Common Causes of Middle Back Pain

Underlying conditions and circumstances can result in middle back pain.

middle back pain

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

ID 22943948 © Robert Kneschke |

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.

As a service to our readers, University Health News offers a vast archive of free digital content. Please note the date published or last update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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Kate Brophy

Kate Brophy is an experienced health writer and editor with a long career in the UK and United States. Kate has been Executive Editor of the Icahn School of Medicine … Read More

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  • Wrong sitting position and wrong sleeping position may cause middle back pain. It’s rare. Most people suffer from lower back pain due to incorrect sleeping, lifting overweight, irregular exercise etc. Thank you, Andre

  • This article is awesome! Thank you Kate for this. Other causes include aging and obesity. Inversion therapy, using an inversion chair or table, can help to relieve middle back pain.

  • I had to opinions from surgeons that I need surgery on my lower back lately the middle and top back have been hurting I also have been nauseous on top of feeling very tired it could be a virus maybe but how long after feeling like this should I be concerned if any

  • Most of the time people hurt their back doing something simple like bending over to tie their shoes, or trying to get out of the recliner…or God forbid…they injure themselves sleeping! Things like that are NOT traumatic events and they shouldn’t ever cause your back to “go out.” They are really just an indication of a bigger underlying problem that you can fix,if you correct your body imbalances. This is ultimately the secret to long term back pain relief. Identify your unique body imbalances and correct them. and here is the crazy thing…Regardless of your age or diagnosis. If you restore balance to your body, it takes the stress off of your back and you feel better. Period.

  • If your body is balanced, you can live a long, active life without back pain.
    When it is out of balance (too much of a curve, not enough curve, leaning too far forward, leaning too far back, muscles tighter on one side than the other) your back simply won’t hold up over time.

  • I appreciate the information given in this blog about the cause of back pain and different types of preventive measures which should be taken to cure such problems. Stagnant lifestyle is solely responsible for the origin of the back pain. Besides, stagnant lifestyle also responsible for the origin of many health issues including issues in the cardiovascular system of the body. Besides, massage therapy also helps to heal the damages done to the muscle tissue of our body. For more assistance in this regard, visit

  • I get sudden cramp like sharp pain accompanied with full feeling pains in my ribs and middle back that get more intense if I don’t hold my breath and push out the air in my lungs hard like I’m trying to stretch them out words. It will eventually ease up and I can go about my day but sometimes it takes a long time and other times it goes away shortly. I have to hold my ribs and sit down too. I’ve been having this problem since I was a kid. I have problems with severe night cramps in my inner thighs randomly that makes me scream and cry for mercy as well and that can take up to half an hour to reside. T is rather embarrassing to be crying and screaming in pain when someone heard me do this and I haven’t warned them ahead of time. I’m pretty tough when it come to pain but this is so intense that it impossible not to scream in agony especially if it attacks both inner thighs at the same time. I get anxiety when it kicks in suddenly because I know what excruciating pain is coming my way. I have to tell anyone that is around to ignore my screams and don’t try to help me because there is nothing anyone can do except maybe knock me out with a chokehold or something like that.

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