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Thoracic Pain (Mid Back Pain)

This guide was created by Dr. Michael Hoiles as an educational resource for people experiencing thoracic (middle back) pain. 

Pain in the middle back can make everyday activities such as sitting, reaching, lifting, twisting, or even taking a deep breath uncomfortable. Although thoracic pain is generally less common than neck or lower back pain, it can still interfere with work, exercise, sleep, and daily life. Fortunately, most cases improve with conservative treatment, movement, and a progressive rehabilitation program. 

This guide explains common causes of thoracic pain, symptoms, diagnosis, treatment options, recovery expectations, and when it may be appropriate to seek an assessment. 

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Quick Facts 

✅ Thoracic pain often improves with conservative treatment. 

✅ Poor posture is only one of many possible contributing factors. 

✅ Exercise and regular movement are usually more beneficial than prolonged rest. 

✅ Muscle, joint, rib, and disc problems can all contribute to middle back pain. 

✅ Most people recover without surgery. 

✅ Seek immediate medical attention if pain follows significant trauma or is associated with fever, unexplained weight loss, or difficulty breathing. 

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Anatomy 

The thoracic spine consists of 12 vertebrae (T1-T12) located between the neck and lower back. 

Unlike the neck and lower back, each thoracic vertebra connects to a rib, creating a stable framework that helps protect the heart and lungs while allowing controlled movement. 

Several structures can contribute to thoracic pain, including: 

  • Muscles  

  • Ligaments  

  • Facet joints  

  • Intervertebral discs  

  • Costovertebral (rib) joints  

  • Nerves  

Because many tissues work together, identifying the primary source of pain requires a thorough assessment. 

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What Is a Disc Injury? 

Thoracic pain refers to discomfort arising from the middle portion of the spine or surrounding tissues. 

Pain may develop suddenly after lifting, twisting, or sports participation, or gradually from repetitive activities, prolonged sitting, or sustained postures. 

Although many people describe their pain as being "between the shoulder blades," the source may involve muscles, joints, ribs, discs, or nearby connective tissues. 

Most thoracic pain is mechanical, meaning symptoms change with movement, position, and activity. 

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Common Causes & Risk Factors 

Thoracic pain often develops from several contributing factors rather than a single injury. 

Common causes include: 

  • Muscle strain  

  • Joint irritation  

  • Rib joint dysfunction  

  • Poor tolerance to prolonged sitting  

  • Repetitive bending or lifting  

  • Disc irritation  

  • Sudden twisting movements  

  • Sporting activities  

  • Previous spinal injuries  

  • Physical deconditioning  

Risk factors may include: 

  • Sedentary work  

  • Poor ergonomic setup  

  • Repetitive overhead work  

  • Reduced upper back mobility  

  • Smoking  

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Common Symptoms 

Thoracic pain can present in many different ways. 

Symptoms may include: 

  • Pain between the shoulder blades  

  • Localized middle back pain  

  • Stiffness  

  • Pain with twisting  

  • Pain during deep breathing  

  • Pain while sitting for prolonged periods  

  • Muscle tightness  

  • Difficulty rotating the trunk  

  • Pain during lifting  

  • Pain that improves with movement  

Some people notice discomfort extending toward the ribs or chest wall. 

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How Is It Diagnosed? 

Diagnosis begins with a detailed history and physical examination. 

Your chiropractor or healthcare provider may assess: 

  • Pain location  

  • Movement patterns  

  • Posture  

  • Thoracic mobility  

  • Rib mobility  

  • Muscle strength  

  • Shoulder movement  

  • Neck mobility  

  • Neurological examination when appropriate  

Imaging is not routinely required for most cases of mechanical thoracic pain. 

X-rays, MRI, or other imaging may be recommended if serious pathology, fracture, infection, inflammatory conditions, or other concerning findings are suspected. 

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What Helps? 

Most cases respond well to conservative treatment. 

