Mid Back Pain

Acute Mid-Back Pain (0–72 Hours)

Common Causes

  • Sudden twisting or bending injury
  • Muscle strain (mid-trapezius, rhomboids, paraspinals)
  • Costovertebral or costotransverse joint irritation
  • Acute facet joint locking
  • Poor-sleep posture
  • Lifting injury
  • Sudden sports strain (cricket, running, gym)

Biomechanics in Acute Thoracic Pain

  • Local spasm in mid-trapezius, rhomboids, thoracic paraspinals
  • Fascial tension in thoracolumbar fascia & scapulothoracic region
  • Restricted thoracic rotation & extension
  • Pain radiating to front chest (costochondral referral)
  • Guarded breathing due to thoracic stiffness
  • Agonist/antagonist imbalance → triggers in upper traps, levator scapulae
  • Rib movement restriction (painful inhalation)

Treatment Glimpse – Acute Stage

Pain & Inflammation Control
  • Ice / cryotherapy
  • Electrotherapy (TENS / IFT)
  • Laser therapy for joint/ligament irritation
  • Gentle thoracic support taping
  • Gentle soft-tissue release for:
  • Rhomboids
  • Mid & lower trapezius
  • Intercostal muscles
  • Paraspinals
  • Thoracolumbar fascia
  • Diaphragmatic breathing
  • Rib mobility breathing drills
  • Helps reduce fascial tightness
  • Cat-camel
  • Thoracic rotations (within comfort)
  • Shoulder blade glides
  • Avoid twisting, overhead lifting
  • Sleep position correction
  • Kinesio-taping for thoracic support

Goal

  • Reduce pain & muscle guarding
  • Restore safe thoracic movement
  • Reduce breathing-related pain
  • Prevent conversion to chronic mid-back pain

Sub-Acute Mid-Back Pain (3 days – 6 weeks)

Common Causes

  • Poor posture / prolonged sitting
  • Muscular imbalance between chest & back
  • Weak scapular stabilisers
  • Postural kyphosis strain
  • Intercostal muscle stiffness

Biomechanics in Sub-Acute Stage

  • Tight chest muscles → pulling thoracic spine forward
  • Weak rhomboids, mid/lower trapezius
  • Reduced thoracic extension
  • Fascial restriction along rib cage & scapula
  • “Desk posture” pattern:
  • Rounded upper back
  • Forward shoulders
  • Stiff thoracic spine
  • Pain on long sitting/driving

Treatment Glimpse – Sub-Acute Stage

Manual Therapy
  • Thoracic mobilisation (Grade I–III)
  • Rib mobility techniques
  • Scapulothoracic joint mobilisation
  • Myofascial release for intercostals
  • Scapular setting
  • Middle & lower trapezius activation
  • Serratus anterior activation
  • Rhomboid strengthening
  • Chest (pectoralis major/minor)
  • Upper trapezius
  • Latissimus dorsi
  • Thoracic paraspinals
  • Thoracic extension mobility drills
  • Desk posture correction
  • Breathing mechanics training
  • Kinesio taping for scapular stability
  • Posture taping to reduce slouching

Goal of Sub-Acute Stage

  • Restore thoracic mobility
  • Activate stabiliser muscles
  • Reduce postural strain
  • Improve breathing mechanics
  • Prevent recurrence

Chronic Mid-Back Pain (6+ Weeks)

Common Causes

  • Postural kyphosis (rounded back)
  • Long sitting / laptop posture
  • Weak scapular muscles
  • Thoracic hypomobility
  • Repetitive lifting strain
  • Rib cage stiffness
  • Chronic overuse of upper trapezius
  • Myofascial adhesions in thoracolumbar fascia

Biomechanics in Chronic Stage

  • Long-term rounded back posture
  • Tight anterior chest chain
  • Weak upper back muscles (mid/lower trap, rhomboids)
  • Thoracic joint stiffness
  • Poor thoracic extension
  • Scapular dyskinesis (poor movement)
  • Breath dysfunction (shallow breathing)

Treatment Glimpse – Chronic Stage

Advanced Manual Therapy
  • Thoracic spine mobilisation (Grade III–V)
  • Rib rotations & glides
  • Myofascial release for chronic adhesions
  • Thoracolumbar fascia decompression
  • Scapular stability program
  • Resistance band exercises
  • Thoracic extension strengthening
  • Upper back endurance drills
  • Reverse-rounded-back program
  • Foam roller thoracic extension
  • Desk ergonomics correction
  • Scapular retraction control
  • Return-to-work training
  • Lifting mechanics correction
  • Sports-specific drills (running, cricket, cycling)
  • Sitting breaks
  • Posture awareness
  • Stretching routine
  • Breathing correction

Goal

  • Correct long-term posture imbalance
  • Restore full thoracic extension
  • Build upper back endurance
  • Prevent repeated mid-back stiffness
  • Return to normal work & sports

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