The Causes and Treatment of Thoracic Spine Pain

Thoracic spine pain, or pain in the upper and mid-back that corresponds to the area of your rib cage, is not nearly as common as low back pain or neck pain. Just the same, it occurs fairly frequently, particularly in younger people, older people, and females.

Thoracic spine pain affects up to 35.5% of the population per year, according to a 2009 systematic review published ​in BMC Musculoskeletal Disorders.

Woman holding her back, having lower back pain from PID
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Thoracic Spine Pain Definition

Let's start with a reliable definition of thoracic spine pain which necessarily includes a reliable definition of the thoracic region.

Thoracic spine pain is defined as pain in the back that is located between your first thoracic vertebra and your 12th thoracic vertebra.

Your first thoracic vertebra represents the place where your neck ends and your rib cage area begins. It is located approximately at the level of your shoulders (or just a little above). Your 12th thoracic vertebra corresponds to the bottom of your rib cage.

There are 12 rib pairs in all, and in back, each attaches to one spinal bone. So T1, which is your first thoracic vertebra, provides a place of articulation for the first ribs; T2 provides a place of articulation for the second ribs, and so on down the line.

The lowest or last ribs connect to T12, which is also the last bone in the thoracic spine. The bone below T12 is L1, or your first lumbar (low back) vertebra. Because the thoracic region is large, it is often divided into upper and lower areas for diagnosis and communication purposes.

What Causes the Pain

There are a number of possible causes of thoracic spine pain. Mechanically, it can arise when something is going on in your thoracic spine or your cervical spine (neck). But it may also be due to issues in other areas of the body.

For example, problems in your gastrointestinal tract, organs, cardiopulmonary system (heart and lungs), and/or your kidneys may refer pain to the thoracic region. Low bone density and myelopathy (symptoms that occur when your spinal cord is irritated) may also cause thoracic spine pain.

Your occupation may have a lot to do with whether or not you get pain in your mid or upper back. For example, if you do repetitive work or if your work involves bending over for long periods of time, you may be at a higher risk.

The 2009 review also found that teens may be prone to thoracic spine pain due to backpack use. Textbooks and other things that go into a student's backpack can get pretty heavy, so watching for this risk factor in your child may be a good idea.

Chad Cook, a physical therapist, clinical researcher, and professor at Walsh University in Canton, Ohio, says that people who have experienced physical trauma or who have other types of musculoskeletal pain are more prone to thoracic spine pain.

He also says that illnesses that make you cough frequently (asthma, chronic obstructive pulmonary disease, and emphysema, for example) may increase your risk of rib dysfunction and/or vertebral fractures, both known causes of thoracic spine pain.

And finally, Cook says that your choice of sleeping position can contribute to thoracic spine pain. For example, older people—who are generally at higher risk anyway—sometimes like to sleep in recliners. But this only increases the types of posture problems that lead to thoracic spine pain, he says.


Because the amount of neck and low back pain in the general population far exceeds the amount of thoracic spine pain, fewer treatments are available for this area.

Doctors and scientists simply know less about T-spine pain than they do about pain in the cervical and lumbar regions. This is partly due to the fact that fewer research studies are conducted on thoracic spine pain.

But if your T-spine pain really bothers you and you wish to seek treatment, to whom do you turn? Generally, physicians, chiropractors, physical therapists, and massage therapists are practitioners with the most knowledge of and skill with this type of back pain.

Frequently Asked Questions

  • What causes middle-back pain?

    There are many causes of middle-back pain (mid-back thoracic spine pain), some of which are more serious than others. It can be caused by carcinoma, lung cancer, irritated spinal cord, low bone density, and other issues that affect the heart, lungs, kidneys, and gastrointestinal tract.

  • What are the risk factors of occupational back pain?

    Risk factors of occupational back pain that affects the thoracic spine include a past history with back pain, prolonged bending and twisting, driving, heavy lifting, smoking, obesity, poor sleeping position, and certain illnesses associated with frequent coughing like asthma and emphysema.

  • Why does mid-back pain radiate to the ribs?

    Mid-back pain can radiate to the ribs due to a herniated thoracic disc. This referred pain is able to be felt all around the body and sometimes affect one or both legs. A herniated thoracic disc can also affect one or both legs in a few different ways, including causing numbness or tingling, muscle weakness, and increased tightness or stiffness.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  8. Heneghan NR, Gormley S, Hallam C, Rushton A. Management of thoracic spine pain and dysfunction: A survey of clinical practice in the UK. Musculoskelet Sci Pract. 2019;39:58-66. doi:10.1016/j.msksp.2018.11.006

  9. Leri JP. Metastatic Cancer of the Thoracic and Lumbar Spine Presenting as Mid- and Low Back Pain in a Long Distance Runner. J Chiropr Med. 2018;17(2):121-127. doi:10.1016/j.jcm.2017.11.004

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By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.