Thoracic back pain: causes, symptoms, and treatment

Thoracic back pain affects the area between the neck and lower back. This is the middle part of your spine. It consists of 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 sitting in front of a computer for long hours. Others develop it after unusual physical exertion or a poor night's sleep. Your thoracic spine is a strong, well-designed structure. It protects your vital organs while allowing the rotation and flexion movements necessary for your daily activities. If you experience pain in this area, this guide will help you understand what is happening and what to do about it.

For an overview of back problems, see our comprehensive 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 the neck (C7 vertebra) and the bottom of the 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 flexion and extension movements. However, it allows for good trunk rotation.

Chest pain can manifest itself in several ways. Some people experience a dull, constant pain. Others experience sharp pains that occur with certain movements. The pain may remain localized in the middle of the back. It may also radiate to the ribs, chest, or abdomen.

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

The good news: as with other areas of the back, chest pain is rarely caused by a serious problem. In most cases, it results from muscle tension, joint stiffness, or postural problems. These conditions respond very well to conservative treatments such as physical therapy.

What is the difference between chest pain and lower back pain?

Chest pain is located in the middle of the back. It involves the T1 to T12 vertebrae, which are attached to the ribs. Lower back pain affects the lower back (L1 to L5 vertebrae). These two areas have different functions and movements, and therefore different problems.

The thoracic region is naturally more stable than the lumbar region. This stability comes from several factors. The ribs create a rigid frame 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 most of your body weight. It allows for wide ranges of motion in flexion (bending forward) and extension (stretching backward). This is why disc problems are more common in the lower back than in the middle.

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

Lower back pain tends to worsen with flexion (bending over) or prolonged extension (standing for long periods). It can radiate down the legs if a nerve is irritated. Chest pain rarely extends below the waist.

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

What causes thoracic back pain?

The most common causes are muscle tension, joint dysfunction (stiff or locked joints), posture problems, and rib dysfunction. Unlike the lower back, herniated discs are rare in the thoracic region. This is 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 provider.

Muscle tension and spasms

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

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

Common causes of chest muscle tension include:

• Sitting in front of a computer for long periods of time
• Strengthen by lifting heavy loads
• Sleeping in an uncomfortable position
• Make 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 may occur after:

• Prolonged immobility (sitting still for long periods of time)
• A sudden movement
• Minor trauma
• A posture maintained for hours

Rib dysfunctions

Your ribs articulate 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 joints can become dysfunctional and cause pain.

Rib dysfunction can cause pain that:

• Located next to your spine
• Radiate along the coast toward the front
• Increases with deep breathing
• Worsens when you cough or sneeze

Rib dysfunctions are sometimes confused with heart or lung problems when the pain radiates to the chest. This is an important reason to seek medical advice for an accurate diagnosis.

Postural problems

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

This posture, often referred to as "office posture" or excessive thoracic kyphosis, can:

• Overstretching the muscles in your upper back
• Compress the facet joints
• Reducing 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. Physical therapy 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 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 more slowly than the back. This creates wedge-shaped vertebrae that contribute to 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:

Thoracic disc herniation : 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 rigidity of this region protects the discs. To understand disc herniations in more detail, see our guide to lumbar disc herniation, because the principles are similar. Thoracic outlet syndrome This condition affects the nerves and blood vessels that run between your neck and shoulder. It can cause pain in your upper back, shoulder, and arm. Thoracic osteoarthritis Like all joints, those in your thoracic spine can develop osteoarthritis with age. However, the presence of osteoarthritis on an X-ray does not necessarily mean pain. Many people have osteoarthritis without any symptoms.

What are the symptoms of thoracic back pain?

Typical symptoms include pain in the middle of the back, which may be dull or sharp. It may radiate along the ribs. It often increases with certain movements or positions. You may also experience stiffness, muscle tension, or sensitivity to 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 physical therapist.

