Clinically reviewed by What is middle back pain
Middle back pain is pain in the thoracic spine, the twelve vertebrae your ribs attach to, running from the bottom of the shoulder blades to the bottom of the ribs. Patients point to the spot and say darmiyani kamar mein dard.
It is much less common than lower back pain. This part of the spine is braced by the rib cage and moves less, so it is loaded less and strained less.
That is also why it deserves more care. When the middle back hurts with no clear mechanical reason, the chance the pain comes from an organ rather than the spine is higher here than anywhere else in the back.
Symptoms you might have
- Ache or stiffness across the middle of the back, often to one side of the spine
- A sharp catch with a deep breath, a cough or a sneeze, when a rib joint is involved
- Pain that wraps around the side of the chest along the line of a rib
- A clear link to one position or movement, which is a reassuring sign
- No link to movement at all, pain the same in every position, which is not reassuring
- Pain with fever, vomiting, burning urine or pain boring through to the front
Why it happens
- Stiff rib and spinal joints after long hours bent over work
- Motorbike riding on broken roads, which jars the whole spine
- A fall or a road accident, which can crack a rib or a vertebra
- Thinning bones, where a vertebra in the middle back can fracture under very little force. Our osteoporosis page covers this
- Pain referred from organs. The kidneys, gall bladder, stomach, pancreas, lungs and heart all refer into the middle back
- Shingles, which can give a band of burning pain a few days before the rash appears
When you should see a physiotherapist
Come in if the pain changes with movement and position, if it began after lifting, or if there is a stiff catch when you breathe in. That pattern is mechanical and physiotherapy handles it well.
See a doctor before a physiotherapist if the pain does not change with position, if it is worse at night, or if it comes with fever, vomiting, burning urine, blood in the urine or unexplained weight loss. The middle back is the one part of the spine where an organ cause is common enough to rule out first.
Go to a hospital the same day with numbness around the groin or back passage, loss of bladder or bowel control or weakness in both legs, and immediately with crushing chest pain, breathlessness or heavy sweating.
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اپائنٹمنٹ کے بارے میں پوچھیںAppointment ke liye poochein
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How it is treated
Once an organ cause is ruled out or clearly not the picture, treatment is aimed at the joints, the ribs and the muscles.
- Manual therapy to the thoracic and rib joints, usually the quickest win. A rib joint that starts moving again often settles the catch on breathing within days
- Exercise therapy: rotation, extension and trunk strengthening, so the area is not relying on being held still
- Breathing work, because people guard the breath when the middle back hurts, and shallow breathing keeps the ribs stiff
- Dry needling for the muscles beside the spine when they are locked in spasm
- Electrotherapy and TENS for pain relief in the first week or two
- Hijama (cupping therapy) for widespread tightness across the middle and upper back
Surgery is almost never needed for mechanical middle back pain. Thoracic disc problems severe enough to operate on are uncommon, and that decision belongs to a spine surgeon.
Exercises, and what to avoid
What helps
- Open book rotation, lying on your side with the knees bent and turning the top shoulder back
- Extension over a rolled towel placed across the middle back, a minute or two at a time
- Deep breathing with a hand on the side of the chest, so you can feel the lower ribs expand
- Band rows and shoulder blade work, to build endurance in the muscles that hold you upright
What to avoid
- Having your back cracked by untrained hands. Ribs are easy to injure
- Heavy overhead lifting while it is sore
- Holding your breath through exercises, which keeps the rib joints locked
- Stretching and heating pain that does not change with position. That pain needs a diagnosis, not treatment
What you can do at home
Heat is right for mechanical middle back pain. A hot pack for 15 to 20 minutes, two or three times a day. Ice has little use here beyond the first day after a direct knock.
Keep breathing deeply even if it catches. Guarded shallow breathing stiffens the ribs, and in older patients it raises the risk of a chest infection.
Do not strap or bind the chest to feel supported. It restricts exactly the movement you need.
If you have been told your bones are thin, treat new middle back pain as something to get checked rather than something to stretch out.
How long it takes
Mechanical middle back pain usually improves within two to four weeks. A stiff rib joint often eases within the first week once it moves again.
Muscle strain after lifting settles in two to three weeks.
A vertebral fracture in thinning bone is a different timeline. Pain from it usually eases over six to twelve weeks as the bone heals, managed with a doctor, with physiotherapy working on gentle movement, posture and bone loading afterwards.
If four weeks of proper treatment has changed nothing at all, that is a reason to go back to a doctor rather than to keep treating it.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
درمیانی کمر کا درد نچلی کمر کے مقابلے کم ہوتا ہے، کیونکہ یہ حصہ پسلیوں سے مضبوط جدا ہوتا ہے۔
یہاں احتیاط زیادہ چاہیے۔ گردے، پتے، معدے اور پھیپھڑوں کا درد بھی درمیانی کمر میں محسوس ہوتا ہے۔
اگر درد حرکت سے بدلتا ہے تو یہ جوڑ اور پٹھوں کا مسئلہ ہوتا ہے۔ مینول تھراپی، سانس کی ورزش، ٹینس اور گرم سیک فائدہ دیتے ہیں۔
پہلے ڈاکٹر کو دکھائیں اگر: درد کسی بھی پوزیشن میں کم نہ ہو، رات کو بڑھ جائے، بخار ہو، پیشاب میں جلن ہو، یا وزن بلا وجہ کم ہو رہا ہو۔
فوراً ہسپتال جائیں اگر: شرمگاہ یا پاخانے کے گرد سن ہونا ہو، پیشاب پاخانے پر کنٹرول ختم ہو جائے، دونوں ٹانگیں کمزور ہوں، یا سینے میں سخت درد ہو۔
Roman Urdu
Darmiyani kamar ka dard lower kamar ke muqable kam hota hai, kyunke ye hissa pasliyon se mazboot juda hota hai.
Yahan ehtiyat zyada chahiye. Gurde, pitte, meday aur phephron ka dard bhi darmiyani kamar mein mehsoos hota hai.
Agar dard harkat se badalta hai to ye jor aur pathon ka masla hota hai. Manual therapy, saans ki warzish, TENS aur garam sek faida dete hain.
Pehle doctor ko dikhayen agar: dard kisi bhi position mein kam na ho, raat ko barh jaye, bukhar ho, peshab mein jalan ho, ya wazan bila wajah kam ho raha ho.
Foran hospital jayen agar: sharamgah ya pakhane ke gird sun hona ho, peshab pakhane par control khatam ho jaye, dono taangein kamzor hon, ya seene mein sakht dard ho.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Questions people ask
Why is middle back pain treated more carefully than lower back pain?
What does it mean if my middle back hurts when I breathe in?
Can kidney problems cause middle back pain?
Could middle back pain be a fracture?
Is my middle back pain from gas or acidity?
Related conditions
- Lower back pain treatment
- Slip disc treatment
- Upper back pain treatment
- Scoliosis physiotherapy
- Kyphosis and rounded back