Severe (Spinal) Middle Back Pain

middle back pain after running Brain & Neurology

Middle back pain prevails throughout life but is not too studied as neck pain or low back pain. Middle back pain is more often due to major spinal pathology than neck or low back pain however middle back pain is also prevalent among healthy people without any serious underlying cause.


An evaluation discovered the variety of occurrence price quotes of thoracic back pain in the basic population to be really broad because of many factors, foring example the various definitions and duration of thoracic back pain included. The outcomes of the evaluation were as follows:

Occurrence data varied from 4.0-72.0 % (at any one time), 0.5-51.4 % (7-day), 1.4-34.8 % (1-month), 4.8-7.0 % (3-month), 3.5-34.8 % (1-year) and 15.6-19.5 % (lifetime). Studies reported a higher prevalence for thoracic back pain in children and adolescents, particularly for females.

In children and adolescents, thoracic back pain was connected with female gender, postural weather changes associated with knapsack use, knapsack weight, other musculoskeletal symptoms, participation in specific sports, chair height at school and difficulty with homework. Poorer mental health and age shift from early to late teenage years were also substantial threat aspects.

In grownups, thoracic back pain was associated with concurrent other musculoskeletal symptoms and difficulty in performing activities of everyday living.

Quite often severe spinal pain in middle back appears after car accident, eating, running, epidural, exercise, pregnancy, bowel movement, hysterectomy, walking, a fall, sleeping, gallbladder surgery, squats, deadlifts, bending over, bronchitis, bench press, baby, being sick, etc.

Causes of Severe Spinal Pain in Middle Back

Severe back pain can take place as a result of trauma or sudden injury, or it can happen through strain or bad posture in time.

The most common reason for spinal pain in middle back appears to originate from muscular inflammation or other soft tissue issues. These can arise from absence of stamina, bad posture, prolonged sitting at a computer, utilizing a backpack, overuse injuries (such as recurring movement), or injury (such as a whiplash injury brought on by a car mishap or as an outcome of a sports injury).

A research study of cadavers recommends an association in between cervical spinal column stenosis and thoracic spine stenosis. Asymptomatic thoracic disc herniations are relatively typical but symptomatic disc herniations are unusual. They take place in around 5 in 1,000 disc herniations presenting in a clinical setting.
The thoracic spinal column is a reasonably common site for inflammatory, degenerative, metabolic, infective and neoplastic conditions.

Spinal pain and dysfunction are associated with conditions such as main and secondary osteoporosis (particularly vertebral fractures and hyperkyphosis developing from vertebral bone loss), ankylosing spondylitis, osteoarthritis and Scheuermann’s disease.

Red flags

Severe middle back pain is most likely than neck or low back pain to be triggered by major underlying pathology. Nevertheless, many patients with middle back pain have a benign, mechanical cause. Red flags for possible serious spinal pathology consist of:

  • Current violent injury (such as a car accident or fall from a height).
  • Minor injury, or even just laborious lifting, in home owner with osteoporosis.
  • Age at beginning less than 20 or over 50 years (new back pain).
  • History of cancer, drug abuse, HIV, immunosuppression or long term usage of corticosteroids.
  • Constitutional symptoms – eg, fever, chills, unusual weight loss.
  • Recent bacterial infection.
  • Pain that is:
    Continuous, severe and progressive.
    Non-mechanical without remedy for bed rest or postural adjustment.
    The same despite treatment for 2-4 weeks.
    Accompanied by severe morning stiffness (rheumatoid arthritis and ankylosing spondylitis).
    Structural defect.
    Severe or progressive neurological deficit in the lower extremities.

Intervertebral disc prolapse

  • Pain: localised to the spine or also radicular along the pertinent dermatome.
  • Sensory disturbances:
    Sensory disturbance might happen in a dermatomal distribution.
    Broader distribution of sensory disturbance below the level of pain is consistent with myelopathy due to cord compression.
  • Weakness:
    Unlikely to be an early presenting issue.
    Weakness in the lower extremities may show cord compression.
    Bladder symptoms and incontinence of faeces may suggest cord compression and myelopathy.

Differential medical diagnosis

Problems affecting the lung (consisting of a Pancoast tumour), oesophagus, stomach, liver, gallbladder and pancreas can all cause referred pain in the interscapular area.
Interscapular pain may also be referred from disc prolapse or spinal dysfunction influencing the cervical or lumbar spine.


As with the lumbar spine, degenerative signs identified in imaging of the thoracic spinal column are not always associated with pain. Examinations are generally used to explore underlying musculoskeletal or other illness causing the severe spinal (back) pain.

Middle back pain might cause substantial constraints and exclusion of domestic, leisure, educational and work activities.


  • Numerous cases of middle back pain willpower without treatment.
  • Where there is a secondary cause, treatment depends on the underlying pathology.
  • Sharp middle back pain originating from aspect joint pathology might react to imaging-guided intra-articular injection.
  • Surgical treatment of symptomatic thoracic spine herniation has been related to considerable morbidity as well as death. However, the strategy of percutaneous thoracic intervertebral disc nucleoplasty has been explained which has decreased morbidity and much shorter operating times than traditional approaches.


  • The prognosis of spinal pain in middle back will depend upon the underling cause and specific conditions of the individual.
  • Middle back pain is more likely to indicate underlying pathology than neck pain or low back pain.
  • Lots of cases of nonspecific middle back pain willpower within a couple of weeks.


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