What Causes Thoracic Back Pain & What Are the Symptoms?

Quick answer: Thoracic back pain is pain in the upper and middle back, between the base of the neck and the bottom of the ribs. Most of it is muscular — from sitting, posture and load — and it responds well to the right exercise: in office workers with neck and upper-back pain, targeted strengthening reduced pain more than other approaches. A few signs, listed below, mean it should be checked by a doctor first.

Introduction

Experiencing discomfort in your upper back and wondering what it is or what’s causing it? It could be thoracic back pain. In this article, we closely examine thoracic back pain, discussing its causes, effective remedies, and the benefits of incorporating posture therapy into your journey toward a healthier, more comfortable back.

Thoracic back pain is common and sometimes nasty. The condition affects people of all ages, fitness levels, and lifestyles.  Bad posture, certain activities or lifestyle habits, recent injuries, or underlying medical conditions can cause it. Fortunately, understanding the causes and knowing the right treatments can help you manage your thoracic back pain.

What is Thoracic Back Pain?

Thoracic back pain is discomfort or pain that occurs in the upper and middle regions of the back (known as the thoracic spine). Stiffness, spasms, soreness, and other achy or painful symptoms often appear in this area from various causes, such as poor posture or overuse. To better understand thoracic back pain, let’s get familiar with the anatomy in this spine area.

The thoracic back is part of the vertebral column between the cervical spine (neck) and the lumbar spine (lower back). Its 12 vertebrae (labeled T1-T12) are uniquely designed. While the spine works together to support various functions, such as protecting the spinal cord and its nerve roots, the thoracic vertebrae create a stable column while providing attachment points for the ribs. The thoracic spine protects vital organs such as the heart, lungs, and internal structures by supporting the rib cage. In addition, it supports the upper extremities, head, and neck and allows for limited movements, such as rotation and flexion.

The entire spine works together and determines how we move our body, with the cervical and lumbar spine providing more mobility. The thoracic spine is more stable in its functional role and limited in motion due to its connection with the rib cage. Therefore, thoracic back pain is typically not seen as often as neck (cervical) and lower back (lumbar) pain (though we are seeing more with bad postures, as we discuss later). Regardless, thoracic back pain can be just as disruptive and uncomfortable when it occurs.

Differentiating thoracic back pain from other types of back pain will ensure proper treatment and prevention. For instance, cervical pain typically involves discomfort in the neck or shoulders and can radiate into the arms and hands. Lumbar pain affects the lower back and can radiate to the hips and legs. However, thoracic pain is localized in the upper and middle back regions. Recognizing the differences in location and sensation will allow you to address thoracic back pain more effectively and seek appropriate care.

What are the Symptoms of Thoracic Back Pain?

As you may already know, symptoms of thoracic back pain include pain, tightness, and discomfort, ranging from mild to severe. Sometimes, additional symptoms include stiffness, muscle spasms, difficulty breathing, pins-and-needles sensations, tenderness in the area, changes in posture or function, and a weakened range of motion. 

Common symptoms include:

• Aching or sharp pain in the upper or middle back, which may be localized or spread across a larger area
• Stiffness or tightness in the muscles surrounding the thoracic spine
• Limited range of motion, making it difficult to twist or bend the upper body
• Discomfort or tenderness when pressing on the soft tissue of the area
• Pain that worsens with certain movements, such as lifting, reaching, or prolonged sitting

As mentioned, the intensity and duration of thoracic back pain symptoms differ significantly from one person to the next. Some individuals may experience mild discomfort that comes and goes, while others may have persistent, severe pain that significantly impacts their daily life. Factors like posture, activity level, and general health can influence the severity and persistence of symptoms.

Knowing when to seek medical attention for thoracic back pain is important because there can be serious underlying pathology. While many with mild to moderate thoracic back pain may manage it with at-home remedies and lifestyle modifications, there are instances when professional help is necessary.