Common pain patterns

Localized and occasional pain You can identify a specific point that is sensitive. This presentation often suggests joint dysfunction or a muscle trigger point (an area of hyperirritability in a muscle). Diffuse, dull pain : Pain covering a larger area, often between the shoulder blades. It is typical of chronic muscle tension or postural problems. Radiating pain Pain that follows the path of a rib, from the back to the front of the body. This suggests rib dysfunction or irritation of an intercostal nerve (nerve that runs along the rib). Pain that increases with breathing When breathing deeply, coughing, or sneezing increases your pain, it is often related to the joints between your ribs and vertebrae.

Associated symptoms

In addition to pain, you may 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 the muscles of your back.

• Sensitivity to touch: Certain areas of your back may be sensitive when you press on them.

• Cracking or popping sounds: Cracking sounds during certain movements. These sounds are usually harmless and do not mean that anything is damaged.

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

What is normal and what is not

Most chest 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?

The diagnosis is based primarily on clinical evaluation. Your healthcare provider will ask you questions about your symptoms, examine your posture, test your movements, and palpate the structures of your back. Imaging is not usually necessary unless there are red flags present.

Clinical evaluation

The evaluation begins with a detailed discussion of your symptoms. Your physical therapist or doctor will want to know:

• When the pain began
• How it appeared (gradually or suddenly)
• Where exactly do you feel the pain?
• What increases or decreases your pain
• If you have other symptoms (numbness, weakness, breathing problems)
• Your daily activities and work

The physical examination includes several elements:

Posture observation Your therapist will look at your standing and sitting posture. He or she will note the curvature of your spine and the position of your shoulders and head. Movement tests You will be asked to perform various movements: flexion (bending forward), extension (bending backward), rotation (turning), and lateral flexion (bending to the side). This helps identify which movements reproduce your pain. Palpation Your therapist will touch the structures of your back to identify sensitive areas, muscle tension, and restrictions in movement. Specific tests Additional tests may be performed to evaluate specific joints, nerves, or muscle structures.

Medical imaging

Imaging (X-ray, MRI, CT scan) is generally not necessary 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 provider suspects a specific condition that requires confirmation.

It is important to know that imaging results must be interpreted with caution. "Abnormalities" on an X-ray or MRI are often present in people who have no 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 does not 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 is important to recognize the signs that require immediate medical attention.

Symptoms requiring urgent medical attention

Seek immediate emergency medical attention if you have:

• Sudden, severe chest pain, especially if it radiates 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 control of your bladder or bowels
• Pain following a significant trauma (fall, car accident)

Symptoms requiring prompt medical attention

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 is not relieved by any position
• Pain that gradually worsens despite rest
• A history of intravenous drug use or immunosuppression

Chest pain and heart problems

Chest pain can sometimes be confused with heart problems, and vice versa. Musculoskeletal pain in the thoracic back is usually:

• Reproduced 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 during exercise
• Felt as pressure or tightness

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

What are the treatment options for thoracic back pain?

Treatment options include physical therapy, mobility and strengthening exercises, postural modifications, stress management, and sometimes anti-inflammatory medications. Surgery is very rarely necessary 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 aid recovery. Continue your normal activities as much as possible, while avoiding movements that significantly aggravate your pain. Apply heat Heat can help relax tense muscles and improve blood circulation in the area. Use a hot water bottle or heating pad for 15 to 20 minutes several times a day. Exercise regularly Gentle movements such as trunk rotations, stretching, and walking can help maintain mobility and prevent stiffness. Manage your posture If you work sitting down for long periods of time, take regular breaks to stand up, walk around, and stretch. Adjust your workstation to reduce strain on your back.

Medicines

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

• Anti-inflammatory drugs (such as ibuprofen): Can help reduce inflammation and pain. Use them as directed and no 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.

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

Physiotherapy

Physical therapy is generally the most effective treatment for musculoskeletal chest pain. Your physical therapist can:

• Accurately assess the source of your pain
• Use manual techniques to improve joint and soft tissue mobility.
• Teaching you specific exercises for your condition
• Helping you correct the factors contributing to your pain

To learn more about how physical therapy can specifically help you with your thoracic back pain, check out our guide to physical therapy for thoracic back pain.

