Pain guide · Back pain

Middle back pain: the muscles, joints and ribs, the organs that can cause it, and how to build back

Middle back pain, between the bottom of the shoulder blades and the bottom of the ribs, usually comes from the back's muscles, joints and ribs, and usually improves within a few weeks. It is common, and posture is rarely the whole story. But the heart, lungs, kidneys and gut can also be felt here, so the warning signs come first.

Call 999 or go to accident and emergency (A&E) for back pain with chest pain or sudden breathlessness; call 999 for chest pain spreading to your arms, neck or jaw, or a sudden tearing pain; and contact a general practitioner (GP) or the National Health Service's 111 line (NHS 111) the same day if you feel hot, cold, shivery or generally unwell. This guide maps the causes by spot and pattern, explains what helps (staying active, and strength for the upper back, borrowed from neck and shoulder trials; spinal manipulation did no better than a sham in the one middle back trial), and gives a three-stage plan with 3D demos.

3-stage exercise plan When to get help 47 sourcesUpdated 25 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Call 999 or go to A&E: back pain with chest pain, or back pain that started after a serious accident, such as a car crash.
Call 999 if you have chest pain that feels tight or like squeezing on your chest, chest pain that's spreading to your arms, neck or jaw, or severe difficulty breathing (gasping, choking or not able to get words out), if your lips or skin are pale, blue or grey, or if someone has passed out and is not responding normally. It could be a heart attack. Don't drive yourself to A&E. The British Heart Foundation also lists pain that spreads to either arm, your neck, jaw, upper back or stomach among the symptoms of a heart attack.
Call 999 or go to A&E: you have difficulty breathing which comes on suddenly, you feel pain in your chest or upper back, your heart is beating very fast, or someone has passed out. These could be signs of a pulmonary embolism (a blood clot in the lungs) or another serious condition. Don't drive yourself.
Call 999: sudden chest or back pain that can feel like something being torn inside, and causes shortness of breath, and problems with walking, vision and speaking. It can be a tear in the wall of the body's main artery (an aortic dissection). Don't drive yourself to A&E.
Call 999: sudden, severe pain in the tummy or back, which can come with breathlessness, pale or grey skin, or collapse. It can be a burst abdominal aortic aneurysm, most common in men aged 65 or over and in people who smoke or used to smoke.
Call 999 or go to A&E: pain spreading from the tummy to the back, with vomiting.
Call 999 or go to A&E: you get sudden, severe pain in your tummy and the pain is spreading to your back, you have bloating that does not go away or keeps coming back, you have a fast heartbeat or difficulty breathing, or the skin around your belly button, waist or upper outer thigh appears blue or bruised. It can be acute pancreatitis.
Call 999 or go to A&E: loss of feeling or numbness around the genitals or bottom, new trouble peeing or controlling your bladder or bowels, changes in genital sensation during sex or problems with erections or orgasm, or pain, tingling, weakness or numbness in both legs. These are signs of cauda equina syndrome, which needs treating in hospital urgently. Don't drive yourself.
Call 999 or go to A&E: new problems walking, loss of bladder or bowel control, or a sudden loss of coordination, such as difficulty doing up buttons. These can be signs of pressure on the spinal cord.
Call 999: after a fall, you may have hurt your head, neck, back or hip, or you cannot get up.
Same day (GP or NHS 111): back pain and you feel hot, cold, shivery or generally unwell, or severe pain that starts suddenly or is getting worse quickly.
Ask for an urgent GP appointment or get help from NHS 111 if you think you may have a kidney infection (often pain in your lower back or side, with burning or stinging when you pee or needing to pee more often) and you have a very high temperature or feel hot, cold or shivery, a temperature below 36C, pain in the lower tummy or in the back just under the ribs, blood in your pee, you feel or are sick, you haven't had a pee all day, or you're pregnant. Call 999 or go to A&E if you're confused, drowsy or have difficulty speaking.
Ask for an urgent GP appointment or get help from NHS 111 if you think you have kidney stones and you're in severe pain, or you have a high temperature or feel hot, cold or shivery. Kidney stone pain usually starts in the side of the tummy or the lower back, can spread to the groin, and may come and go.
Same day (urgent GP appointment or NHS 111): pain in your tummy, often in the middle or just under the ribs on the right, that lasts longer than 30 minutes; it may spread from there to your side or shoulder blade. It can be gallstones.
Ask for an urgent GP appointment or get help from NHS 111: you have sharp chest pain that comes and goes, or only happens when breathing or coughing; sharp chest pain that has not got better after a few days; you've coughed up a few small spots, flecks or streaks of blood, or noticed blood in your phlegm; or you're feeling short of breath regularly. It can be pleurisy or a chest infection.
Same day: you have or have had cancer, and new back pain that is severe and doesn't let up, is getting steadily worse, is worse at night and disturbs your sleep, is worse when you cough, sneeze or strain, or comes with tenderness over the spine. Contact your cancer team or GP urgently. With cancer, new weakness, difficulty walking, numbness or bladder or bowel problems are an emergency.
Contact your GP or midwife urgently: back pain in the second or third trimester of pregnancy, or back pain in pregnancy with a fever, vaginal bleeding, pain when you pee, or pain in one or more of your sides (under your ribs). It could be early labour or an infection.
Get urgent medical help: you're pregnant or have given birth in the last few weeks and have symptoms of pre-eclampsia, such as pain below the ribs, a severe headache that does not go away with simple painkillers, vision problems such as blurred vision or seeing flashing lights, or sudden swelling of the face, hands or feet. If you're pregnant, call your maternity unit if you have the number; if you've recently given birth or cannot call your maternity unit, call 111.