Consult a healthcare professional if:

• Your pain is intense, constant, and worsens over time
• You have difficulty performing daily activities due to pain or limited mobility
• Constitutional symptoms, such as fever, chills, or unexplained weight loss
• The pain is the result of an injury, such as a fall, car accident, or trauma to your back
• Your pain is non-mechanical without relief from rest or postural changes
• You have chest pain or pressure, shortness of breath, sweating or nausea — call 911
• The pain spreads into your jaw or arm
• You have a history of cancer, or osteoporosis or long-term steroid use and the pain started suddenly
• You notice numbness, tingling or weakness in your legs, or changes in balance or bladder or bowel control

By recognizing the symptoms of thoracic back pain and understanding when to seek medical attention, you can take a proactive approach to your health and ensure you receive the appropriate care for your condition.

Acute and Chronic Thoracic Spine Pain

There are various types of thoracic back pain, each with its own set of symptoms and causes. Acutethoracic back pain typically lasts fewer than 12 weeks and can arise from a number of causes, such as muscle strain or sprain, arthritis, intervertebral disc herniation, radiculopathy, fractured vertebrae, or poor posture. Chronic thoracic back pain is usually caused by conditions such as spinal stenosis, degenerative disc disease, facet jointdysfunction, and scoliosis.

Causes of Thoracic Back Pain

Several potential causes of thoracic back pain exist, each of which usually requires a different approach to treat or prevent. Let’s examine some of the most common causes:

1. Poor posture: Slouching, excessive sitting, hunching over a computer, or problematic postures we’ll discuss later can strain the muscles and ligaments in the thoracic spine, leading to pain and discomfort. Poor posture can also cause imbalances in the surrounding muscles, exacerbating the issue.
2. Muscle strain and overuse: Engaging in repetitive movements or overexerting yourself during physical activities can lead to muscle strains, a common cause of thoracic back pain. Inadequate rest or recovery time between activities can further aggravate these strains.
3. Herniated discs: The spinal discs, which act as cushions between the vertebrae, can become damaged or herniated, causing them to bulge out and press on nearby nerves. More common in the cervical and lumbar spine, it can also occur in the thoracic region, leading to pain and discomfort.
4. Joint dysfunction: The thoracic spine contains numerous joints that help facilitate movement. If these joints become injured or inflamed, they can cause pain and limit mobility. Joint dysfunction can result from trauma, degeneration, or certain medical conditions.
5. Osteoarthritis: Osteoarthritis is a degenerative joint disease that can affect the thoracic spine, leading to pain, stiffness, and reduced range of motion. This condition is more common in older adults and can be worsened by factors such as obesity and a sedentary lifestyle.
6. Emotional stress and tension: Psychological factors like stress and anxiety can cause muscle tension in the upper back and shoulders. This tension can lead to thoracic back pain if not addressed and managed effectively.
7. Inflammation: Inflammation can occur in the muscles, ligaments, and joints of the thoracic spine (based on many of the reasons above), resulting in pain and discomfort. Inflammatory conditions, such as rheumatoid arthritis or ankylosing spondylitis, can also contribute to thoracic back pain.

Understanding the various causes of thoracic back pain can help you identify potential risk factors and take appropriate steps to prevent or alleviate discomfort. You can work towards a healthier, more comfortable back by making lifestyle changes and seeking professional guidance when necessary.

Posture Dysfunctions Related to Thoracic Back Pain

Several common posture patterns show up alongside thoracic back pain. None of them is a diagnosis on its own — many people have them without any pain — but they shape how load reaches the upper and mid back, which is what an assessment looks at:

