Mid Back Pain: Why The Middle Of Your Back Aches, And What Helps
Mid back pain: the short answer
Mid back pain sits in the middle of the back, where the ribs join the spine. This is the part of the spine built to turn. When it goes stiff from long sitting, a held breath or one-sided habits, it aches, and the lower back and neck start doing its work.
Most middle back pain is muscular and settles with gentle, regular movement. Here is the article in short form:
- The middle back carries the ribs and does the turning.
- Mr Iyengar saw strain, wear and discs as the usual causes.
- A held breath stiffens the ribs and the mid back.
- Lift first, then turn: twists come from the middle and upper back.
- Six Iyengar trials for back and neck pain all favoured yoga.
- Some mid back pain is worth telling your teacher about.
A quick word on Iyengar yoga. Iyengar yoga is the style developed by Mr BKS Iyengar. In the 20th century he did more than anyone to set down traditional Indian yoga, through his books and his teaching, and he pioneered the use of props. It is the style we teach at Flametree, in Darwin and live online.
A gentle twist on a chair. The chair holds the pelvis still, so the turn comes from the middle and upper back, the part built to turn.
What is the mid back, and why does it hurt?
The spine is a chain of small bones: seven in the neck, twelve in the upper and middle back, and five in the lower back. The twelve in the middle section are the thoracic spine. Each one carries a pair of ribs.
Rachel Krentzman, an American physiotherapist and yoga therapist, explains in Yoga for a Happy Back that the small joints at the back of each bone face different ways at different levels. The lower back bends well but turns very little. The thoracic spine does most of the turning. The neck turns a lot, and is easily overworked.
So when the middle of the back stops turning, something else turns for it. Usually that is the lower back, which was not built for it, or the neck. The middle back itself aches from being held still.
The spine is a chain. The middle back carries the ribs and does most of the turning.
What causes middle back pain?
In his book Yoga: The Path to Holistic Health, Mr Iyengar treats the back as three regions, each with its own usual causes. For the middle back he lists muscle strain, arthritis and torn ligaments. Most often, he says, it is a slipped (herniated) disc, which tends to come back. He links it to extra weight and poor posture.
The Yoga Rahasya writers (senior teachers writing in the Iyengar yoga journal from Pune) point out that a “slip disc” is “a slip in the terminology”. The disc does not slide out. Its tough outer ring weakens, and the soft centre can bulge.
In our experience, the most common mid back ache in class is simpler. It is a back that sits all day, turns little, and breathes high and shallow. That is very changeable.
Why does a stiff mid back come from sitting?
Because sitting holds the middle back still, rounded and turned in one direction. Most desk days, and most drives, never ask it to turn or lift at all.
Geeta Iyengar, Mr Iyengar’s daughter and senior teacher, described what the years bring if we let them: “the joints become brittle and the muscles shorten and get hardened. The rib cage gets contracted and shrinks.” Many people in the West have a contracted chest from long sitting, and opening it is a big part of what an Iyengar class does.
In class, standing poses, chair twists and supported backbends over a chair take the middle back the other way: lifted, turned and opened. Done regularly, the stiffness of a sitting day starts to ease.
A supported backbend over a chair opens the chest and the middle back, the parts a day of sitting closes down.
Can the way I breathe cause pain between the ribs and spine?
It can add to it. Every rib joins the spine at the back. When you breathe in, the ribs lift and widen, and the middle back moves a little with them. When the breath is held or kept high in the chest, those joints barely move all day.
When a stretch gets strong, most of us hold the breath without knowing it. The jaw sets and the shoulders creep up. Mr Iyengar put it in one line: “When we hold the breath, the brain becomes stiff.”
In our classes, learning to soften the breath is one of the quickest ways to let a clenched back release. Lying back over a bolster lets the chest open and the ribs move with each breath, with no effort. The research fits: slow breathing calms the body, and a calm body guards less.
A held breath turns the alarm up. A long, soft out-breath lets the ribs and the mid back move again.
Get the free ebook Happy Backs. New to Flametree, or away for 3 months or more? You get 2 free classes + 2 ebooks, only available via this offer. Already coming to class? You can still get the book.
Does yoga help mid back pain?
Yes, it is very likely to help, and it is certainly worth trying, based on our experience. Most trials have looked at the lower back or the neck, the two ends of the same chain. A 2015 review found six trials of Iyengar yoga for back and neck pain, with 570 people. In all six, the yoga group did better.
The 2017 Cochrane review, the most trusted kind of research summary, found yoga improved how well backs worked in daily life, and eased pain. The middle of the back has been studied less on its own. That is a gap in the research, not a sign yoga does not help. Not yet tested is not the same as wrong.