See a doctor or physiotherapist if

Pain at the top of the back, between the shoulders, rather than in the lower back.
Contact your GP practice if your back pain is persistent and unchanging after following the self-care advice, the level of pain isn't affected by movement, or the pain is worse at night.
Pain that doesn't improve with rest or is worse at night, or pain that is worse when you sneeze, cough or poo.
Unexplained weight loss, or a lump, swelling or change in the shape of your back.
Unexplained back pain with muscle spasms, loss of height, or a curved spine or change in posture: a possible osteoporotic spinal fracture, more likely with older age or long-term steroid tablets.
Sudden pain in the middle of the spine after a minor fall, lift, cough or sneeze, from 50 or with long-term steroid tablets: see a GP. The UK osteoporosis guideline recommends checking for a spinal fracture in sudden back pain with risk factors for osteoporosis, because most are never diagnosed.
Contact your GP practice if you have lower back pain for more than 3 months, morning stiffness that lasts more than 30 minutes and you're 40 or younger, or back pain that gets better with exercise and worse at rest. Ankylosing spondylitis usually starts in teenagers or young adults and can cause pain at the ribs.
A burning, tingling or painful patch of skin on one side of your back or chest, with or without a rash: get advice from a pharmacist or NHS 111 as soon as possible. Shingles can cause pain a few days before the rash appears, and rarely without one. Try to see a pharmacist within 3 days of the rash appearing.
See a GP if you've lost a noticeable amount of weight, or have pain at the top of your tummy and your back that gets worse or doesn't get better after 2 weeks. Ask for an urgent GP appointment or NHS 111 if the whites of your eyes or your skin turn yellow.
Back pain that hasn't improved after a few weeks of looking after it at home, stops you doing day-to-day activities, or worries you.

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

Either side of the spine in the middle of the back, an ache that changes as you move

Usually the back's muscles and joints, often after long, still spells, lifting or a busy day; this guide's plan covers it.

A sharp spot beside the spine on a deep breath, a cough or a twist

Possibly a rib joint, a joint of the spine or a strained muscle between the ribs.

Read: Rib pain →Between the shoulder blades

Our upper back pain guide.

Read: Upper back pain →Under or around one shoulder blade

Our shoulder blade guide maps the causes, including the organs that can be felt there.

Read: Pain under the shoulder blade →The middle or upper back after a day at a desk

Our upper back pain from sitting guide covers the desk set-up and breaks.

Read: Upper back pain from sitting →Sudden pain in the middle of the spine after a minor fall, lift, cough or sneeze, from 50 or with long-term steroid tablets

Possibly a spinal fracture from osteoporosis: see a GP.

Read: Spinal compression fracture →A teenager's upper back that stays rounded when they stand tall

Possibly Scheuermann's disease, where the vertebrae grow wedge-shaped.

Read: Scheuermann's disease →

Stiffness for 30 minutes or more each morning that eases with exercise, in a teenager or young adult

See a GP: it can be ankylosing spondylitis, which can also cause pain at the ribs.

A burning or tingling band on one side, then a rash

Possibly shingles: get advice from a pharmacist or NHS 111 as soon as possible, and try to see a pharmacist within 3 days of the rash appearing.

In the side or the back just under the ribs, with a fever, burning pee or feeling sick

Possibly a kidney infection: ask for an urgent GP appointment or call NHS 111.

Read: Lower back pain on one side →Under the right ribs, spreading to the side or shoulder blade, for more than 30 minutes

Possibly gallstones: ask for an urgent GP appointment or call NHS 111.

Read: Pain under the shoulder blade →The top of the tummy through to the back, better leaning forward

Possibly the pancreas: sudden, severe tummy pain spreading to the back is a 999 call.