1. Kyphosis: A rounder-than-usual curve in the upper back. Postural rounding changes with position and responds to strengthening — in one trial, supervised strength training improved upper-back rounding by 6.7°. Scheuermann’s disease, where the vertebrae themselves are wedge-shaped, needs medical follow-up alongside exercise.
2. Neck hump: A prominent bump at the base of the neck with increased curvature of the upper thoracic spine, sometimes called by an older name, Dowager’s hump. It often comes with stiffness and aching, and in older adults it can also reflect bone changes worth checking with a doctor.
3. Scoliosis: A sideways curve with rotation, often in the thoracic spine. Functional curves — where the spine is compensating for the pelvis or shoulders — often respond well when the cause is addressed; structural curves need medical monitoring alongside an active exercise program. More on levoscoliosis and dextroscoliosis.
4. Forward head posture: The head sits forward of the shoulders, so the neck and upper-back muscles work harder to hold it up. It’s common, and often seen alongside a rounded upper back.
5. Rounded shoulders: The shoulder blades sit forward and the chest muscles work harder, which leaves the mid-back muscles that hold you upright working at a disadvantage.
6. Sway back: The hips sit forward of the ankles and the upper back leans back to balance them, which can shift extra work onto the upper and mid back.
7. Spine rotation: The trunk sits slightly twisted, often in response to the pelvis or shoulders, so one side of the mid back works harder than the other.
8. Anterior pelvic tilt: The pelvis tips forward. It’s the most common pelvic position, even in people without pain, but it changes how the spine above it is stacked and loaded.

Because these patterns connect, we look at them together rather than chasing the spot that hurts. Strength work, mobility, and changes to how you sit and move are what shift them.

Conditions and Disorders of the Thoracic Back

Various conditions and disorders affect the thoracic spine, contributing to spinal pain and further problems in the upper back. Understanding these issues is essential for seeking appropriate treatment and maintaining a healthy spine. Pain in the thoracic back is frequently linked to the following:

• Herniated disc: As mentioned earlier, a herniated disc occurs when a spinal disc’s soft, gel-like interior bulges out and presses on nearby nerves. Granted, disc issues are problems more commonly found in the cervical and lumbar spines, but they also occur in the thoracic region, causing pain, numbness, and weakness in the affected area.
• Osteoarthritis: As a degenerative joint condition, osteoarthritis impacts millions of people. It develops when the fibrous cartilage that protects the ends of bones gradually deteriorates. This ailment can influence the facet joints within the thoracic spine, leading to discomfort, rigidity, and restricted movement. While osteoarthritis is more prevalent among elderly individuals, risk factors such as obesity, injuries, smoking, and a lack of physical activity can also contribute to its development.
• Osteoporosis: This condition causes the bones to become brittle and more prone to fractures. Osteoporosis (or its precursor, osteopenia) can lead to compression fractures and discomfort in the thoracic spine. Some risk factors, such as age and sex,  can’t be avoided, but others, like dietary choices, regular weight-bearing activities, and maintaining good posture, benefit your bones.
• Disc degeneration: Over time, wear and tear, muscle imbalances, misalignments, or injury can cause the thoracic vertebral discs can lose their flexibility, elasticity, and shock-absorbing capabilities. Disc degeneration in the thoracic spine can lead to increased pressure on the facet joints and surrounding structures, with the result being pain and discomfort.

Understanding these conditions and disorders can help you identify potential risk factors and seek appropriate care when necessary. In some cases, working with a healthcare professional to develop a personalized treatment plan can be beneficial for managing symptoms and maintaining a healthy thoracic back.

Whole-body Posture Therapy for Thoracic Back Pain Relief

Activ8 Posture looks at the whole body rather than just the spot that hurts. Upper-back pain is often fed from elsewhere: a pelvis that tips or rotates changes how the spine above it stacks, and shoulders that round or hike change what the mid-back muscles are asked to do. We assess from the feet up, find what’s contributing, and build strength, mobility and better movement habits around it — so the change holds up because the load has changed, not just the symptom.

Whole-body posture therapy can significantly enhance overall well-being by:

1. Reducing thoracic back pain and discomfort
2. Improving spinal alignment and posture
3. Enhancing muscle strength and flexibility
4. Promoting better body awareness and self-care habits
5. Encouraging relaxation and stress reduction

What Helps, and by How Much

Most thoracic back pain is muscular, and it responds to the right kind of work:

In other words, the muscles that hold your upper back up are trainable at any age, and building them is one of the most direct things you can do about thoracic pain that comes from how you sit, stand and move.

