Thoracic Back Pain: Causes, Symptoms, and Treatment

Thoracic back pain affects the area between your neck and lower back. This is the middle part of your spine. It includes 12 vertebrae (T1 to T12) that connect to your ribs. This type of pain is less common than lower back pain, but it can be just as uncomfortable. Rest assured: in the vast majority of cases, it does not indicate a serious problem.

Many people experience this pain after long hours sitting at a computer. Others develop it after unusual physical exertion or a poor night's sleep. Your thoracic back is a strong and well-designed structure. It protects your vital organs while allowing the rotational and bending movements necessary for your daily activities. If you are experiencing pain in this region, this guide will help you understand what's happening and what to do.

For an overview of back problems, consult our complete guide to back pain.

What is Thoracic Back Pain?

Thoracic back pain is discomfort felt in the middle part of your back. It is located between the base of your neck (C7 vertebra) and the bottom of your ribs (T12 vertebra). This region includes 12 thoracic vertebrae that attach to your 12 pairs of ribs. Together, these ribs form your rib cage.

The thoracic region of your spine plays a unique role. Unlike the neck (cervical region) and lower back (lumbar region), it is more rigid. This rigidity comes from its attachment to the ribs. Each thoracic vertebra connects to a pair of ribs through joints called costovertebral joints. This connection naturally limits bending and extension movements. However, it allows for good trunk rotation.

Thoracic pain can manifest in several ways. Some people experience a dull, constant ache. Others have sharp pains that appear with certain movements. The pain can remain localized in the middle back. It can also radiate towards the ribs, chest, or abdomen.

It is estimated that thoracic pain affects approximately 15 to 30% of adults at some point in their lives. This is less common than lumbar pain (80%) or cervical pain (50%). However, when it does occur, it can be a source of concern, especially when it radiates to the chest.

The good news is that, like other back regions, thoracic pain is rarely caused by a serious problem. In most cases, it results from muscle tension, joint stiffness, or postural issues. These conditions respond very well to conservative treatments like physiotherapy.

What is the difference between thoracic pain and lumbar pain?

Thoracic pain is located in the middle back. It involves vertebrae T1 to T12, which are attached to the ribs. Lumbar pain affects the lower back (vertebrae L1 to L5). These two regions have different functions and movements, leading to different types of problems.

The thoracic region is naturally more stable than the lumbar region. This stability comes from several factors. The ribs create a rigid framework around your thoracic vertebrae. The facet joints (small joints between the vertebrae) are oriented differently. They limit flexion and extension while allowing rotation.

The lumbar region, on the other hand, bears the majority of your body's weight. It allows for extensive movements of flexion (bending forward) and extension (stretching backward). This is why disc problems are more common in the lower back than in the middle back.

Thoracic pain also has distinct characteristics. It can often be reproduced by pressure on the ribs or by rotational movements. It can radiate along the ribs towards the front of the body. When you breathe deeply, the pain may increase if the problem involves the joints between the ribs and the vertebrae.

Lumbar pain, however, tends to worsen with flexion (bending) or prolonged extension (standing for a long time). It can travel down the legs if a nerve is irritated. Thoracic pain rarely extends below the waist.

To better understand the anatomy of your spine and how its different regions interact, consult our guide to spinal anatomy.

What are the causes of thoracic back pain?

The most common causes are muscle tension, joint dysfunctions (stiff or blocked joints), postural problems, and rib dysfunctions. Unlike the lower back, disc herniations are rare in the thoracic region due to the natural stability of this area.

Several structures can cause pain in your thoracic back. Understanding these causes helps you better interpret your symptoms and communicate effectively with your healthcare professional.

Muscle Tension and Spasms

The muscles of the thoracic back are constantly engaged. They maintain your posture, allow trunk rotation, and also participate in breathing. When these muscles are overworked or tense, they can become painful.

Frequently involved muscles include the rhomboids (between your shoulder blades), the trapezius (which covers a large part of your upper back), and the erector spinae (the muscles along your spine). A spasm in these muscles can create a dull, constant pain. You might feel a tender spot or a tight area.

Common causes of thoracic muscle tension include:

• Sitting for long periods in front of a computer
• Straining while lifting heavy objects
• Sleeping in an uncomfortable position
• Making a sudden or unusual movement
• Emotional stress (which often creates tension in the shoulders and upper back)

Joint dysfunctions

Your thoracic region contains several types of joints. Facet joints connect the vertebrae to each other. Costovertebral joints connect the ribs to the vertebrae. Costotransverse joints connect the ribs to the transverse processes (small bony projections on the sides of the vertebrae).