Read: Back pain when lying down →

Chest pain, or pain spreading to the arm, neck, jaw or upper back, with breathlessness or sweating

Possibly the heart: call 999.

Sudden breathlessness with pain in the chest or upper back

Possibly a clot in the lungs: call 999.

Sudden tearing pain in the chest or back

Call 999.

In pregnancy, pain in one or both sides under the ribs

Contact your GP or midwife urgently.

The lower back instead

Our lower back pain guide.

Read: Back pain →

Understand it

What "middle back" means here

The upper back (the thoracic spine) has 12 vertebrae, each carrying a pair of ribs. The middle back is its lower half, from the lower tips of the shoulder blades to the bottom of the ribs, with the back of the ribs on each side. The kidneys sit here, under the lower ribs at the back, which is where the NHS places kidney infection pain: "in the back, just under the ribs". The NHS has no separate middle back page; its back pain page asks you to see a GP for back pain at the top of the back, between the shoulders, rather than the lower back.

Sources 1, 2

Most middle back pain is the back's muscles and jointsEmerging evidence

Back pain often starts for no obvious reason, and staying in one position too long, lifting something awkwardly, a flare-up of an old problem and doing more than usual can all set it off, NHS inform says; the spine is strong, and serious disease or damage is rare. Pain in the thoracic spine is common: across 33 studies, between 3.5% and 34.8% of people had it over a year, more often children, teenagers and women, and it was linked with backpacks, other aches and psychological factors. The ranges are wide because the studies defined it differently.

Sources 3, 4, 2

The rib joints and the small joints of the spineEmerging evidence

Each rib meets the spine at small joints, and the vertebrae have small joints of their own. When the rib joints were injected in 8 healthy male volunteers, they caused a deep, dull ache over the joint itself; when the small spinal joints of the mid back were injected in 9 healthy volunteers, they caused local and referred pain, with the areas for different joints overlapping. In a US pain clinic study, 42% of people with long-term thoracic pain were relieved by numbing these spinal joints, though single test blocks gave false positives 55% of the time. So these joints are a plausible source of a sharp, one-sided ache beside the spine, but no examination can confirm them.

Sources 5, 6, 7

Posture and sittingMixed evidence

An umbrella review of 41 reviews found no consensus that spinal postures, sitting, bending or twisting cause back pain, though most of that research is about the lower back. Forward head posture went with neck pain in adults but not in teenagers, in 15 studies. NHS inform says your posture doesn't need to be perfect; move often so you don't stay in one position for long. In 3,420 Chinese school students, carrying a backpack on one shoulder and slumped sitting went with back pain, including over time, but a study like this can't show cause and effect. No study we read tested posture as a cause of middle back pain.

Sources 8, 9, 3, 10

A spinal fracture from osteoporosisStrong evidence

With weak bones, a cough or sneeze can cause the partial collapse of a bone in the spine, the NHS says. About 86,000 spinal fractures happen in the UK each year, and most never come to medical attention, the UK osteoporosis guideline says. In 13,562 Europeans aged 50 and over, wedge-shaped fractures clustered in the middle of the thoracic spine and where the mid and lower back meet. In a US population, 83% of diagnosed spinal fractures followed moderate or no trauma, and 3% came from disease in the bone. A spinal fracture heals in 6 to 12 weeks, in its new, compressed shape, the Royal Osteoporosis Society says.

Sources 11, 12, 13, 14, 15

Teenagers and young adultsEmerging evidence

A rounded upper back in a teenager is usually postural kyphosis, the most common type, the NHS says; in Scheuermann's kyphosis, the vertebrae grow wedge-shaped. Ankylosing spondylitis usually starts in teenagers or young adults, with back pain and morning stiffness of 30 minutes or more that eases through the day or with activity, and it can cause painful inflammation where tendons and ligaments join the bone, including at the ribs, NHS inform says.

Sources 16, 17, 18

The organs that can be felt in the middle of the backStrong evidence

Each has its own clues, and the warning signs above give the action for each:

The heart: the NHS heart attack page lists chest pain that feels tight or squeezing, spreading to the arms, neck or jaw, with breathlessness. The British Heart Foundation also lists pain that spreads to either arm, the neck, jaw, upper back or stomach, and says women sometimes have the less well-known symptoms rather than chest pain.
The aorta, the body's main artery: sudden chest or back pain that can feel like something being torn inside, or sudden, severe tummy or back pain.
The lungs: sudden breathlessness with pain in the chest or upper back (a clot in the lungs), or sharp chest pain on breathing in, often worse when you cough (pleurisy), which can spread to the shoulders and back.
The kidneys: pain in the lower back or side, or in the back just under the ribs, with a fever, burning when you pee or feeling sick (an infection); or waves of severe pain starting in the side or lower back and spreading to the groin (a stone).
The gallbladder: pain under the right ribs or in the middle of the tummy for more than 30 minutes, which may spread to the side or shoulder blade.
The pancreas: pain at the top of the tummy that can spread through to the back or below the left shoulder blade, often eased by leaning forward and worse lying flat or after eating.

