Strategic Plan Fiscal Years 2020-2024 | NIAMS

Middle Back Pain: Causes And Relief

Middle back pain can have several causes, including impact trauma, arthritis, herniated discs, muscle strains, scoliosis, poor posture, and more. Depending on the cause, medical treatments, home remedies, and exercises may help.

The term 'middle back' often refers to the thoracic spine — the region of the back between the rib cage and the base of the neck. This region has 12 spinal disks, several vertebrae, and many muscles and ligaments. Damage or irritation to these structures can lead to back pain.

Read on to learn more about the causes of middle back pain and discover techniques to find relief.

There are many possible causes of middle back pain, ranging from injury to poor posture.

Potential causes include:

Arthritis

There are several different forms of arthritis, some of which can affect the back.

Osteoarthritis (OA) is a common degenerative joint disease that affects 32.5 million adults in the United States. OA causes the ends of bones to rub together, leading to pain, swelling, and stiffness.

Ankylosing spondylitis is a type of arthritis that affects the spine. Symptoms include pain and stiffness in the back. Over time, it causes the vertebrae to fuse, impacting posture and mobility.

Rheumatoid arthritis is a form of inflammatory arthritis that typically affects joints in the hands, feet, and legs. However, it can also affect spinal joints and other parts of the body. It occurs when a person's immune system mistakenly attacks joint tissue.

Fractured vertebrae

A fracture or broken bone can occur in any vertebrae in the middle back due to a sports injury, automobile crash, or fall.

Extreme deterioration of the spine over time, such as from osteoarthritis, can also cause a fractured vertebra.

Symptoms include intense pain that gets worse with movement. If the injury affects the spinal cord, it can lead to tingling, numbness, and incontinence. Fractures require immediate medical treatment.

Herniated discs

Spinal discs are soft tissue formations between each vertebra. They contain liquid and act as shock-absorbing cushions, and aid in spinal mobility.

Discs can rupture or bulge outward. This is known as a herniated or slipped disc and puts pressure on the surrounding nerves.

A herniated disk in the middle back does not always cause symptoms, but it may result in pain, tingling, or numbness. Spinal discs can also rupture completely.

Kidney problems

The most common causes of kidney pain are infections and kidney stones. These may cause pain that feels as though it radiates through a person's back.

Additional symptoms include:

Learn more about the differences between kidney pain and back pain here.

Lifestyle factors

A lack of exercise leads to weak muscles, which can contribute to pain. People who exercise improper lifting techniques can also experience pain in the back.

Research suggests that people who smoke tobacco also have an increased risk of developing chronic back pain.

Muscle strain or sprain

Repeatedly lifting heavy objects or carrying items improperly can cause the muscles and ligaments in the back to stretch or tear.

Overweight and obesity

Being overweight or obese puts additional strain on the back muscles, bones, and other structures.

Higher body weight and a lack of physical activity can increase a person's risk of general back pain.

More specifically, obesity has strong associations with an increase in lower back pain.

Osteoporosis

Osteoporosis is a type of bone disease that results in brittle bones.

Osteoporosis can cause a decrease in bone mineral density and bone mass. It can also lead to a change in the quality of bone structure. These changes can cause bones to weaken, increasing the risk of fractures.

Approximately 10 million U.S. Adults over 50 have osteoporosis. A further 43.3 million people have low bone density, which may put them at risk of the disease.

People with osteoporosis in the back can experience severe back pain due to strains or compression fractures.

Poor posture

Incorrect posture while sitting or standing is a leading cause of back pain. Slouching increases pressure on the spine and leads to strained muscles as they try to maintain balance.

Mental health conditions

People who experience depression or anxiety tend to be at increased risk of developing back pain.

Scoliosis

Scoliosis causes the spine to curve sideways. It leads to an uneven distribution of weight throughout the back and may cause middle back pain.

Living with scoliosis may cause muscle imbalances in the back, contributing to back pain.

