How to manage pain in the middle back

When people complain about back pain, they usually mean their lower back hurts, or sometimes they suffer from pain in the shoulders and neck. Most of my back pain students will have either or both. Pain in the middle back is less common. When my middle back started to feel achy during a recent ski trip, I decided to investigate and see what could soothe this ache. Was I doing particular movements while skiing that caused the pain? Or was my posture different in an effort to stay upright on the very slippery slopes? Finally, how could I manage this pain in the middle back? In this blog I describe the movements that eased my middle back discomfort.

Our spine has 24 moveable vertebrae: seven small vertebrae in the neck, 12 in the thoracic area, where the ribs attach to the spine, and five in the lumbar area. The lumbar vertebrae are the largest and they are meant for stability. They can cause trouble when they are out of alignment, when they are drawn together by tight muscles, or when they are not supported by a strong core and glut muscles. The neck, with the heavy head as its constant weight, suffers equally when it is out of alignment, or when it is squashed by stress and tight muscles. Many of my other blogs address one or the other. Only a few of my students complain about pain in the middle back, so why is it less common and what causes it?

What causes pain in the middle back?

The middle back, sometimes also called the thoracic back, or even confusingly the upper back, is very sturdy because the ribs are attached to the thoracic vertebrae and keep this part of the spine more stable. Causes of middle back pain include poor posture, improper lifting, overuse, injury, scoliosis, and arthritis. The ache I experienced during my ski week must have come from muscle tension and poor posture. I suspect my back was working harder and my upper back was possibly more rounded than it would be on a leisurely walk. I may just have been focusing more on staying upright and thrown all my own advice about posture overboard.

The poses below relieved the muscle tightness I experienced in my lower thoracic back. As always with tight muscles, it is important to stretch gently, with the breath. Small movements in which we gently stretch with the exhalation are particularly helpful. I did the poses twice a day, in the morning and evening, together with leg stretches. The exercises below are not appropriate for pain caused by a herniated disc or nerve pain. The latter require careful and individualised yoga therapy. 

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This movement gently stretches and lengthens the muscles along the spine.

-Lie on your back with the knees drawn up to the chest.

-Place one hand on each knee.

-Bring both knees a little closer to the chest when you exhale, while making sure not to lift the lower back off the floor.

-Inhale and bring the knees further away from you.

-Repeat a comfortable number of times.

Twist with knees up

Unlike a twist with the feet on the floor, this movement reaches higher up the spine, giving a delicious stretch for the lower part of the middle back.

-Start lying on the back with the knees drawn up to the chest, feet and knees together.

-The arms are out to the side but ready to support the legs so the legs don’t have to hang in mid air. 

-Exhale and lower the knees to one side, only halfway down.

-Try to keep both shoulder blades on the floor.

-Inhale and return the knees to the centre and exhale them to the other side, again supporting the knees with one hand.

-The head moves as well, looking away from the knees.

-Repeat a few times to each side.

Pelvic tilt with arms above the head

This movement also lengthens the muscles along the spine. Placing the arms overhead lifts the ribcage and stretches the middle back tightness a little more.

-Lying on the back with the legs bent, hold one elbow with each hand and bring your square-shaped arms to the floor overhead, or wherever they will go.

-Put weight on the feet and lower the back of the waist on the floor.

-Inhale and release.

-Repeat 3-5x times.

Dog pose

Dog pose allows the spine to lengthen in an inverted way, with the help of gravity. It is not an easy pose for shoulders or hamstrings so I tell my students to bend the legs if their hamstrings are tight. This enables the spine to be freer.

This pose is not appropriate for people with acute or severe lower back pain.

-Start in child’s pose, resting with the hips on the feet and head on the mat.

-Straighten the arms and place the hands mat-width apart with the fingers spread.

-Turn the toes under.

-Unfold the legs. If the hamstrings are tight, don’t straighten the legs all the way. First send your tailbone up and back, tilting the pelvis so that the back is straighter and the spine can hang down.

-Avoid pushing the ribs down. This would only cause more pain in the middle back.

-Stay a few breaths if comfortable and return to child’s pose.

Child’s pose

A lovely stretch for the whole back.

-Fold your hands under your forehead if your head doesn’t touch the mat.

-With every exhalation allow the head and the hips to relax more.


This Post Has 3 Comments

  1. Sue jensen

    Thank you. I’d forgotten the pelvic tilt with arms above the head.

  2. Christine Kendell

    Exactly what I need – thank you!

  3. Cherry castasus

    Thanks for the nice inout i will surely do it from today

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