Sources 19, 20, 21, 22, 23, 24, 25, 1, 26, 27, 28, 29, 30, 31

Shingles, pregnancy, cancer and discs

Less common causes, each with its own clues:

Shingles: a tingling or painful patch of skin on one side, then a rash a few days later, usually on the chest and tummy.
Pregnancy: back pain with pain in one or both sides under the ribs needs your GP or midwife urgently, and pain below the ribs with a severe headache, vision problems or sudden swelling needs urgent help (pre-eclampsia).
Cancer: with cancer now or in the past, new back pain that is severe, getting worse, worse at night or worse when you strain needs urgent advice, the National Institute for Health and Care Excellence (NICE) says; in people aged 60 and over, NICE asks GPs to test for myeloma with persistent bone pain, particularly back pain.
A disc: disc herniations in the mid back are uncommon compared with the neck and lower back, a surgical review says.

Sources 32, 33, 34, 35, 36, 37

Tests and scansStrong evidence

Most back problems don't need an X-ray or a magnetic resonance imaging (MRI) scan, NHS inform says. The UK osteoporosis guideline recommends checking for a spinal fracture in people aged 50 and over with sudden back pain and risk factors for osteoporosis, or with 4 cm or more of height loss, a curved upper back or long-term steroids. With cancer, suspected spread to the spine needs an MRI, within 24 hours when the spinal cord may be squeezed, NICE says. Kidney stones are diagnosed from the symptoms, with urine or blood tests and sometimes a computerised tomography (CT) scan. An international framework notes that most single warning signs have little evidence of how accurate they are: they prompt a check, not a diagnosis.

Sources 3, 12, 35, 26, 38

How it usually goesEmerging evidence

Back pain often improves on its own within a few weeks, the NHS says, and most new back problems improve within 6 weeks, with the biggest change in the first couple of weeks, NHS inform says. In a trial of 143 people with mid back pain, pain and disability improved over 12 months whatever the treatment, including a sham. A spinal fracture heals in 6 to 12 weeks. No one can promise a date.

Sources 2, 3, 39, 15

What helps, and how strong the evidence is

Stay active: the health services' first stepsStrong evidence

The NHS says stay active and try to continue your daily activities, don't stay in bed for long periods, try an anti-inflammatory such as ibuprofen if it suits you (paracetamol on its own isn't recommended for back pain), use an ice pack for pain and swelling and a heat pack for stiffness or spasm, and try exercises and stretches; walking, swimming, yoga and pilates may also help. NHS inform adds: don't brace or hold yourself still, don't sit or rest for too long, change position regularly, and stay at or return to work.

Sources 2, 3

Exercise for middle back pain: borrowed from neck and shoulder trialsMixed evidence

No trial has tested exercise for middle back pain itself, so the benefit is borrowed from neck and shoulder trials. In 48 women in computer-heavy jobs with neck and shoulder muscle pain, 10 weeks of specific strength training for the painful muscle cut their worst pain by about 79%, while cycling gave only a small, short-lived drop. A Cochrane review of 27 trials (2,485 people) found strength training for the neck, shoulder blades and upper body eased long-lasting neck pain by a moderate to large amount, on moderate-quality evidence.

The one fully powered trial in mid back pain (143 people) tested treatments other than exercise, and everyone improved, including the sham group. So the plan's rows, shoulder-blade and back-extension work is a reasonable borrowing, not a tested treatment for this pain.

Sources 40, 41, 39

Manipulation and an instrument massage did no better than a shamEmerging evidence

In 143 people with mid back pain, spinal manipulation and an instrument-assisted soft tissue technique did no better than a sham (switched-off ultrasound) at any point up to 12 months; all three groups improved with time. It was one trial at one clinic. The NHS lists manual therapy among the options if back pain hasn't improved after a few weeks, alongside group exercise, physiotherapy and talking therapy.

Sources 39, 2

Posture, desks and breaks: sensible, but untested for middle back painMixed evidence

There's no consensus that postures cause back pain, and NHS inform says your posture doesn't need to be perfect. For comfort at a screen, the Health and Safety Executive (HSE) suggests the top of the screen level with your eyes about an arm's length away, a seat that supports your thighs and lower back, the screen and keyboard straight in front so you don't twist, and short, frequent breaks: 5 to 10 minutes every hour is better than 20 minutes every 2 hours. None of this has been tested as a treatment for middle back pain.