When these joints become stiff or restricted in their movement, they can cause pain. This is known as joint dysfunction or hypomobility. The pain is often localized and can be reproduced by applying pressure to the affected joint.

These dysfunctions can occur after:

• Prolonged immobility (sitting for long periods without moving)
• A sudden movement
• A minor injury
• Maintaining a posture for hours

Rib Dysfunctions

Your ribs connect with your thoracic vertebrae at the back and with your sternum at the front (except for the last two pairs of ribs, which are floating). These connections can become dysfunctional and cause pain.

A rib dysfunction can cause pain that:

• Is located next to your spine
• Radiates along the rib towards the front
• Increases with deep breathing
• Worsens when you cough or sneeze

Rib dysfunctions are sometimes mistaken for heart or lung problems when the pain radiates to the chest. This is an important reason to seek a precise diagnosis.

Postural problems

Posture plays an important role in the health of your thoracic back. A posture with rounded shoulders and a forward head increases the load on the structures in your thoracic region.

This posture, often called "desk posture" or excessive thoracic kyphosis, can:

• Excessively stretch the muscles in your upper back
• Compress the facet joints
• Reduce the mobility of your ribs
• Create chronic tension points

The good news is that posture is not a life sentence. Your body can adapt and change. Physiotherapy can help you improve your mobility and reduce posture-related tension.

Scheuermann's Disease

Scheuermann's disease is a condition that develops during adolescence. It causes an excessive rounding of the thoracic spine (hyperkyphosis). This condition affects approximately 1 to 8% of adolescents.

In this condition, the thoracic vertebrae develop asymmetrically. The front of the vertebra grows slower than the back. This creates wedge-shaped vertebrae that contribute to the excessive rounding.

In adults, Scheuermann's disease can cause:

• Stiffness in the upper back
• Pain after prolonged activities
• Muscle fatigue
• A more rounded posture

Less common conditions

Some conditions are less common but worth mentioning:

Herniated Thoracic Disc : Discs in the thoracic region can herniate, but this is rare. Thoracic disc herniations account for less than 1% of all disc herniations. The natural stiffness of this region protects the discs. To understand disc herniations in more detail, please refer to our guide to lumbar disc herniation, as the principles are similar. Thoracic Outlet Syndrome : This condition affects the nerves and blood vessels that pass between your neck and shoulder. It can cause pain in your upper back, shoulder, and arm. Thoracic Osteoarthritis : Like all joints, those in your upper back (thoracic spine) can develop osteoarthritis as you age. However, the presence of osteoarthritis on an X-ray doesn't necessarily mean you'll experience pain. Many people have osteoarthritis without any symptoms.

What are the symptoms of thoracic back pain?

Typical symptoms include a dull or sharp pain in the middle of the back. It can radiate along the ribs. It often increases with certain movements or positions. You may also feel stiffness, muscle tension, or tenderness to the touch in the affected area.

Thoracic back pain presents differently depending on its cause. Recognizing your symptoms helps you better understand your condition and communicate effectively with your physiotherapist.

Common pain patterns

Localized and Pinpoint Pain : You might be able to identify a specific, tender spot. This often suggests a joint problem or a muscle trigger point (a very sensitive area within a muscle). Dull and Widespread Pain : This is pain that covers a larger area, often felt between your shoulder blades. It's typical of chronic muscle tension or postural problems. Radiating Pain : This is pain that follows the path of a rib, from the back towards the front of your body. It suggests a rib joint problem or irritation of an intercostal nerve (a nerve that runs along the rib). Pain that Increases with Breathing : When deep breathing, coughing, or sneezing makes your pain worse, it's often related to the joints between your ribs and your spine.

Associated symptoms

In addition to pain, you might experience:

• Stiffness: Difficulty turning your torso or bending over. This stiffness is often worse in the morning or after a period of inactivity.

• Muscle Tension: A feeling of knots or tight bands in your back muscles.

• Tenderness to the Touch: Certain areas of your back may be sensitive when you press on them.

• Cracking or Popping Sounds: Cracking sounds during certain movements. These noises are generally harmless and do not mean that something is damaged.

• Referred Pain: Pain may be felt in other areas such as the front ribs, flanks, or even the abdomen.