Tumor

If a tumor grows in the middle back, it can affect spinal alignment and pressure the nearby nerves, muscles, and ligaments, resulting in pain.

The treatment for middle back pain will depend on the underlying cause. Doctors usually suggest home remedies first but may recommend medical and surgical interventions if needed.

Home remedies

At-home methods to treat middle back pain include:

Heat therapy: Alternating hot and cold compresses, or ice and heat, can provide relief from many types of middle back pain.

Over-the-counter pain relief: Ibuprofen (Advil) or naproxen (Aleve) may relieve pain and swelling.

Posture improvements: Poor posture should be corrected to alleviate back pain. Practice correct posture by standing tall with the shoulders back and minimizing not slouching.

Exercises

Several exercises may help to stretch and strengthen the muscles in the middle back to treat and prevent pain.

Beneficial stretches include:

Cat-Cow Pose: Position yourself on your hands and knees. Then, arch your back as far as comfortable (like a cat) before sinking your back toward the ground in a U-shape (like a cow).

Cobra Pose: Lying flat on the ground, use your arms to prop up the upper body, stretching the back.

Seated twist: Sitting cross-legged, twist your upper body to the right, placing your left hand on the right knee for support. Repeat on the other side.

Beneficial exercises include:

Low impact activities. Good options include yoga, swimming, and walking.

Core-strengthening exercises. Working the abdominal and back muscles using bridges and planks helps to support the back.

People should speak with a doctor or physical therapist before beginning any new exercise regimen.

Medical treatments

A person should see a doctor for back pain that persists for several days or does not respond to home remedies.

Possible medical treatments for middle back pain typically include prescription medications, including painkillers, muscle relaxants, or steroid injections, and physical therapy, such as exercises and massage.

Surgery

If medication or physical therapy do not alleviate middle back pain, surgery may be necessary. Types of surgery for the middle back include:

Discectomy: People with a herniated disk may need a discectomy to remove the injured part of the disk and prevent further damage.

Fusion: A fusion procedure involves joining two vertebrae and using a spacer to replace damaged disks.

Laminectomy: Used to decompress the spinal cord, a laminectomy removes the back wall of a vertebra (the lamina).

Laminotomy: In this surgery, a surgeon removes a portion of the lamina to treat a pinched nerve.

Not all cases of middle back pain are preventable, but the following steps may reduce the risk of injury:

reach or maintain a moderate weight

sleep on one side or on the back

practice proper posture

ergonomically optimize all workspaces

practice safe lifting techniques

try physical therapy

A person should see a doctor if they experience any symptoms for more than 3 days, especially if they do not respond to home remedies.

Symptoms of severe back pain that require prompt medical treatment include:

a tingling sensation in the arms, chest, or legs

chest pain

incontinence

numbness

weakness

People should seek immediate medical treatment for back symptoms following a fall, collision, or injury.

Middle back pain can have a great many causes. These can range from impact injuries to the spinal column, poor posture, muscle weakness, and chronic inflammatory conditions.

Treatment will typically vary depending on the underlying cause, and prevention may not always be possible.

However, maintaining a moderate weight, leading an active lifestyle, and minimizing stress placed on the back muscles can all be of benefit to overall back health.

5 Common Orthopaedic Problems You Might Experience After Age 40

As we age, our bodies undergo a series of changes that often manifest in the form of orthopaedic issues. From what I have seen in my career as an orthopaedic doctor, the age of 40 is a common milestone when some of these problems become more pronounced. Understanding what to expect can help individuals remain proactive about their health and seek appropriate medical care when necessary. Read on as Dr Syed Imran, Consultant Orthopaedic, Arthroscopy and Joint Replacement Surgeon shares five orthopaedic issues that are common in people above 40.

Orthopaedic Problems After Age 40

Here are five common orthopaedic problems one might experience after hitting the big 40:

Osteoarthritis (OA)

This is the most common type of arthritis, caused due to wearing down of cartilage that provides cushioning to the bones. This is common in hands, knees, spine and hip.

What Causes Osteoarthritis?