Sources 8, 9, 3, 42, 43

Bags: carrying on one shoulder went with back pain in school studentsEmerging evidence

Backpack use goes with thoracic spine pain in children and teenagers, and in Chinese school students, carrying a backpack on one shoulder and slumped sitting went with back pain, including over time. These are observational studies. Two straps and a lighter load are sensible, but no trial has tested them.

Sources 10, 4

With osteoporosis or after a spinal fracture: back-extension work, less roundingEmerging evidence

A UK expert consensus recommends spinal extension (arching) exercise to improve posture, avoiding positions with a lot of spinal rounding in exercise and daily life, and, after a spinal fracture, impact only up to the level of brisk walking, ideally with specialist advice. The Royal Osteoporosis Society says movement doesn't affect healing and recommends staying as active as possible. Our spinal compression fracture guide has the full plan.

Sources 44, 15, 12

Sore ribs: breathe and cough normallyEmerging evidence

For a bruised or broken rib, the NHS says breathe normally and cough when you need to, holding a pillow against your chest; walk around and sometimes move your shoulders; regularly take slow, deep breaths to clear your lungs; and try sleeping more upright for the first few nights. After a rib injury, call 999 or go to A&E for shortness of breath that's getting worse, chest pain that's getting worse, pain in your tummy or shoulder, or coughing up blood.

Source 45

How much pain is OK while you exercise?

Up to about 5 out of 10, no worse the next morning; chest, breathing and tummy symptoms are never a pain-rule questionEmerging evidence

Some discomfort during exercise is fine, and it doesn't mean you are doing damage. Aim for pain you would call mild to moderate, no more than about 5 out of 10. It should settle within an hour or so, and your back should be no worse the next morning. If it is worse, do less next time (fewer reps, a smaller range, a lighter load), not nothing. This is the back hub's rule.

NHS inform's back exercises use the same scale: 0 to 3 is minimal pain, 4 to 5 acceptable and 6 to 10 too much; if it goes higher, do fewer repetitions, move more slowly or rest longer between movements; soreness from new exercises should ease quickly, and your pain should be no worse the morning after. Stop exercises that make your symptoms worse or bring on new pain. The 5 out of 10 figure hasn't been tested in a back pain trial; in trials of long-lasting muscle and joint pain, exercise that allowed some pain did no harm.

With sore ribs, breathe and cough normally and avoid sharp pain at the sore rib. With a known or possible spinal fracture, use our spinal compression fracture guide's rule instead. If a movement sends pain, pins and needles or numbness into an arm or leg, make it smaller or leave it out.

Chest pain, pain spreading to the arm, jaw or neck, breathlessness, sweating, feeling sick, a fever, burning when you pee, tummy pain, yellow skin or eyes, or a new rash is never a pain-rule question: see the warning signs.

Sources 46, 47, 45, 15

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Settle: keep the middle back and ribs moving

About the first 2 weeks, daily, little and often. Stay active, change position regularly and don't brace (the NHS and NHS inform), and walk every day. If these doses feel like too much at first, use NHS inform's pacing for back exercises: 2 or 3 repetitions at a time, practised every hour, adding 1 or 2 every few days as it gets easier.

Thoracic rotation demonstrated on the 3D figure

3D demoThoracic rotationBeginner · No equipment

6 rotations per side, moving with the breath · The move page's dose, as in our upper back pain guide

Easier: Side-lying open book · Harder: World's greatest stretch

Side-lying open book demonstrated on the 3D figure

3D demoSide-lying open bookBeginner · No equipment

8 to 10 slow openings each side, pausing 2 s at the end · The move page's dose, an editorial starting point

Harder: Thoracic rotation

3D demoCat-cowBeginner · No equipment

8 waves, slower than feels natural · The move page's dose; NHS inform's back exercises include the same curl and arch on hands and knees

Harder: Half lord of the fishes (Ardha Matsyendrasana)

Standing trunk twist demonstrated on the 3D figure

3D demoStanding trunk twistBeginner · No equipment

Hold each turn about 5 s, 5 times each side · The move page's dose, the NHS's seated upper-body twist

Harder: Cobra pose (Bhujangasana)

Lateral breathing (Pilates breathing) demonstrated on the 3D figure

3D demoLateral breathing (Pilates breathing)Beginner · No equipment

5 to 8 breaths at the start of every session · The move page's dose, a suggested starting point. With sore ribs, also take slow, deep breaths regularly through the day, as the NHS advises

Harder: Roll-up (Pilates)

Treadmill walking demonstrated on the 3D figure

3D demoTreadmill walkingBeginner · Cardio machine

10 to 20 min a day, letting the arms swing · As in our upper back pain guide (editorial); walking outdoors counts the same

Harder: Treadmill jogging

Move on when: Turning, reaching and deep breaths are more comfortable, the pain is settling, and it is no worse the next morning.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Build: back and shoulder-blade strength

About weeks 2 to 6, two or three sessions a week, with stage 1 on the other days: strength for the muscles that hold the shoulder blades and extend the upper back, the type of training that helped neck and shoulder muscle pain in trials (borrowed: no trial has tested it in middle back pain).