What is normal and what is not

Most thoracic pain is benign. It improves with time and appropriate treatment. However, some symptoms require prompt medical attention. We will discuss these red flags later in this guide.

How is thoracic back pain diagnosed?

Diagnosis is mainly based on a clinical assessment. Your healthcare professional will ask you about your symptoms, examine your posture, test your movements, and feel the structures in your back. Imaging is generally not needed unless "red flags" are present.

Clinical evaluation

The assessment begins with a detailed discussion of your symptoms. Your physiotherapist or doctor will want to know:

• When the pain began
• How it started (gradually or suddenly)
• Where exactly you feel the pain
• What makes your pain better or worse
• If you have other symptoms (numbness, weakness, breathing problems)
• Your daily activities and your work

The physical examination includes several elements:

Posture Assessment : Your therapist will observe your posture while you are standing and sitting. They will note the curve of your spine, and the position of your shoulders and head. Movement Tests : You will be asked to perform various movements, such as bending forward (flexion), bending backward (extension), twisting (rotation), and bending sideways (lateral flexion). This helps identify which movements reproduce your pain. Palpation : Your therapist will gently touch the structures of your back to identify tender areas, muscle tension, and any restricted movement. Specific tests : Additional tests may be performed to assess specific joints, nerves, or muscle structures.

Medical imaging

Imaging (X-ray, MRI, CT scan) is generally not needed for typical chest pain. Research shows that routine imaging does not improve treatment outcomes for most back pain.

Imaging may be recommended if:

• Your symptoms do not improve after several weeks of treatment
• You have "red flags" (see next section)
• Your healthcare professional suspects a specific condition that needs confirmation

It's important to know that imaging results should be interpreted carefully. "Abnormalities" on an X-ray or MRI are often present in people who don't have any pain. Having degenerative changes on imaging does not mean that this is the cause of your pain.

What are the "red flags" for thoracic back pain?

"Red flags" include sudden severe chest pain, pain accompanied by fever or unexplained weight loss, coordination problems or weakness in the legs, and pain that doesn't improve with rest. These situations are rare but require prompt medical evaluation.

Rest assured: serious causes of chest pain are rare. Less than 1% of back pain is caused by a serious condition. However, it's important to recognize signs that require immediate medical attention.

Symptoms requiring urgent consultation

Consult an emergency room immediately if you have:

• Sudden and severe chest pain, especially if it spreads to the chest, left arm, or jaw (possible heart problem)
• Difficulty breathing or severe shortness of breath
• Weakness or numbness in both legs
• Loss of bladder or bowel control
• Pain following a significant injury (fall, car accident)

Symptoms requiring prompt medical consultation

Consult your doctor in the next few days if you have:

• Fever accompanying your back pain
• Unexplained weight loss
• A history of cancer
• Pain that wakes you up at night and isn't relieved by any position
• Pain that gradually worsens despite rest
• A history of intravenous drug use or immune suppression

Chest Pain and Heart Problems

Chest pain can sometimes be mistaken for heart problems, and vice versa. Musculoskeletal pain in the thoracic back is generally:

• Triggered by movements or pressure on the back
• Localized and stable (does not move)
• Not accompanied by shortness of breath, sweating, or nausea
• Present for days or weeks

Heart pain tends to be:

• Not affected by back movements or pressure
• Accompanied by other symptoms (shortness of breath, sweating, nausea)
• More intense with exertion
• Felt as a pressure or tightness

When in doubt, always consult a professional. Your health is worth this precaution.

What are the treatment options for thoracic back pain?

Treatment options include physiotherapy, mobility and strengthening exercises, postural adjustments, stress management, and sometimes anti-inflammatory medications. Surgery is very rarely needed for chest pain. Most cases improve with conservative treatments.

The Initial Approach

When chest pain occurs, here are the recommended first steps:

Stay Active : Contrary to what was once believed, prolonged bed rest does not help with healing. Continue your normal activities as much as possible, while avoiding movements that significantly worsen your pain. Apply Heat : Heat can help relax tense muscles and improve blood circulation in the area. Use a hot water bottle or a heating pad for 15 to 20 minutes, several times a day. Move Regularly : Gentle movements like trunk rotations, stretches, and walking can help maintain mobility and prevent stiffness. Manage Your Posture : If you work sitting for long periods, take regular breaks to stand up, walk, and stretch. Adjust your workstation to reduce strain on your back.