According to Dr Imran, the exact cause of OA is multifaceted. While age is a significant factor, other contributors include:

Genetics: Some people inherit genes that make them more susceptible to OA.

Joint injuries: Past injuries, such as torn cartilage or dislocated joints, can increase the risk of developing OA in the future.

Obesity: Carrying extra weight puts additional stress on weight-bearing joints, particularly the knees, hips, and spine, increasing the risk of wear and tear.

Managing OA

While there's no cure for OA, a combination of strategies can help manage symptoms of osteoarthritis:

Medications: Over-the-counter pain relievers and anti-inflammatories can help alleviate pain.

Physical therapy: A physical therapist can devise exercises to strengthen the muscles around your joint, increasing its stability and reducing pain.

Lifestyle modifications: Maintaining a healthy weight and staying active can help reduce symptoms and prevent the progression of OA.

Osteoporosis

Dr Imran shares, "As we age, bone density decreases, making bones more fragile and prone to fractures. Osteoporosis particularly affects postmenopausal women, although men can also develop it. Regular checkup after 40, a calcium-rich diet, weight-bearing exercises, and certain medications can help manage and prevent osteoporosis."

What Causes Osteoporosis:

Hormonal Changes: Reduction in estrogen levels during menopause in women and a decrease in testosterone in men can lead to osteoporosis.

Calcium and Vitamin D Deficiency: Insufficient intake or poor absorption of these essential bone nutrients can weaken bone density.

Certain Medications: Long-term use of corticosteroids or some antiseizure medications can reduce bone density.

Managing Osteoporosis:

Dietary Changes: Increase intake of calcium and vitamin D through foods like dairy, green leafy vegetables, and fish.

Supplements: Consider taking calcium and vitamin D supplements if dietary intake is insufficient.

Exercise: Engage in regular weight-bearing exercises like walking, dancing, or resistance training to strengthen bones.

Rotator Cuff Tears

"With age, rotator cuff tendons can degenerate or become damaged, often due to repetitive overhead motions. Symptoms include pain at rest and at night, weakness when lifting or rotating the arm, and a crackling sensation when moving the shoulder," explains Dr Imran.

What Causes Rotator Cuff Tears:

Ageing: Natural wear and tear over the years can weaken and degenerate tendons, making them more susceptible.

Repetitive motion: Overhead activities (like painting, lifting, or playing certain sports) can strain the rotator cuff.

Acute injury: A sudden force or trauma, like a fall on an outstretched arm or lifting something heavy abruptly.

Managing Rotator Cuff Tears:

Rest: Avoiding activities that worsen the pain or strain the shoulder.

Cold compress: Applying ice packs can reduce inflammation and pain.

Physical therapy: Strengthening exercises and stretches can restore function and alleviate pain.

Degenerative Disc Disease

Over time, the discs between the vertebrae in our spine can break down, leading to degenerative disc disease. This condition can cause chronic neck or lower back pain. Activities that were once easy, such as bending or twisting, may become painful. Although it's part of the natural ageing process, certain factors like obesity, smoking, or injury can exacerbate the condition.

What Causes Degenerative Disc Disease:

Natural Ageing Process: Over time, the discs in our spine lose hydration and elasticity, leading to decreased ability to act as shock absorbers.

Wear and Tear: Everyday movements and activities can cause wear on the discs.

Injuries: Trauma to the spine, such as from a fall or car accident, can start or accelerate the degeneration of discs.

Managing Degenerative Disc Disease:

Physical Therapy: A well-structured physical therapy program can help strengthen back muscles and improve flexibility.

Exercise: Low-impact activities such as walking, swimming, or cycling can reduce pain and improve back health. 

Tendinitis and Bursitis

Both conditions are associated with inflammation. Tendinitis affects the tendons, which are cords that attach muscle to bone, while bursitis concerns the bursae, small, fluid-filled sacs that cushion bones, tendons, and muscles. Common areas affected include the shoulder, elbow, hip, and knee. Overuse, injury, and age-related wear and tear are common culprits.