Are twists good or bad for the mid back?
Good, done the right way. The thoracic spine is the part built to turn, so gentle twists use it for its proper job. The way matters more than the depth:
- Lift first, then turn. A long spine turns further and more safely than a slumped one.
- A chair holds the pelvis steady. The turn then comes from the middle and upper back, not the lower back.
- The neck turns last, and never wrenches round.
Geeta’s 1996 programme for disc trouble used supported lying poses, gentle twists and supported forward stretches, with no hunched bending. Notice the pattern: length, space and gentle turning.
Lying over a bolster lets the chest open and the ribs move with each breath, with no effort at all.
What should I tell my teacher about mid back pain?
Most mid back pain is muscular. Tell your teacher before class about any back injury, and if you have thin bones (osteoporosis), so they can adapt the poses.
Feel free to check with your professional advisers if you wish, but also give yoga a try.
Where can I get help for mid back pain in Darwin?
For mid back pain in Darwin, come to a class at Flametree’s Woolner studio, or join live online from anywhere in Australia. Our beginner classes all work the middle and upper back, with standing poses, chair twists and supported rests, and every class is adjusted to the people in it. Wednesday evening’s Yoga For Backs class, in the studio, focuses on backs.
See also our posts on how to reduce lower back pain, upper back pain and whether twists are bad for your back.
Happy Backs, our free ebook, covers the lower, middle and upper back.
Your free copy of Happy Backs is waiting. New to Flametree, or away for 3 months or more? You get 2 free classes + 2 ebooks, only available via this offer. Already coming to class? You can still get the book.
Frequently asked questions
What causes pain in the middle of the back?
Most often muscle strain and a back held still for hours, from sitting, driving and shallow breathing. Mr Iyengar also listed arthritis, torn ligaments and disc trouble for the middle back, which he linked to extra weight and poor posture.
Is mid back pain serious?
Usually not. Most mid back pain is muscular and settles with gentle, regular movement. Tell your teacher before class about any back injury, and if you have thin bones, so they can adapt the poses.
Why does my mid back hurt when I breathe deeply?
Every rib joins the spine at the back, so a stiff mid back can catch as the ribs move. A held, high breath keeps those joints still all day. Slow, soft breathing and supported chest openers help them move again.
Are twists good for mid back pain?
Done gently, yes. The middle back is the part of the spine built to turn. Lift the spine first, let a chair hold the pelvis steady, and turn from the middle and upper back, with the neck turning last. Forced or wrenching twists are not the aim.
Can sitting at a desk cause mid back pain?
It often adds to it. Long sitting holds the middle back rounded and still, and the chest closes. Geeta Iyengar described the rib cage contracting with the years. Standing poses, chair twists and supported backbends open it up again.
Can stress cause mid back pain?
It can add to it. Stress tightens the breath and the muscles around the ribs and shoulders. A long, soft out-breath is the body’s brake, and in our classes softening the breath is one of the quickest ways a clenched back lets go.
How long does mid back pain take to ease with yoga?
Many people feel easier within a few weeks of regular classes. The back trials ran for 12 to 24 weeks, once or twice a week, and gains lasted best for people who kept going.
Where can I get help for mid back pain in Darwin?
Flametree Yoga Studio teaches Iyengar yoga at Woolner in Darwin and live online. Beginner classes work the middle and upper back with standing poses, chair twists and supported rests, and the Wednesday evening Yoga For Backs class focuses on backs.
Where to next
- New to yoga, or coming back? Start with our half price 10 class pass with 2 classes free, in Darwin or live online.
- For a workplace, team or group: book private yoga classes for groups, online, at a Flametree studio or at your venue.
- Want to see class times first? Look at the beginner timetable.
Flametree Yoga Studio, Darwin and live online. This article is general information, not medical advice. Feel free to check with your professional advisers if you wish, but also give yoga a try.
Sources: Crow EM and colleagues, Effectiveness of Iyengar yoga in treating spinal (back and neck) pain, International Journal of Yoga, 2015 (doi 10.4103/0973-6131.146046); Wieland LS and colleagues, Cochrane review of yoga for chronic low back pain, 2017; BKS Iyengar, Yoga: The Path to Holistic Health; BKS Iyengar, The Tree of Yoga; Rachel Krentzman, Yoga for a Happy Back; Geeta S Iyengar, Sydney programme for disc trouble, 1996; Yoga Rahasya. Full references are in the Happy Backs ebook.