How can physical therapy help with thoracic back pain?

Physical therapy 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 chest pain.

What physical therapy offers

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

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

Education Your physical therapist will explain your condition, teach you self-management strategies, and help you modify the factors that contribute to your pain.

When to seek physical therapy

Consult a physical therapist if:

• Your pain persists beyond a few days
• Pain limits your daily activities
• You want to understand the cause of your pain
• You want strategies to prevent recurrence
• You have recurring episodes of chest pain

Physical therapy is effective for the vast majority of musculoskeletal chest pain. Most patients see significant improvement within a few weeks of treatment. For a comprehensive guide to specific techniques and approaches, see our guide to physical therapy for thoracic back pain.

Frequently asked questions about thoracic back pain

Can stress cause thoracic back pain?

Yes, emotional stress can contribute to chest 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 chest pain of muscular or joint origin 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 further evaluation.

Can I exercise with chest back pain?

Generally yes, but with modifications. Avoid exercises that significantly aggravate your pain. Gentle exercises such as walking, swimming, or stationary cycling are often well tolerated. Consult your physical therapist for recommendations specific to your condition.

What exercises can help chest pain?

Chest mobility exercises (rotations, foam roller extensions), pectoral muscle stretches, and exercises to strengthen the muscles between the shoulder blades are often beneficial. Your physical therapist can show you the exercises that are most appropriate for your situation.

Can chest pain cause breathing problems?

Yes, if the joints between your ribs and vertebrae are stiff, this can limit the expansion of your rib cage when you take a deep breath. This can make you feel short of breath or cause difficulty taking a deep breath. Physical therapy can improve this mobility.

When should I be concerned about my thoracic back pain?

Seek immediate medical attention if your pain is accompanied by fever, unexplained weight loss, weakness in the legs, bladder or bowel problems, or if it radiates to the chest with symptoms such as shortness of breath. These situations are rare but require medical evaluation.

Key points to remember about thoracic back pain

Thoracic back pain is usually caused by muscle tension, joint stiffness, or postural problems. It is rarely related to a serious condition. Most cases improve with conservative care, including physical therapy, exercises, and postural modifications.

Your thoracic spine is a strong and resilient structure. Even though it is painful now, it has the ability to heal and adapt. Physical therapy can speed up your recovery and give you the tools to prevent recurrence.

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

References

• Briggs AM, et al. Thoracic spine pain in the general population: prevalence, incidence, and associated factors in children, adolescents, and adults. BMC Musculoskeletal Disorders. 2009;10:77.
• Fouquet B, et al. Prevalence of thoracic spine pain in a working population and associated factors. Rev Rhum Engl Ed. 1998;65(12):751-6.
• Manchikanti L, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Pain Physician. 2013;16(2 Suppl):S1-106.
• Bogduk N. Clinical Anatomy of the Lumbar Spine and Sacrum. 4th ed. Edinburgh: Churchill Livingstone; 2005.
• Lee DG. The Thorax: An Integrated Approach. 2nd ed. OPTP; 2003.
• Edmondston SJ, Singer KP. Thoracic spine: anatomical and biomechanical considerations for manual therapy. Man Ther. 1997;2(3):132-143.
• Griegel-Morris P, et al. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Phys Ther. 1992;72(6):425-31.
• Soo CL, Noble PC, Esses SI. Scheuermann kyphosis: long-term follow-up. Spine J. 2002;2(1):49-56.
• Arce CA, Dohrmann GJ. Herniated thoracic disks. Neurol Clin. 1985;3(2):383-92.
• Sanders RJ, Hammond SL. Management of thoracic outlet syndrome. J Vasc Surg. 2007;46(3):601-4.
• Cleland JA, et al. Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy. J Orthop Sports Phys Ther. 2005;35(12):802-11.
• Chou R, et al. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373(9662):463-72.
• Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363-70.
• Waddell G, et al. Low back pain evidence review. London: Royal College of General Practitioners; 1999.
• Cleeland JA, et al. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain. Phys Ther. 2007;87(1):9-23.