Upper Back Pain
Although upper back pain is not a very
common spinal disorder, it can cause significant discomfort
and pain when it does occur. The most common causes of upper
back pain are muscular irritation (myofascial pain)
and joint dysfunction.
There can be an injury to a disc in the upper back (such
as a thoracic herniated disc or degenerated disc) that
causes upper back pain, but such injuries are very rare.
It is important to note that the thoracic spine
(also called upper back, middle
back, or mid-back) is very
different in form and function than the cervical spine
(neck) or the lumbar spine (lower back). While the neck and
lower back are designed to provide us with mobility, the
thoracic spine is designed to be very strong and stable to
allow us to stand upright and to protect the vital internal
organs in the chest. Because this section of the spinal
column has a great deal of stability and only limited
movement, there is generally little risk of injury or
degeneration over time in the upper back.
Anatomy of the Upper Back
The word “thoracic” means pertaining to the chest, and
the thoracic spine (also called the upper back or mid-back)
is the portion of the spinal column that corresponds to the
- Twelve vertebrae in the middle of the spine with
ribs attached make up the thoracic spine. When viewed
from the side, this section of the spine is slightly
- Each vertebra in the thoracic spine is connected to
a rib on both sides at every level and these in turn
meet in the front and attach to the sternum (the
breastbone). This creates a cage (the thoracic cage)
that provides structural protection for the vital organs
of the heart, lungs and liver, and also creates a cavity
for the lungs to expand and contract.
- The upper nine ribs start at the spine, curve around
and are joined at the front of the chest. Because the
ribs are firmly attached at the back (the spine) and the
front (the sternum), they allow for very limited motion
in the spine.
- The lower three ribs do not join together at the
front, but do function to protect the vital organs while
allowing for slightly more motion.
- The joints between the bottom thoracic vertebra
(T12) and the top lumber vertebra (L1 in the lower back)
allow twisting movement from side to side.
Because there is little motion and a great deal of
stability throughout the upper back (thoracic spine), this
section of the spine does not tend to develop common spinal
disorders, such as a herniated disc, spinal stenosis,
degenerative disc disease, or spinal instability. These
conditions can cause upper back pain but are exceedingly
rare in the upper back.
Because of this stability and lack of motion, in most
cases anatomic causes of upper back pain cannot be found,
and an MRI scan or CT scan will rarely image an anatomic
problem that is amenable to any sort of surgical solution
for the upper back pain.