Staying Active 

Remaining active within your comfort level often promotes recovery more effectively than prolonged rest. 

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Exercise Rehabilitation 

A progressive exercise program can help improve mobility, strength, endurance, and confidence with movement. 

 

Chiropractic Care 

Treatment may include: 

  • Joint mobilization  

  • Spinal manipulation (when appropriate)  

  • Soft tissue therapy  

  • Rib mobilization  

  • Movement assessment  

  • Exercise prescription  

  • Ergonomic advice  

 

Pain Management 

Some individuals may benefit from short-term medication recommended by their physician. 

Lifestyle Modifications 

Helpful strategies may include: 

  • Frequent movement breaks  

  • Improving workstation ergonomics  

  • Walking  

  • Strength training  

  • Gradually returning to normal activity  

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How Chiropractic Can Help 

Every episode of thoracic pain is different. 

Following a thorough assessment, treatment is individualized based on the structures involved, symptom behaviour, and your goals. 

Treatment may include: 

  • Manual therapy  

  • Thoracic spinal manipulation or mobilization  

  • Rib mobilization  

  • Soft tissue therapy  

  • Mobility exercises  

  • Strengthening exercises  

  • Postural retraining  

  • Return-to-work or sport planning  

The goal is to reduce pain while improving movement, restoring function, and helping prevent recurrence. 

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Recovery Timeline 

Recovery varies depending on the underlying cause and severity. 

  • Mild muscle or joint irritation: Often improves within 2–4 weeks. 

  • Moderate mechanical thoracic pain: Typically improves over 4–8 weeks. 

  • Persistent or recurrent thoracic pain: May require several months of progressive rehabilitation and activity modification. 

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Can I Still Exercise? 

Usually, yes. 

Remaining active is encouraged, although certain activities may need temporary modification. 

Walking, gentle mobility exercises, and progressive strengthening are often well tolerated. 

As symptoms improve, resistance training, recreational activities, and sports can gradually be reintroduced. 

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Exercises Commonly Recommended 

Phase 1: Reduce Pain & Restore Mobility 

  • Walking  

  • Thoracic extension over a foam roller  

  • Cat-Camel  

  • Open Book rotations  

  • Diaphragmatic breathing  

 

Phase 2: Restore Strength & Control 

  • Bird Dog  

  • Resistance band rows  

  • Wall angels  

  • Dead Bug  

  • Modified side planks  

 

Phase 3: Return to Activity 

  • Farmer carries  

  • Romanian deadlifts  

  • Cable rows  

  • Pallof press  

  • Rotational strengthening exercises  

  • Functional lifting drills  

Exercises should always be individualized based on your symptoms, goals, and stage of recovery. 

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Common Mistakes That Slow Recovery 

Avoid these common setbacks: 

  • Avoiding movement because of pain  

  • Sitting for prolonged periods without breaks  

  • Returning to heavy lifting too quickly  

  • Ignoring upper back mobility  

  • Poor workstation ergonomics  

  • Stopping rehabilitation once pain improves  

  • Relying solely on passive treatment  

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When Should I Seek an Assessment? 

Consider an assessment if: 

  • Pain lasts longer than several weeks  

  • Symptoms continue returning  

  • Pain limits work or exercise  

  • Pain interferes with sleep  

  • Pain spreads around the ribs or into the chest  

  • You're unsure which activities are appropriate  

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When Should I Worry? 

Seek immediate medical attention if thoracic pain is associated with: 

  • Significant trauma  

  • Difficulty breathing  

  • Chest pain suggestive of a cardiac cause  

  • Fever or chills  

  • Unexplained weight loss  

  • Night pain that is severe or progressively worsening  

  • Progressive numbness or weakness  

  • Changes in bowel or bladder function  

Although these causes are uncommon, they require prompt medical evaluation.

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Frequently Asked Questions 

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Is thoracic pain the same as pain between the shoulder blades? 

