The causes and treatment of mid-back and upper back pain

Dr. Lev Kalika

The mid-back refers to the area of the spine from the upper border of the shoulder blades to the bottommost ribs. Even though pain in the mid-back is not as dangerous as pain in the lower back or neck it can be just as disabling.

Pain in the mid-back is very common especially nowadays due to the use of computers and hand-held devices. It is synonymous with interscapular pain. However, pain in the mid-back may manifest itself be anywhere along the spine and ribcage. In the past, doctors and scientists disregarded this region and concentrated their attention on the cervical and lumbar spine. Recently however there has been an increased interest in the anatomy, biomechanics and function of the mid-back. The latest research indicates that the integrity of thoracic spine and ribcage is vital to the proper function of the neck and low back.


The mid-back is a part of a functional unit which is called the trunk. The trunk consists of twelve thoracic vertebrae and ribs, which connect the spine to the sternum and abdomen. The shoulder blades connect the trunk to the arms and shoulders. The core muscles in this area connects the trunk to the pelvis from the inside and the outside. Functionally the legs are connected to the trunk via the psoas muscles. The functional unit connecting the lower body to the trunk is called the abdominal canister. The coordinated activity of the diaphragm and back and abdominal muscles creates spinal and pelvic stability by means of intraabdominal pressure. Another important role of the of the trunk is integration of breathing with spinal stability. The visceral organs are suspended and anchored from the trunk (spine and ribcage) and are interconnected with the muscles of the trunk though the fascial network.

Most people think of the core is being the abdomen, however the it genuine location is in muscles connecting the trunk to lower extremities via the pelvis. The core is a functional unit of the body which has multiple functions:

1. Spinal stability
2. Lumbopelvic/hip stability
3. Control of basic rotation
4. Functional connection of the upper with lower extremities


The trunk (ribcage and thoracic spine) is the anatomical, functional and physiological crossroad of the entire body. It connects the lower and upper body together. The natural, reciprocal movement of walking could not be achieved without these intricate trunk connections. The body’s rotation mostly occurs in the trunk, as does the integration of breathing. The body’s core is also part of the trunk.


Symptoms may vary in location and intensity depending on which structures are generating pain.

Pain in the mid-back is divided into five categories:

Myofascialmost commonly coexist

Vertebrogenicmost commonly coexist




     The most common pain in the mid-back is myofascial while the second most common pain in the thorax is vertebrogenic (spinal joints) and vertebro-costal (rib joints). Pain in the trunk typically arises from both.
     There is also mid-back pain of neurogenic or neural origins, often involving a herniated disk in the thoracic spine though this is very rare.

Intercostal neuralgia
(irritated nerves in the area between ribs)

Slipped rib syndrome

There is also viscerosomatic pain that arises from visceral (internal organs) organs. However, what is more common is viscerosomatic pain in the mid-back.

Risk factors

  • Poor ergonomics
  • Poor posture
  • Paradoxical breathing
  • Trauma (injury)
  • Neck and low back disorders
  • Functional organ disease or dysfunction

Treatment of mid back pain in NYC at NYDNRehab

Since mid-back and upper back pain involves the anatomical and functional crossroads of the human body, its resolution requires a whole person or integrative approach. At NYDNR we are proud of our highly successful program of quickly remediating and resolving pain using a combination of DNS (Dynamic Neuromuscular Stimulation), ISM (Integrated Systems Model), myofacial release techniques, chiropractic, acupuncture, and ESWT (Extracorporeal Shock Wave Therapy).

Given the fact the trunk (thorax) is a critical player in the proper, healthy function of the entire musculoskeletal system, it is important that once the pain has been banished therapists focus on restoring the strength, flexibility and motor control of this area.

We are proud to be in the forefront of mid-back disorders rehabilitation using a holistic approach.


Meet CAREN, our computer assisted rehabilitation environment. CAREN takes patient diagnosis and treatment to a whole new level by challenging motor neurons to adapt. First developed by the US military to help wounded warriors recover from amputations and other extremity traumas, CAREN is now available to the public.

Because human gait patterns can be impaired by trauma, disease, or age-related natural decline, gait analysis helps physical therapists identify impaired gait patterns. CAREN then provides a virtual reality environment for purposes of rehab. Rather than walking on a treadmill against the backdrop of the sights, sounds and smells of a clinical environment, CAREN patients are engaged and motivated as they steer a boat across a tranquil lake, drive a car down a city street, or take a nature hike along a rocky path. CAREN provides patients with a positive virtual reality rehab experience that translates to dramatically improved gait, balance and coordination.

From research we know that people with Low back pain (lbp) belong to different categories (or groups) and therefore should be treated with individual approach.

CAREN can successfully facilitate treatment of people with LBP which belong to following categories:

  1. 1. insufficient dynamic core activation
  2. 2. excessive core activation
  3. 3. Low back pain which results from gait (walking) impairment due to asymmetrical weight bearing such as with adaptation to healing by unweighting the injured extremity as well as many other types of weight bearing asymmetry
  4. 4. Loss of balance
  5. 5. Gravitational / postural disorders where there is an uneven distribution of trunk versus pelvis and feet as well as loss of control of the center of mass (COM) ober base of support (BOS) Lumbar fatigue: (rephrase for explanation) or may be leave it but isnt it to long?

Protection against spinal injury requires proper anticipation of events, appropriate sensation of body position, and reasonable muscular responses. Lumbar fatigue is known to delay lumbar muscle responses to sudden loads. Patients with chronic low back trouble had significantly poorer ability than control subjects on the average to sense a change in lumbar position, which was noticed before and after the fatiguing procedure. This feature was found in patients and control subjects, but patients with low back trouble had poorer ability to sense a change in lumbar position than control subjects even when they were not fatigued.

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Your body is a masterpiece of form and function, designed to move in fluid and coordinated patterns governed by your nervous system. But oftentimes, overuse, underuse or abuse of your muscular system can result in pain, injury, uncoordinated movement and poor performance. Thankfully, through proper training and rehabilitation, your miraculous body is able to heal and recoup its natural functional capacity.


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