What Causes Tendinitis and Bursitis:

Overuse: Repetitive motions or activities can strain the tendons or irritate the bursae.

Injury: Direct trauma or sudden, forceful movements can lead to inflammation of the tendon or bursa.

Age: As we get older, tendons lose their elasticity and bursae can become more prone to inflammation.

Managing Tendinitis and Bursitis:

Rest: Give the affected area a break to reduce inflammation and prevent further injury.

Ice: Use ice packs on the affected area to reduce pain and swelling.

Compression: Use bandages or braces to support the affected area.

Final Word

Reaching our 40s doesn't mean we're destined to experience these orthopaedic issues, but being aware of them allows us to take preventative measures and seek timely interventions. Regular check-ups, a balanced diet, proper exercise, and an awareness of our body's signals can help mitigate the effects of these conditions and ensure we remain active and pain-free for years to come.

DePuy Launches New Interbody Implant For Degenerative Disc Disease

DePuy Synthes, an orthopedic and neurosurgery company owned by Johnson & Johnson, recently announced the launch of their new flagship technology, the CONCORDE LIFT Interbody Implant. The new implantable device was designed to help treat patients suffering from degenerative disc disease, a condition that can cause extreme pain from a damaged disc in the spine.

The implantable device was designed as part of a new procedural solution that can simplify minimally invasive spine surgery procedures used to help restore disc height in the spinal column. This is typically done through the process of spinal fusion, a surgical procedure that places bone or bone-like material within the space between two spinal vertebrae. In an effort to simplify the procedure, DePuy created the CONCORDE LIFT implant to provide patients with a device that can specifically fit each patient's anatomy due to a continuous expansion mechanism.

"To help treat patients suffering from advanced degenerative disc disease, the degenerated disc is first removed, and then the CONCORDE LIFT Expandable Interbody device is inserted and expanded, with the procedural aim of restoring height of the disc space," said Nadav Tomer, worldwide president of DePuy Synthes. "The device is an expandable titanium cage with instrumentation that delivers control and performance to clinicians through tactile feedback and reliable graft delivery. It is designed with a continuous expansion mechanism, which allows the surgeon to specifically fit the intervertebral cage to the patient's anatomy, creating a more personalized solution."

Perhaps the most novel part of the technology comes after the implant is inserted and the surgeon creates the necessary expansion. After implantation, the device can then be backfilled with bone graft to maximize bone graft contact and containment, which will help promote bone growth and increase the chances of successful spinal fusion.

"The key difference compared to the majority of other expandable cages on the market is the fact that the CONCORDE LIFT can be backfilled with bone graft post-expansion," Tomer said. "One of the key requirements for successful fusion is adequately packing the disc space with bone graft, which promotes adequate bone graft-endplate contact. Even though the disc space is typically pre-filled with bone graft prior to cage expansion, an additional void is created when the cage gets expanded. By using the post expansion backfilling technique, in which the bone graft can be pushed through the inserter into the implant and disc space, this void created by the expansion of the device can be filled to create a more homogenous bone environment for spinal fusion to occur."

The implant itself is made from a medical grade titanium alloy, one of the most commonly used titanium alloys, and is currently used in a variety of different medical applications. The company recently conducted an anatomic lab study using the device and found that the implant saved significant procedure time during disc removal, cage implantation, and screw placement when compared to a control group of current market product offerings. Tomer believes these results will help pave the way toward more minimally invasive treatments for patients suffering from degenerative disc disease.

"By 2020, it is estimated that half of all spinal fusion procedures will be performed using a minimally invasive approach," Tomer said. "While it has a steep learning curve, minimally invasive spine surgery has been associated with reducing complications, blood loss, muscular damage, and pain — all with a faster recovery for patients when compared to conventional open spine surgery. With the launch of the CONCORDE LIFT implant, DePuy Synthes is demonstrating our commitment to innovative offerings that reduce surgical complexity, improve patient outcomes, and potentially lower the cost to deliver quality patient care."

---