Middle back pain consists of problems in the thoracic spine which is the middle region of the spine, along with the rib cage which attaches into this part of the spine and wraps around to the front
of the chest. The thoracic spine (or mid back) is a very large part of the spine, with many joints and muscles in this region- all which can be a source of pain. This is a very common source
of pain and injury in this part of the back. Muscle strains and sprains commonly occur from bending down to pick something up, irritation from repetitive activity, or playing a sport. There are many muscles in this part of the spine and rib cage. When these get injured they can get inflamed and extremely tender and sore and end up causing pain with daily activities. Postural problems are a growing trend due to
increasing amount of people using computers, sitting for long periods, and commuting to work.This can lead to poor posture which causes significant stress on the muscles that run down the spine along with irritation of the joints and ligaments in this region, which can lead to significant pain. Disc Herniation/degeneration is where the discs are meant to provide cushion and spacing between the vertebral bodies.
Discs can also become injured and bulge out or herniated. Discs can also become degenerated or wear out over time. Both of these conditions can lead to pain in the low back or pain that radiates. This is another very common source of pain, primarily seen with aging. Over time the joints in this region can become arthritic and begin to wear out causing pain and
limitation with movement. In addition the vertebral bodies can begin to degenerate over time, causing decreased height which can lead to pain and possible irritation of the nerves. Pain in the ribs can be caused by an injury, a fall, or even poor posture. This can lead to irritation of the joints where they attach in the mid-back, or the muscles running between each rib. This can lead to pain in the mid-back or
pain that wraps around the side. Ribs attach in the mid-back and wrap around to connect to the sternum in the chest area. When ribs become injured, they can lead to pain in the muscles or joints in the chest region.
It is important when you are experiencing mid-back or rib pain to limit your activity and rest so that your back can heal. Apply cold packs to your mid-back or ribs to help decrease your pain and inflammation in the joints and muscles. To prevent damage to skin and surrounding tissue, cold packs should only be applied in
15 minute intervals. If you don’t have increased pain with movement, stretching the back muscles can be the first step in helping to loosen up your back and decrease the pain. Physical therapy consists of hands-on treatment to loosen muscles and joints, education on proper posture and movement to
decrease pain, instruction on stretching and strengthening exercises to restore mobility and strength, and modalities such as electrical stimulation, cold/heat and ultrasound. Following are a few exercises you can perform that may help alleviate pain. Please go to LIFE+ for more videos that may help you. Please consult your physician before trying these, and stop
if you experience any pain or discomfort.What is Mid-Back & Rib Pain?
Types of Mid-Back & Rib Pain
Muscle Strain or Sprains
Postural Related
Disc Involvement
Arthritis and Degeneration
Rib Dysfunction
Costochondritis
STEPS TO MID-BACK & RIB PAIN RELIEF
1
REST
2
COLD PACKS
3
STRETCH
4
PHYSICAL THERAPY
MID-BACK & RIB PAIN EXERCISES
By
Published on Mar 1, 2022
In this article:
- Understanding the thoracic spine
- Causes of pain in the ribs and back
- Treatment
The thoracic spine and ribs are like a no man’s land for many physicians, including spine experts. While many physicians are comfortable treating and diagnosing neck and low back problems when it comes to things like pain around the ribs and back symptoms, they draw a blank.
First, let’s define what we mean by pain around the ribs and back. Basically, the pain wraps around the back of the rib — generally at least to the side and at times all the way to the front. There is also upper-back pain that often accompanies this pain. Movement usually leads to intense pain or makes it feel like something is “out of place” and needs to be popped back in place. Sometimes specific motions or activities will make this better or worse.
Understanding the Thoracic Spine
The thoracic spine is between the neck (cervical) and the low back (lumbar). Its bones (vertebrae) are numbered 1-12 and the abbreviation ‘T” is used for “thoracic.” Hence, “T6” means the sixth thoracic vertebra (1).
What’s unique is that the ribs attach here to the thoracic vertebrae. These two structures both constrain and define which movements are possible by the other. And because they’re connected, what happens in one is often felt in the other. In addition, the thoracic vertebrae act as pivot points for the ribs as you breathe in and out. This is often why patients experience pain when taking a deep breath.
