keep your hips, knees and 2nd toes aligned.

Start further away from the wall and move closer to progressively make it more difficult.

W lift

Start lying on your stomach. Take your arms out to the side with your elbows at right angles. Lengthen and align your body through your toes to the top of your head. Maintain with width of your chest and back.

Lift your arms up and feel your shoulder blades move towards your spine. In a controlled manner, lower your arms back to the starting position.

To make this harder, you can hold a light weight in your hands.

Y lift

Start lying on your stomach, with your arms diagonally above your head. Lengthen and align your body through your toes to top of your head.

Maintain the width of your chest and back. Lift your arms up and feel your shoulder blades move towards your spine.

In a controlled manner, lower your arms back to the starting position. To make this harder, you can hold a light weight in your hands.

Bird dog

Woodchop

Stand tall and hold a weight plate with hold hands. Squat down, rotate from your trunk and bring the weight plate to one side, next to your thigh.

Maintain a neutral position with your spine and keep your chest up. Then push back up, shift your weight to the opposite side leg, rotate from your hips and pelvis, while bringing the weight plate diagonally over your head with straight arms.

Slowly return to the starting position with control. Repeat in the other direction.

Need more help?

Consider self referring using the link below:

If you have a new injury or problem, please look at the self help information in our advice pages. We will often complete the same exercises and share information in clinic appointments.

If you still need some more help you can self refer into our service. Please note that the NHS is currently experiencing longer than normal waits, for more information visit our waiting times page.

Refer yourself to physiotherapy