Complementary Approaches to Help Thoracic Back Pain

The Activ8 Posture approach to thoracic back pain works well with complementary remedies and strategies:

1. Ergonomic adjustments: Create healthier work and home environments to minimize strain on your thoracic spine. Use adjustable chairs, sit-stand desks, and properly position computer monitors to encourage good posture. (Refer to our Ergonomics Checklist for guidance).
2. Stretching and strengthening exercises: With a custom posture plan, regularly practice exercises targeting muscles supporting the thoracic spine to alleviate pain and improve alignment. Focus on whole-body exercises that stretch and strengthen beyond the upper back and shoulders.
3. Yoga and Pilates: Programs like yoga and Pilates also help improve posture, flexibility, and strength while reducing stress and tension that contribute to thoracic back pain.
4. Massage therapy: Massages release tight muscles, improve circulation, and promote relaxation, contributing to pain relief and better posture.
5. Heat and cold therapy: Applying heat relaxes tight muscles and improves blood flow, while cold therapy reduces inflammation and numbs the pain. Alternating between the two can effectively manage thoracic back pain.
6. Acupuncture: Acupuncture is a holistic approach that works synergistically with our posture therapy program. Treatments stimulate and balance the Qi flow in the body (energy pathways)  to relieve pain and promote healing.

Incorporating these complementary remedies and strategies into a whole-body posture therapy approach helps achieve lasting relief from thoracic back pain and improved mobility and function. In many cases, working with a posture therapist along with complementary healthcare professionals can offer additional guidance and support for personalizing your treatment plan.

Tips for Maintaining a Healthy Thoracic Back and Preventing Pain

Taking care of your thoracic back and preventing pain requires a proactive approach to maintaining overall spinal health. Here are some tips to help you preserve a healthy thoracic back and reduce the risk of pain:

1. Improve Your Posture: Misalignments of the body reveal muscle imbalances that are detrimental to a well-functioning spine. By engaging in a posture therapy program to correct imbalances and align your body, you’ll take a shortcut to feel better.
2. Participate in regular physical activity: Your body must move, so staying active is critical for maintaining spinal health and keeping your muscles strong and flexible. Engaging in low-impact activities like walking, swimming, or corrective exercises promotes better posture and reduces the risk of thoracic back pain.
3. Maintain a healthy weight: Bearing excess weight places additional strain on your spine, leading to pain and discomfort. Maintaining a healthy weight through a balanced diet and regular exercise will help alleviate this strain and promote better spinal health.
4. Use proper lifting techniques: Improper lifting techniques can cause injury and pain in the thoracic back. Good posture and function will help you when lifting heavy objects, bending at your knees and hips, keeping your back straight, and using your leg muscles to lift. Avoid twisting your spine and lifting with your back muscles if you have pain.
5. Employ stress management techniques: Stress and tension can contribute to muscle tightness and pain in the thoracic back. Incorporate stress-reduction techniques into your daily routine, such as deep breathing, meditation, or engaging in activities you enjoy. A healthy work-life balance is also essential for reducing stress and promoting mental-emotional wellness.
6. Practice good sleeping positions: How you sleep can impact your thoracic back health. Aim to maintain a neutral spine position while sleeping, and use pillows to support your neck and knees as needed. Sleeping on your back or side is typically better for spinal alignment than sleeping on your stomach.

Following these tips and adopting a proactive approach to your spinal health will help you maintain a healthy thoracic back and prevent pain. Remember that addressing concerns or pain early on can lead to better outcomes, so don’t hesitate to seek professional help sooner than later.

Conclusion

Most thoracic back pain is muscular, and it responds well to the right work: targeted strengthening, better mobility, and changes to how you sit and move. Because the upper back is often loaded by what’s happening at the pelvis and shoulders, the most lasting progress comes from looking at the whole body, not just the spot that hurts. And if any of the warning signs above apply, see a doctor first.