There’s an immense amount going on in the thoracic spine. First, there are facet joints where the two vertebrae meet. There is a spinal nerve that exists in this area at each vertebra. The nerve begins as the thoracic spinal nerve and then continues all the way around to the front of the chest as the intercostal nerve. There’s a disc that acts as a shock absorber as well as a multitude of muscles and ligaments. Then there are two areas where each rib attaches to each vertebra (the costotransverse and costovertebral joints) (2). Realize that there can be problems with any one of these structures that can cause pain around the ribs and back symptoms.
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The Top 5 Causes of Pain In Ribs and Back
Our clinic has had a special interest in the thoracic spine for many years. As an example, most spinal interventionalists have only ever performed a handful of thoracic epidural or facet injections. I’ve done hundreds of each. In all of those years helping patients with pain in ribs and back recover, these are the top five medical conditions that we see in our clinic:
Thoracic Disc Bulge:
The thoracic spine, just like your neck and lower back, has discs that act as shock absorbers for the spinal bones. These can bulge when they get damaged and can press on and irritate spinal nerves. This can lead to pain around the ribs and back symptoms. In particular, this could be just pain or an electrical feeling. There also may be some numbness in the back and ribs.
Rib Facet Pain:
Each rib is attached to its corresponding vertebra at two points with ligaments. Doctors sometimes call these “rib facets.” Technically, they’re called the costovertebral and costotransverse joints. These joints can get damaged and cause referred pain in ribs and back. This pain is often localized to one spot and may get worse with a deep breath. The area may also feel “out of place.”
Thoracic Facet Joint Pain:
The vertebral facets are the joints where each vertebra meets up with the next above or below. These can become injured or get arthritis like any joint and can cause referred pain that is usually in one spot, but pain can extend out beyond the spine as well. This pain isn’t usually influenced by taking a deep breath, but it can be made worse or better with movement.
Fascia Injury:
The ribs have a tough outer covering called the fascia. This covering is there to help control motion. When it gets injured it can allow too much individual rib motion, which can cause upper back pain that wraps around the ribs. This pain is usually influenced by taking a deep breath. You may also be able to identify a painful rib by palpating the area.
Muscle Trigger Points or Areas of Tendinopathy:
You have muscles in your upper back that can develop areas called “trigger points” that can cause upper back pain and pain that refers around the rib. The muscles also have tendons that can get injured and worn out with time, leading to tendinopathy.
How Can The Pain Be Treated? Juan’s Story
Juan’s pain around the ribs and back symptoms with spasms began in 2007, and he presented to our clinic in 2020. Any movement, rotation, or flexion/extension made the pain worse, while rest and medication made the pain better.
Previously, he had tried ozone injections, steroid injections, and facet injections, which provided temporary relief. Radiofrequency ablation at the T8-T11 facet joints provided relief for only about six to eight months. He had also developed tingling in his right ring finger and pinkie, pain in his right elbow, and weakness in his right hand. This was likely coming from irritation of the brachial plexus by his ribs.
We approached Juan’s problems differently, looking at what was causing all of these issues. In particular, one of the ligaments in the back of his spinal canal (ligamentum flavum) was loose and buckling, which was irritating nerves. Hence, we concentrated his own blood platelets (platelet-rich plasma) to inject into that specific ligament to cause some healing and tightening. In addition, we treated the irritated thoracic nerves by injecting a platelet lysate around the nerves (epidural using X-ray guidance).
Finally, his facet joints had previously been treated with radiofrequency, which burns the nerve that communicates pain from the joint. Because of this, nobody had ever tried helping the joint with substances that can promote healing. So again I carefully injected high-dose platelet-rich plasma into those joints using sophisticated image guidance technology. How did he do? He’s reporting 90% relief, with pain only during certain activities.
As you can see, there’s quite a bit that can cause pain around the ribs and back symptoms. The first order of business is getting an accurate diagnosis of why you hurt, which is what we did with Juan. Rather than injecting Juan with steroids that could harm tissue or burn nerves, we focused on the root cause of his problems and tried to improve the function of the spine.
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Learn about Regenexx procedures for spine conditions.References
(1) Thoracic Anatomy. Physiopedia. //www.physio-pedia.com/Thoracic_Anatomy. Accessed August 12, 2021.
(2) Chopra P. Thoracic Pain. In Smith H. Current Therapy in Pain. Elsevier; 2009:194-201. doi:10.1016/B978-1-4160-4836-7.00026-2
Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile
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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.
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