Thoracic back pain: symptoms, causes, treatments

You don’t often hear people talk about thoracic back pain (or middle back pain), but it’s more common than you may think. This type of back pain affects the area between your neck and lower back and can show up as stiffness, soreness, or discomfort around the shoulder blades or ribs.

“Thoracic back pain can have a lot of contributors — from stress and inactivity to spending too much time in one position,” says Rodrigo Quevedo, PT, DPT, a physical therapist at Hinge Health. “But gentle movement is one of the most reliable ways to help alleviate thoracic back pain and get you back to doing what you love.”

Read on to learn what causes thoracic back pain and how to manage it, including targeted exercises recommended by Hinge Health physical therapists.

What is thoracic back pain?

Thoracic back pain refers to pain between your neck and lower back. It includes 12 vertebrae that connect with your ribs and help form your rib cage, which protects your heart and lungs.

The mid-back works together with your ribs and chest to support everyday movements like rotating, reaching, and turning. It tends to be less involved in day-to-day movement than your neck or low back — especially if you spend a lot of time sitting. “Because this part of your spine stabilizes your rib cage, it moves a bit less than those other areas, which can lead to stiffness and discomfort,” Dr. Quevedo says.

Your thoracic spine is resilient and designed to be strong and adaptable, but it can sometimes become sore or stiff, especially if surrounding muscles become strained. While it may feel counterintuitive to exercise when you have middle back pain, movement can help you get relief. “Adding gentle rotation and extension exercises can help restore comfort and make daily activities feel easier,” says Dr. Quevedo.

Causes of thoracic spine pain 

Thoracic back pain is rarely linked to just one cause. Some contributors — like age, underlying health conditions, or past injuries — are part of life. But others are more controllable, including your activity, movement habits, and stress levels. Common contributors include:

• Muscle strain. Your back is strong and designed to lift and carry heavy items, but doing more than your body is ready for, lifting while fatigued, or making a sudden movement can pull (strain) a muscle in your mid-back. 

• Doing more than usual. Your body is designed to bend, twist, reach, and lift. However, suddenly doing these activities much more than you are used to can sometimes irritate your mid-back.

• Postural issues. “While there's no such thing as the perfect posture, lack of postural variety can make you achy,” says Dr. Quevedo. When you stay in the same position for a long time — whether you’re standing, sitting bolt upright, or sitting with rounded shoulders working at your desk — it can contribute to middle back pain.

• Inactivity. When your body isn’t moving regularly, many areas — including your mid-back — can become more sensitive and stiff. 

• Stress and tension. Stress can lead to back pain, as it contributes to muscle tension in this area (and all across your body). Ongoing stress can raise nervous system sensitivity and muscle guarding, which can make back discomfort feel more intense. This can create a vicious cycle where pain increases stress and stress amplifies pain. 

• Arthritis and age-related spinal changes. It’s normal for spinal joints and discs to change over time. Osteoarthritis of the mid-back (thoracic spondylosis) and inflammatory forms of arthritis (such as ankylosing spondylitis) can contribute to mid-back pain and stiffness for some people. 

• Spinal stenosis. This condition involves a narrowing of the spinal canal, which can put pressure on neighboring nerves. Spinal stenosis more often affects the lower back and neck, but it's possible to feel discomfort in your middle back too.

• Scoliosis (spinal curvature). This condition causes the spine to curve sideways. When weight is distributed unevenly in your back, it’s possible to have pain throughout the back, including the thoracic spine. “Back pain is usually more common in people with lower-back spinal curvature, but thoracic scoliosis can also cause pain,” says Dr. Quevedo.

• Recent or past back injuries. Falls, accidents, or hard impacts — like a sports collision or car accident — can trigger thoracic back pain. Even a one-time injury can lead to lingering mid-back discomfort for some people.

Symptoms of thoracic spine pain

Not everyone with middle back pain will have the same symptoms. The most common ones include: 

• Aching or stiffness in the mid-back

• Sharp or localized discomfort between the shoulder blades

• Pain with certain movements or deep breathing

• Muscle tension or cramping sensations

• Numbness or tingling

How movement can help alleviate thoracic back pain

If your mid-back is sore, you might feel hesitant to exercise, but movement is medicine. “The thoracic spine is built more for stability than the neck or low back, so it can benefit from a little extra motion,” Dr. Quevedo says. “Stretching and mobility work often help decrease discomfort and make daily activities feel easier.” Once you ease tension in this area, you can begin incorporating gentle strengthening exercises. 

Movement helps reduce stiffness by promoting blood flow, calming pain sensitivity, and improving comfort with everyday tasks, like reaching for an object on a high shelf or twisting to put your seatbelt on in the car. The below exercises can also help your body regain confidence in movement — which is an important part of recovery.

These stretches and strengthening moves can help improve mid-back mobility, ease tension, and make everyday movement feel more comfortable. Practicing them regularly helps your body build tolerance and confidence with motion.