FAQs

What are the causes of thoracic back pain?

Common causes of middle back pain and upper back pain include:

• Poor posture
• Muscle strains
• Repetitive motions and overuse
• Herniated discs
• Spinal stenosis
• Arthritis or other degenerative joint conditions
• Osteoarthritis
• Vertebral fractures
• Inflammation
• Nerve damage

Activ8 Posture’s holistic posture therapy program can help determine the root cause of your pain so you can begin an appropriate treatment plan. That being said, it’s important to speak with your doctor in severe cases to find the appropriate treatment options. 

Where is thoracic back pain located?

Thoracic back pain occurs anywhere in the middle and upper spine between the base of the neck to the lower back. While it’s common that pain in this area could be caused by a muscle strain or misaligned vertebra, conditions such as spinal stenosis, osteoarthritis, herniated discs, tumors, and scoliosis can also produce thoracic pain.

What does thoracic back pain feel like?

Symptoms of thoracic back pain often include a dull ache in the mid to upper back. It may also present as a sharp, shooting pain or throbbing sensation that’s felt when you move or twist your torso. Sometimes, it can radiate down your spine to your lower back, abdomen, or other parts of your body.

Why is thoracic back pain a red flag?

Mechanical musculoskeletal issues such as misalignment, inflammation, or strain cause many cases of thoracic back pain. A recent injury or trauma (like a car crash or a significant fall) that creates pain in the thoracic region should be considered a red flag as it could be a sign of a more serious problem. Visceral (organ) pain and thoracic back pain can mimic each other due to shared nerves coming out of the spinal cord. Persistent, severe thoracic back pain that does not go away with rest or posture correction should not be taken lightly and may require medical attention.

What is the difference between thoracic back pain and lumbar back pain?

Thoracic back pain serves as an umbrella term for any type of discomfort felt in the thoracic region or middle section of your back. In contrast, lumbar back pain specifically involves the lower area, extending from between your rib cage and hips. Generally speaking, pain in the thoracic spine can be more focused, while pain located in the lower back tends to be more spread out. It’s important to identify where the discomfort is coming from so you can take steps to correct the problem.

How can I prevent further upper back pain?

To help prevent further episodes of thoracic back pain, there are a few steps you can take. Exercise regularly, maintain proper posture and body mechanics at work or while playing sports, and do not overdo it with activities.

Additionally, make sure you’re seated in the right position when working at a desk or computer – adjust your chair’s height or add extra support as needed. Also, be mindful of how you lift objects and use appropriate ergonomic techniques. Finally, stretch often to keep your muscles flexible and strong.

What’s the difference between acute thoracic back pain and chronic thoracic back pain?

Acute thoracic back pain develops suddenly, usually from an identifiable injury. It may resolve within a matter of days but may last up to six weeks. Acute back pain can appear from a variety of causes, such as muscle strain or sprain, intervertebral disc herniation, radiculopathy, fractured vertebrae, or poor posture.

Chronic thoracic back pain tends to develop gradually over time and often becomes progressively worse. Chronic back pain is defined as lasting longer than three months or occurring intermittently over six months. Cases of chronic upper back pain can be caused by conditions such as osteoarthritis, herniated disc, spinal stenosis, degenerative disc disease, facet jointdysfunction, scoliosis, and poor posture.

Sources

• Chen X, Coombes BK, Sjøgaard G, Jun D, O’Leary S, Johnston V. Workplace-based interventions for neck pain in office workers: systematic review and meta-analysis. Phys Ther 2018;98(1):40–62. doi:10.1093/ptj/pzx101
• Watson SL, Weeks BK, Weis LJ, et al. High-intensity exercise did not cause vertebral fractures and improves thoracic kyphosis in postmenopausal women with low to very low bone mass: the LIFTMOR trial. Osteoporos Int 2019;30(5):957–964. doi:10.1007/s00198-018-04829-z