3D demoBand rowBeginner · A band + An anchor point

3 sets of 10 to 15, stopping 2 to 3 reps short of failure, with 60 to 90 s rest · The move page's dose, an editorial starting point. Check the anchor before every set, as the move page says

Harder: Supported single-arm dumbbell row

Prone Y-T-W raises demonstrated on the 3D figure

3D demoProne Y-T-W raisesBeginner · No equipment

2 sets of 6 to 8 of each letter · As in our upper back pain guide (editorial). Keep your neck long, as the move page says

Easier: Wall angel · Harder: Bent-over reverse fly

Wall angel demonstrated on the 3D figure

3D demoWall angelBeginner · A wall

2 sets of 8 to 10 · As in our upper back pain guide (editorial)

Easier: Table slide (seated forward reach) · Harder: Prone Y-T-W raises

Seated upper-back lift (sit tall, shoulders back) demonstrated on the 3D figure

3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box

3 to 5 repetitions, each held 3 to 5 s, at least twice a week · The move page's dose, which it takes from the UK osteoporosis consensus

Easier: Elbows back · Harder: Prone Y-T-W raises

Bird dog, one limb at a time demonstrated on the 3D figure

3D demoBird dog, one limb at a timeBeginner · No equipment

2 sets of 5 each side, holding 5 s · Editorial

Easier: Side-lying tummy draw-in · Harder: Bird dog

Move on when: These feel steady, the pain is no worse the next morning, and a working day or a long drive no longer brings it back by the evening (our suggestion, as in our shoulder blade guide).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Strengthen, then lifting, carrying, long sits and sport come back

From about week 6, two or three days a week, ongoing: heavier rows, carries and back-extension work, while desk days, lifting, carrying, sleep and sport come back by the written steps below. The strength trial for neck and shoulder muscle pain ran for 10 weeks.

Chest-supported dumbbell row demonstrated on the 3D figure

3D demoChest-supported dumbbell rowBeginner · A dumbbell + A bench or box

3 sets of 8 to 12 · As in our upper back pain guide (editorial)

Harder: Supported single-arm dumbbell row

Supported single-arm dumbbell row demonstrated on the 3D figure

3D demoSupported single-arm dumbbell rowIntermediate · A dumbbell + A bench or box

3 sets of 8 to 12 each side · As in our upper back pain guide (editorial). Keep the spine still rather than twisting, as the move page says

Easier: Incline ring row · Harder: Bent-over barbell row

Farmer's carry demonstrated on the 3D figure

3D demoFarmer's carryIntermediate · A dumbbell + A kettlebell

3 walks of 20 to 30 m · As in our upper back pain guide (editorial)

Harder: Suitcase carry

Low cobra (Bhujangasana) demonstrated on the 3D figure

3D demoLow cobra (Bhujangasana)Beginner · No equipment

3 to 5 reps, each held 3 to 5 s, at least twice a week · Our upper back pain guide's back-extension dose, which it takes from the UK osteoporosis consensus. Ease off if your lower back pinches, as the move page says

Easier: Sphinx pose (Salamba Bhujangasana) · Harder: Cobra pose (Bhujangasana)

Half-kneeling Pallof press demonstrated on the 3D figure

3D demoHalf-kneeling Pallof pressBeginner · A band + An anchor point

2 sets of 8 to 10 each side, holding 2 s · Editorial: resisting a twist, for carrying and sport

Harder: Pallof press

Hip-hinge practice demonstrated on the 3D figure

3D demoHip-hinge practiceBeginner · No equipment

2 sets of 10 · Editorial: bending and lifting from the hips

Harder: Dumbbell Romanian deadlift

Move on when: Our suggestion: full working days, your usual lifting and carrying, a night's sleep and your sport stay within the pain rule, with nothing worse the next morning. Keep two strength days a week; if a busy week flares it, drop back a stage for a few days rather than stopping.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

Desk, sitting and driving (written steps)

The desk steps are the HSE's and the movement advice NHS inform's; the driving step is our suggestion. None has been tested as a treatment for middle back pain.