Medications

Medications can help manage pain during the acute phase, but they do not treat the underlying cause. Common options include:

• Anti-inflammatories (like ibuprofen): Can help reduce inflammation and pain. Use them as directed and not longer than necessary.

• Acetaminophen (Tylenol): Can help relieve pain without anti-inflammatory effects.

• Muscle relaxants: Sometimes prescribed for severe muscle spasms, but their effectiveness is limited.

Discuss with your doctor or pharmacist before taking any medication, especially if you have other health conditions.

Physiotherapy

Physiotherapy is generally the most effective treatment for musculoskeletal chest pain. Your physiotherapist can:

• Precisely assess the source of your pain
• Use manual techniques to improve the mobility of joints and soft tissues
• Teach you specific exercises for your condition
• Helping you correct the factors that contribute to your pain

To learn more about how physiotherapy can specifically help with your thoracic back pain, consult our guide on physiotherapy for thoracic back pain.

How can physiotherapy help with thoracic back pain?

Physiotherapy helps by improving the mobility of the thoracic joints and ribs, releasing muscle tension, strengthening postural muscles, and teaching you self-management strategies. It is the recommended first-line approach for most mechanical thoracic pain.

What physiotherapy offers

Manual therapy : Your physiotherapist can use joint mobilization techniques to restore normal movement to your vertebrae and ribs. These techniques are gentle and progressive. Soft tissue techniques : Massage, myofascial release, and trigger point therapy can help reduce muscle tension and improve circulation in tense muscles. Therapeutic exercises : You will receive a personalized exercise program which may include:

• Thoracic mobility exercises
• Specific stretches
• Strengthening exercises for back and core muscles
• Breathing exercises

Education : Your physiotherapist will explain your condition, teach you self-management strategies, and help you modify the factors contributing to your pain.

When to seek physiotherapy

Seek physiotherapy if:

• Your pain lasts more than a few days
• Pain limits your daily activities
• You want to understand the cause of your pain
• You want strategies to prevent recurrence
• You experience recurring episodes of thoracic pain

Physiotherapy is effective for the vast majority of musculoskeletal thoracic pain. Most patients see significant improvement within a few weeks of treatment. For a complete guide on specific techniques and approaches, consult our guide on physiotherapy for thoracic back pain.

Frequently Asked Questions about Thoracic Back Pain

Can thoracic back pain be caused by stress?

Yes, emotional stress can contribute to thoracic pain. Stress often causes muscle tension in the shoulders and upper back. This chronic tension can lead to trigger points and pain. Stress management, including deep breathing, exercise, and adequate sleep, can help reduce this tension.

How long does thoracic back pain last?

The duration varies depending on the cause. Most muscle or joint-related thoracic pain improves within a few days to a few weeks with appropriate care. If your pain persists beyond 4 to 6 weeks without improvement, consult a healthcare professional for a more in-depth evaluation.

Can I exercise with thoracic back pain?

Generally, yes, but with modifications. Avoid exercises that significantly worsen your pain. Gentle exercises like walking, swimming, or stationary cycling are often well-tolerated. Consult your physiotherapist for recommendations specific to your condition.

What exercises can help with thoracic pain?

Thoracic mobility exercises (rotations, extensions on a foam roller), pectoral muscle stretches, and strengthening exercises for the muscles between the shoulder blades are often beneficial. Your physiotherapist can show you the most appropriate exercises for your situation.

Can chest pain cause breathing problems?

Yes, if the joints between your ribs and spine are stiff, it can restrict your rib cage from expanding fully when you take a deep breath. This can lead to a feeling of shortness of breath or difficulty taking a full breath. Physiotherapy can help improve this movement.

When should I be concerned about my thoracic back pain?

Seek medical attention promptly if your pain is accompanied by fever, unexplained weight loss, leg weakness, bladder or bowel problems, or if it spreads to your chest with symptoms like shortness of breath. These situations are uncommon but require a medical evaluation.

Key points about thoracic back pain

Thoracic back pain is usually caused by muscle tension, stiff joints, or poor posture. It is rarely linked to a serious condition. Most cases improve with conservative care, including physiotherapy, exercises, and changes to your posture.

Your thoracic back is a strong and resilient structure. Even if it's painful now, it has the ability to heal and adapt. Physiotherapy can speed up your recovery and provide you with the tools to prevent future problems.

If you are experiencing thoracic back pain, don't hesitate to seek professional help. A professional assessment can help you understand exactly what's happening and receive the most appropriate treatment for your condition.

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