Thoracic Pain (Mid-Back Pain)
The thoracic spine is the mid-section of your spine, from the base of the neck to the bottom of the ribcage. Thoracic pain is less commonly discussed than neck or low back pain, but it’s very common — particularly in people with desk-based work, those who’ve had a fall or impact, and those with pre-existing neck or shoulder conditions.
The thoracic spine is also closely linked to shoulder and neck function, so thoracic stiffness frequently contributes to problems elsewhere in the body.
Common Causes
- Postural strain: Prolonged slouching, forward head posture and rounded shoulders
- Costovertebral joint dysfunction: The small joints where ribs attach to the spine can become irritated — causes sharp, localised pain with breathing or movement
- Muscle strain: Overuse, awkward postures or sudden movements
- Scheuermann’s disease: A developmental condition causing wedging of thoracic vertebrae (typically in teens)
- Osteoporosis-related compression fractures: In older adults — requires medical assessment
- Referred pain from the heart or lungs: A rare but important consideration if pain is severe and accompanied by chest pain, breathlessness or other symptoms
Symptoms
- Aching or stiffness across the mid-back
- Sharp, catching pain in one spot with breathing or rotation — suggests rib joint involvement
- Pain that radiates around the ribs (can mimic chest pain or organ pain)
- Stiffness getting up from sitting or in the morning
- Better with movement, worse with sustained postures
Treatment
Thoracic pain often responds very quickly to the right treatment.
Manual Therapy
- Thoracic joint mobilisation and manipulation — frequently provides immediate relief
- Costovertebral joint mobilisation for rib pain
- Soft tissue release for the paraspinal and rhomboid muscles
Exercise and Postural Retraining
- Thoracic extension mobility exercises
- Shoulder blade strengthening and postural correction
- Deep breathing and rib mobility for costovertebral presentations
Workplace and Lifestyle Advice
- Screen height, chair setup and sitting position adjustments
- Movement breaks for desk workers
- Sleeping position advice