It’s normal to feel a little sore when you start new exercises — it doesn’t mean you’re causing harm. Begin gradually and increase your reps and range over time. Aim for about 10 repetitions of each move above, holding stretches for 3-5 seconds, and working within a comfortable range.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for thoracic back pain

Thoracic back pain often improves with simple, at-home care. Strategies like targeted movements, heat or cold therapy, and breathing exercises can help calm symptoms and support recovery. Here are some effective ways to ease mid-back discomfort:

• Try physical therapy and targeted exercises. Targeted exercises, like the ones above, can help you ease tension around your thoracic spine and strengthen key supporting muscles. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. It’s normal to feel cautious about movement when your mid-back hurts, but gentle activity is one of the most reliable ways to feel better. Low-impact options like walking, swimming, or the elliptical can increase blood flow to tender areas. “When you gradually return to comfortable movement, pain often becomes less intense and limiting,” says Dr. Quevedo.

• Apply heat or cold therapy. Either therapy may help you feel better. Cold therapy can help reduce swelling and numb pain receptors. Heat, on the other hand, can help boost blood flow and break up stiffness or muscle tension. Consider alternating between using an ice pack and a heating pad as needed, or stick to the method that works best for you. 

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have middle back pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Try breathing exercises. Deep breathing, especially diaphragmatic breathing, can help manage back pain by calming the nervous system (to relax tense muscles and reduce pain intensity) and strengthening deep core muscles that support the spine. 

• Make lifestyle modifications. Factors like sleep, stress, nutrition, and certain activities can all play a role in how you feel. In fact, many people are surprised to learn that pain isn’t just about what’s happening physically — your daily habits and overall well-being can have a real impact, too. Staying curious about how your routines affect your muscles and joints can help you identify where small changes might help reduce pain. For example, you might notice your pain is less noticeable on low-stress days.

• Consider complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for thoracic back pain relief, such as massage, acupuncture, or chiropractic care.

• Ask about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce back pain. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

Prevention tips for thoracic spine pain

While you can’t always prevent mid-back pain, you can reduce tension in the area with proactive approaches, such as adjusting your posture, making your workstation more ergonomic, and working with a physical therapist when starting a lifting routine. Consider these PT-backed prevention tips:  

• Change positions regularly. Again, there’s no such thing as perfect posture, but you can improve it by switching up your positions regularly and moving throughout the day. This helps keep the muscles supporting your spine flexible and warm. “When sitting or standing, try to keep your shoulders relaxed and rolled slightly back,” Dr. Quevedo suggests. 

• Stay consistent with a strength training routine. Regular strength work — especially for your core and back — helps make everyday movements feel easier and more supported. Think of your core muscles as a natural brace, helping distribute force evenly and reducing strain on your spine and surrounding muscles during daily activities and exercise. 

• Set up your workstation for comfort. Consider using a chair and desk setup that feels supportive and adjustable so you can change positions easily. Small tweaks — like screen height or arm support — can improve comfort, but regular movement breaks matter most.

• Take movement snacks. Take short movement breaks every 30-60 minutes to stand, stretch, or walk and reset your position. “Even the most comfortable workstation setup can’t replace regular movement,” says Dr. Quevedo. “There’s really no substitute for it.” 

• Try foam rolling. Foam rolling uses a foam tube to help relieve back muscle tightness and soreness in the middle back. It applies pressure to areas that are tight, helping to release them.

• Work with a physical therapist to nail lifting form. There’s no single “right” way to lift — everyone’s body looks different. Use a technique that feels natural to you and build up weight and effort gradually to protect your back. Working with a physical therapist can help you find an approach that feels comfortable for you, so you can lift heavy with confidence.

• Try relaxation techniques. Practices like slow breathing, meditation, and progressive muscle relaxation (where you gently tense and then relax different muscle groups) can help calm your nervous system and ease muscle tension throughout your body, including in your mid-back. Simple self-care — like journaling, a warm bath, or time outdoors — can help too.

When to see a doctor

Thoracic back pain often improves on its own with simple, at-home treatments. But if your pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. You should also seek medical care if you start to develop symptoms that could indicate  cardiopulmonary issues, including:

• Pain that started after a significant fall or accident

• Tingling, numbness, or weakness in your legs or buttocks

• Difficulty breathing

• Sudden, severe chest pain that doesn’t go away

• New symptoms such as fever, unexplained weight loss, or bowel or bladder changes

• A new, unusual lump, swelling, or visible change in your back shape

PT tip: Breathe through your targeted movements 

Try to keep your breathing steady and relaxed as you move, says Dr. Quevedo. “If an exercise feels harder than expected, people are often holding their breath without even realizing it,” he says. “Let your breath stay easy and natural as you move.” Breathing through your nose can also help keep your pace calm and controlled.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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3. Branch, N. S. C. and O. (2021, November 30). Living With Back Pain: Health Information Basics for You and Your Family. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/community-outreach-initiative/understanding-muscle-health/living-with-back-pain

4. TOPRAK ÇELENAY, Ş., & ÖZER KAYA, D. (2017). An 8-week thoracic spine stabilization exercise program improves postural back pain, spine alignment, postural sway, and core endurance in university students:a randomized controlled study. TURKISH JOURNAL of MEDICAL SCIENCES, 47(2), 504–513. doi:10.3906/sag-1511-155

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