1. Move often: your posture doesn't need to be perfect, but don't stay in one position for long (NHS inform).
2. Breaks: short and frequent, such as 5 to 10 minutes every hour, rather than 20 minutes every 2 hours (the HSE). Do one stage 1 move at each break.
3. The screen: straight in front of you so you don't twist, with the top level with your eyes, about an arm's length away. With a laptop, a separate keyboard and mouse let you raise the screen on a stand (the HSE).
4. The chair: at a height that supports the front and back of your thighs equally, with good support for your lower back (the HSE).
5. Driving and long journeys: stop every hour or two and walk for a few minutes (our suggestion).

Sources 42, 43, 3

Breathing with sore ribs (written steps)

The NHS's advice for a bruised or broken rib, which suits a sore rib joint too.

1. Breathe normally, and cough when you need to, holding a pillow against your chest.
2. Walk around and move your shoulders now and then.
3. Take slow, deep breaths regularly to clear your lungs.
4. Try sleeping more upright for the first few nights.
5. Painkillers such as paracetamol or ibuprofen gel (or ibuprofen tablets if needed) can help; a pharmacist can say which suits you.

Source 45

Bags, lifting and carrying (written steps)

Our suggestion, built on the backpack studies and the UK osteoporosis consensus; none of it has been tested as a treatment.

1. Bags: use both straps, keep the load lighter and heavy items close to your back.
2. Lifting: keep the load close and bend from the hips; with osteoporosis, avoid lifting with your back rounded.
3. Shopping, children and luggage: split loads between two hands, and build up with farmer's carries first.

Sources 10, 44

Sleep (written steps)

No sleeping position has been tested for middle back pain, so these are our suggestions.

1. Try lying on your side with a pillow between your knees, or on your back with a pillow under your knees.
2. Getting out of bed: NHS inform suggests rolling onto your tummy, edging towards the side of the bed, letting the nearer leg drop towards the floor and pushing up with your hands.
3. Pain that wakes you every night, or is worse at night and doesn't ease when you move, is a reason to contact your GP practice.

Sources 3, 2

Lifting, long sits and sport come back (written steps)

No trial has tested how to bring these back after middle back pain. These steps are our suggestion unless a source is named.

1. Long sits: add 15 minutes at a time while your back stays within the pain rule, and keep the hourly breaks.
2. Lifting and carrying: build up with the stage 3 rows and carries before heavy jobs.
3. Sports that twist and reach (golf, racket sports, swimming, rowing): shorter sessions once stage 2 feels steady, then build up.
4. Work: stay at work or go back as soon as you can; you don't need to be free of pain and symptoms to return, NHS inform says.
5. If it hasn't improved within 6 weeks, talk to a healthcare professional (NHS inform); in many areas you can get physiotherapy from NHS musculoskeletal services without a GP referral (the NHS).

Sources 3, 2

Positions to swap, and why

Habit or position	Why it matters	Instead
Staying in one position for hours at a desk, on a sofa or in a car	NHS inform says move often so you don't stay in one position for long, and the HSE recommends short, frequent breaks.	Get up for a few minutes every hour, with a rotation or a twist at each break.Try: Thoracic rotation
Bracing, holding yourself stiff, or a posture brace	NHS inform says don't brace or hold yourself still; your back is designed to move. No source we read supports posture braces for middle back pain.	Move normally, with gentle spine movements through the day.Try: Cat-cow
Bed rest	The NHS says don't stay in bed for long periods, and NHS inform says resting in bed doesn't help back pain and often makes it harder to get going again.	Short, regular walks.Try: Treadmill walking
Twisting to a screen set off to one side, or one that is too low	The HSE advises the screen and keyboard straight in front, so you don't twist, with the top of the screen at eye level.	Set the screen straight ahead at eye level; a laptop stand and a separate keyboard help.
Shallow, guarded breathing with sore ribs	The NHS says breathe normally and take slow, deep breaths regularly, to keep the lungs clear.	Lateral breathing, and a pillow to hold when you cough.Try: Lateral breathing (Pilates breathing)
A heavy bag on one shoulder	Carrying a backpack on one shoulder went with back pain in school students.	Both straps, a lighter load, heavy items close to the back (our suggestion).
Foam rolling the upper back with osteoporosis	The move page says clear it first with osteoporosis, and the UK consensus favours controlled back-extension work and avoiding lots of rounding.	Seated upper-back lifts and other gentle back-extension work.Try: Seated upper-back lift (sit tall, shoulders back)
Cracking or manipulating the back as the fix	In a trial of mid back pain, manipulation did no better than a sham, and everyone improved with time.	Movement and the strength stages.Try: Band row
Pushing on through pain that doesn't change with movement, is worse at night, or comes with a fever, breathlessness, tummy pain or a rash	These point away from the back's muscles and joints.	Check the warning signs and get it seen.