Often, yes. Many people use the terms interchangeably. Thoracic pain commonly refers to discomfort in the middle back, including the area between the shoulder blades. The exact source may involve muscles, joints, ribs, discs, or surrounding soft tissues. 

 

What causes pain between the shoulder blades? 

Common causes include muscle strain, joint irritation, rib dysfunction, prolonged sitting, repetitive movements, and poor tolerance to sustained postures. Less commonly, pain may be referred from the neck, shoulder, or internal organs, making a thorough assessment important. 

 

Is poor posture the main cause of thoracic pain? 

Not necessarily. While prolonged sitting and certain postures may contribute to symptoms, thoracic pain is usually influenced by several factors including muscle strength, mobility, workload, stress, previous injuries, and overall activity levels. 

 

Can I exercise with thoracic pain? 

In most cases, yes. Gentle movement and progressive exercise are often important parts of recovery. Your program should be individualized based on your symptoms and functional goals. 

 

Is thoracic pain the same as pain between the shoulder blades? 

Often, yes. Many people use the terms interchangeably. Thoracic pain commonly refers to discomfort in the middle back, including the area between the shoulder blades. The exact source may involve muscles, joints, ribs, discs, or surrounding soft tissues. 

 

What causes pain between the shoulder blades? 

Common causes include muscle strain, joint irritation, rib dysfunction, prolonged sitting, repetitive movements, and poor tolerance to sustained postures. Less commonly, pain may be referred from the neck, shoulder, or internal organs, making a thorough assessment important. 

 

Is poor posture the main cause of thoracic pain? 

Not necessarily. While prolonged sitting and certain postures may contribute to symptoms, thoracic pain is usually influenced by several factors including muscle strength, mobility, workload, stress, previous injuries, and overall activity levels. 

 

Can I exercise with thoracic pain? 

In most cases, yes. Gentle movement and progressive exercise are often important parts of recovery. Your program should be individualized based on your symptoms and functional goals. 

 

Can chiropractic treatment help thoracic pain? 

For many people, chiropractic care can help improve joint mobility, reduce muscle tension, and restore normal movement. Treatment often combines hands-on therapy with exercise and education to help improve long-term outcomes. 

 

Do I need an X-ray or MRI? 

Usually not. Most mechanical thoracic pain can be diagnosed through a detailed history and physical examination. Imaging is generally reserved for suspected fractures, significant trauma, infection, inflammatory conditions, or other concerning findings. 

 

How long does thoracic pain take to recover? 

Many people begin improving within several weeks, although recovery depends on the underlying cause and individual factors. Consistent exercise and gradual return to activity often lead to the best long-term outcomes. 

 

When should I seek immediate medical attention? 

Seek urgent medical attention if you experience severe chest pain, difficulty breathing, fever, unexplained weight loss, significant trauma, or progressive neurological symptoms such as weakness or numbness. 

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Summary 

Thoracic pain is a common condition that often responds well to conservative care. 

✔ Most cases improve without surgery. 

✔ Staying active is generally better than prolonged rest. 

✔ Exercise and rehabilitation are important parts of recovery. 

✔ A thorough assessment helps identify the structures contributing to your symptoms. 

✔ Seek an assessment if pain persists, worsens, or limits your daily activities. 

✔ Seek immediate medical attention if pain is associated with trauma, chest pain, difficulty breathing, fever, or progressive neurological symptoms. 

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Ready to Get Back to Moving Comfortably? 

If your thoracic pain isn't improving, continues to return, or is preventing you from working, exercising, or enjoying your daily activities, an assessment can help identify the underlying cause and determine the most appropriate treatment plan. 

Dr. Michael Hoiles is a Calgary chiropractor who provides evidence-informed care combining hands-on treatment, exercise-based rehabilitation, and practical advice to help people recover from injury, move better, and stay active. 

Book an appointment today to begin your recovery and get back to moving comfortably. 

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Related Conditions 

You may also find these resources helpful: 

  • Hip Pain

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