Poor posture or accidental muscle strains can contribute to middle back pain.

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Like the upper back, the mid-back region is very stable, and this stability gives it some protection from injury. But the same underlying conditions and circumstances that can result in upper back pain also can result in middle back pain. These include:

1. Poor posture

This is a major risk factor for middle back pain, particularly if you have a desk job and are in the habit of hunching over a keyboard for long periods of time. You can stop middle back pain (and upper back pain) before it starts by getting into the habit of sitting up straight and doing frequent shoulder rolls and lifts in order to loosen the muscles of your upper back.

2. Muscle strain

Use the correct lifting technique to help you avoid middle back pain due to muscle strain—bend at the knees, and carry heavy objects close to your body.

3. Vertebral fractures

These are especially common in older adults, due to the bone-thinning disease osteoporosis. If you have osteoporosis, follow your doctor’s advice when it comes to taking osteoporosis medications, eating a calcium-rich diet, and supplementing with vitamin D if you don’t get sufficient sun to top up your vitamin D levels. (See also our post 10 Vitamin D Deficiency Symptoms You Can Identify Yourself.)

4. Herniated spinal disk

A herniated disk bulges out from between the vertebrae and may press on the spinal nerves, causing middle back pain. In some cases, surgery may be needed to remove a herniated disk.

5. Myofascial pain

Myofascial pain affects the fascia (the connective tissue in and between muscles), and is characterized by knotty “trigger points” that hurt if pressed. If your middle back pain is a burning, tingling sensation, it may be myofascial in nature, especially if you play sports that require heavy use of the large shoulder muscles. A physical therapist can show you exercises to stretch and strengthen your muscles, and your middle back pain also may respond to massage, trigger-point therapy (pressure applied to areas of knotted muscle), and trigger point injections (lidocaine shots directly into the trigger points).

Serious Causes of Middle-Back Pain

Rarely, middle back pain can herald a serious underlying condition, so always mention the pain to your doctor, particularly if it comes on suddenly or has no obvious cause, or is preceded or accompanied by other symptoms.

Look out for these back pain red flags:

6. Heart Attack

Women in particular may develop referred middle back pain from a heart attack. Call your doctor immediately if your middle back pain is accompanied by a feeling of tightness or pressure in your chest that radiates to your shoulders and arms, shortness of breath, dizziness, nausea, and/or vomiting.

7. Aortic aneurysm

Middle back pain can also be a symptom of aortic aneurysm. The aorta is your largest artery, and carries oxygenated blood and vital nutrients to all parts of your body, including the heart. A healthy aorta has elastic walls that expand and contract with the ebb and flow of blood, but if any part of the aorta is rendered fragile by disease, the abnormal tissue can bulge or balloon out to form an aneurysm. Aortic aneurysms are a serious health risk because the pressure exerted on the aneurysm by normal blood flow may cause it to dissect or rupture. This causes severe chest pain, and rapid blood loss that can be life threatening.

8. Pleurisy

Pleurisy (inflammation of the lining surrounding the lungs) is another chest condition that can cause sharp, stabbing chest pain that radiates to cause pleurisy back pain. Pleurisy is not serious, but it can signal serious conditions like pneumonia and lung cancer.

Abdominal Pain vs. Middle Back Pain

What if the pain in your midsection isn’t related to bone- or muscle-related causes, or to the other conditions described above? It could, for example, involve kidney pain, which can seem as if it emanates from the mid-back region. Kidney pain could indicate a brewing infection that could severely damage your kidneys, particularly if you’ve recently had a urinary tract infection.

Also, pancreas pain caused by pancreatitis can radiate to the mid-back region from the abdomen, so tell your doctor immediately if you experience this type of radiating discomfort. It also may indicate pancreatic cancer. In one study, 17 percent of pancreatic cancer patients reported pain in the middle of their back as a symptom.

Originally published in 2016, this post is regularly updated.