Routines to follow

Upper back mobility routine

A 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.

12 minBeginner8 movesA foam roller, A wall

Spine mobility routine: neck to pelvis, every direction

A 15-minute routine that moves your neck, upper back and lower back through bending, arching, side bending and twisting, then holds the spine steady.

15 minBeginner12 movesNo equipment

3-minute desk movement break

A 3-minute standing break to repeat every 30 to 60 minutes at your desk: sit-to-stands, calf raises, marching, an upper-back turn and chin tucks.

3 minBeginner5 movesA bench or box, A wall

Back workout at home: dumbbells, a band and an optional bar

A back workout at home with dumbbells and a band: pull-ups or band-assisted pulls, two rows, face pulls, reverse flys, shrugs and Romanian deadlifts.

40 minIntermediate14 movesA band, Pull-up bar

Breathing exercises to relax

A 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.

6 minBeginner5 movesNo equipment

More moves for this area

Questions people ask

What causes middle back pain?

Usually the muscles, joints and ribs of the back, often after long, still spells, lifting or doing more than usual. Less often it's a spinal fracture from osteoporosis, shingles, or an organ such as the kidneys, gallbladder, pancreas, heart or lungs, which bring other symptoms with them.

When is middle back pain serious?

Call 999 for back pain with chest pain; chest pain spreading to your arms, neck or jaw; sudden breathlessness; a sudden tearing pain; or pain, tingling, weakness or numbness in both legs, a loss of feeling around your genitals or bottom, or changes in your bladder or bowels. Ask for an urgent GP appointment or call 111 for back pain when you feel hot, cold, shivery or generally unwell.

Is it my back or my kidneys?

A kidney infection usually comes with a high temperature, feeling sick, and burning or needing to pee more often, with pain in the lower back or side, or just under the ribs. Pain from the back's muscles and joints usually changes with movement and position. If in doubt, ask a GP or NHS 111.

Is middle back pain caused by bad posture?

Not usually on its own. Reviews found no consensus that postures cause back pain, and NHS inform says your posture doesn't need to be perfect: move often instead. Breaks and a screen at eye level can make a desk more comfortable.

Why does my middle back hurt when I breathe in?

A sore rib joint or a strained muscle between the ribs can hurt on a deep breath. But pain on breathing with breathlessness, coughing up blood, a fever or chest pain needs urgent help, because the lungs can cause it.

What exercises help middle back pain?

Gentle turning, arching and breathing movements first, then rows and upper back strength, built up over weeks. Strength training for the shoulder blades and upper back eased neck and shoulder muscle pain in trials, but no trial has tested exercise for middle back pain itself.

Why do women get middle back pain?

Mostly for the same reasons as men, though thoracic spine pain is more common in women in population studies. Some causes are more likely in women: pregnancy, spinal fractures from osteoporosis, and gallstones, which are more common in women, particularly after having children. The British Heart Foundation lists pain spreading to the upper back among heart attack symptoms, and says women sometimes have the less well-known symptoms rather than chest pain.

Will a chiropractor or massage fix it?

In a trial of 143 people with mid back pain, spinal manipulation and an instrument-assisted massage did no better than a sham, and everyone improved with time. The NHS lists manual therapy among the options if pain isn't improving after a few weeks.

Can middle back pain be a heart attack?

It can be part of one. The NHS's 999 signs are chest pain that feels tight or squeezing or spreads to your arms, neck or jaw, severe difficulty breathing, or pale, blue or grey lips or skin. The British Heart Foundation also lists pain spreading to the upper back among heart attack symptoms. Call 999 if you think it might be a heart attack.

I'm pregnant and my middle back hurts. When should I worry?

Contact your GP or midwife urgently for back pain in the second or third trimester, or with a fever, bleeding, pain when you pee, or pain in your sides under the ribs. Pain below the ribs with a severe headache, vision problems or sudden swelling needs urgent help.

My back suddenly hurt after a cough, and I'm over 60. Could it be a fracture?

It could: with weaker bones, a cough or sneeze can cause a bone in the spine to partly collapse, and most spinal fractures are never diagnosed. See a GP, who may arrange an X-ray; these fractures usually heal in 6 to 12 weeks.

How long does middle back pain last, and should I rest it?

Back pain often improves within a few weeks, and most back problems improve within 6 weeks. Keep moving rather than resting: the NHS says keep up your daily activities and don't stay in bed for long. See a GP if it isn't improving after a few weeks, stops you doing daily activities, or worries you.

Related exercise guides

Spine guide

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.