What is upper and middle back strain?

Upper and middle back pain may feel like a dull, burning, or sharp pain or muscle tightness or stiffness. These symptoms may:

• Be felt at a single point or over a broad area.
• Start suddenly or slowly get worse.
• Be constant or come and go.
• Get worse when you do certain activities or move and sit in a certain way.

More serious symptoms that need to be treated right away include:

• Weakness in your arms or legs.
• Numbness or tingling in your arms, legs, chest, or belly.
• Loss of bowel or bladder control.

There are many treatments for upper and middle back pain. Work with your doctor to find what is best for you.

Treatment is based on:

• How bad your symptoms are.
• How much your symptoms prevent you from doing your daily tasks.
• How well other treatments have worked.

Treatment for mild to moderate pain

In most cases, people with mild to moderate upper and middle back pain can manage their symptoms with:

• Over-the-counter pain medicines. These include acetaminophen (such as Tylenol) and NSAIDs (such as Advil, Aleve, aspirin, or Motrin), to reduce pain.
• Topical pain medicines. These are medicines that you put on your skin.
  • Nonsteroidal anti-inflammatory drugs (NSAIDS). This is a cream that you can rub over the sore area and may help relieve pain.
  • Capsaicin cream. This may help relieve pain. It's a substance found in cayenne peppers. Capsaicin cream is applied directly to the skin over the painful area.
• Heat or ice.
• Exercise to stretch and strengthen the muscles of your back, shoulders, and stomach.
• Physical therapy to help increase your flexibility, strength, and balance. Your physical therapist may teach you an exercise program so you can do it at home.
• Massage.
• Spinal manipulation. It can range from massage and slow pressing to a quick thrust.
• Acupuncture. It involves putting tiny needles into your skin at certain points on the body.

Treatment if back pain is severe or lasts a long time

If your back pain doesn't get better or is severe, your doctor may recommend:

Prescription medicines.

These may include:

• Muscle relaxants to help reduce pain and muscle tension and help you move better. These can help with severe muscle spasms that happen when the back pain starts (acute phase).
• Antidepressants, such as duloxetine. They can help treat long-lasting (chronic) back pain.
• Prescription pain medicines.

Steroid shots.

They may help reduce swelling and relieve pressure on nerves and nerve roots. But there is little evidence showing that these shots can help control back pain.

In some cases, a back brace may be used to support the bones in the spine after a fracture.

Surgery

Surgery is seldom used to treat upper and middle back pain. If your doctor recommends surgery, the type will depend on the problem you have.

Surgery choices may include:

Kyphoplasty or vertebroplasty.

Bone cement is injected through a needle into the broken vertebrae to try to stabilize the bone. These surgeries are not done very often, because most fractures heal on their own. And there is no evidence that kyphoplasty or vertebroplasty are better than nonsurgical treatment.

Herniated disc removal.

This is done to remove the portion of the disc that is herniated and pushing into the spinal canal. In most cases, herniated discs that occur in the upper and middle back are small and don't need surgery. But you may need surgery for a large herniated disc that presses on the spinal cord.

Spinal decompression for stenosis.

This is done to widen the spinal canal that has narrowed. It relieves pressure on the spinal cord or nerves. This procedure is not done very often. That's because spinal stenosis in the upper and middle back is rare.

Stay as active as you can, but stop or reduce any activity that causes pain. Try heat or ice to see if it helps. Put a thin cloth between the heat or ice and your skin. Take medicines as instructed. Find a comfortable sleeping position. Return to your usual level of activity slowly.

Upper and middle back pain is pain that occurs anywhere from the base of your neck to the bottom of your rib cage. Your ribs attach to the sternum and attach to and wrap around your back. If a nerve in this area is pinched, irritated, or injured, you may also feel pain in other places where the nerve travels. For example, you may have pain in your arms, legs, chest, and belly.

The upper and middle back is called the thoracic spine. Back pain in this area is less common than low back or neck pain. That's because the bones in the upper and middle back don't move as much as the lower back or neck bones.

In most cases, upper and middle back pain is caused by:

• Overuse, strain, or injury of the muscles, ligaments, or discs that support the spine. For example, some people hurt their backs when they:
  • Play sports or do yard work.
  • Get jolted in a car accident.
  • Get hit hard in the back.
  • Lift something heavy.
• Poor posture. Some people have pain because they slump or slouch when they sit or stand.
• Myofascial pain that affects the connective tissue of a muscle or group of muscles.

Conditions that affect the spine

Conditions that put pressure on the spinal nerves also can cause pain. These include:

Osteoarthritis.

This occurs when the cartilage that cushions the small facet joints in the spine breaks down. When this happens, the back bones rub together and cause damage and pain. Osteoarthritis is caused by the normal wear and tear of the cartilage as you age.

A fracture of the vertebrae.

This can occur when a lot of force is put on the spine. This force can be from a car or bike accident or a direct blow to the spine. A compression fracture occurs when an injury to the bones in the spine causes them to break and collapse (compress) on each other, such as from a fall. Osteoporosis makes the bones brittle and weak. In people who have osteoporosis, a spinal bone can also break and collapse from only a minor injury or simply moving the wrong way.

An odd-shaped spine.

An odd-shaped spine can make your back hurt. When a person has scoliosis, the spine curves from side to side, often in an S or C shape. It may also be twisted. When a person has kyphosis, the upper spine is rounded and looks like a hump. In bad cases of scoliosis or kyphosis, a person may have a hard time breathing.

A herniated disc.

A herniated disc occurs when one of the small, spongy discs that cushion your spine bulges or breaks open and presses on the nerves in the spine. A herniated disc may be caused by normal wear and tear of the disc as you age. Or it may be brought on by activities that you do over and over again that cause a lot of vibration or motion (such as using a jackhammer) or by a sudden heavy strain or increased force to your back. In most cases, a herniated disc occurs in the lower back or neck. It can occur in the upper or middle back, but this is rare.

Spinal stenosis.

The spinal cord runs through an opening in the bones called the spinal canal. Spinal stenosis occurs when that opening narrows. In some cases, bone, ligament, and disc tissue grows into the spinal canal and presses on the nerves that branch out from the spinal cord. The tissue can also squeeze and irritate or injure the spinal cord itself. In most cases, spinal stenosis occurs in the lower back and neck. It can occur in your upper or middle back, but this is rare.

Degenerative disc disease.

Degenerative disc disease is a term used to describe the normal changes that occur in your spinal discs as you age. Over time, the discs in your spine break down, or degenerate. This problem can occur anywhere on your spine. But in most cases, it occurs in the discs in the lower back and neck.

Rare causes of pain

In rare cases, pain may be caused by other problems, such a gallbladder disease, cancer, or an infection.