As adults age, they undergo several physical and psychosocial changes(7). Back pain in elderly prevalence has been reported as one of the conditions plaguing the elderly(8).
Apart from neck pain and chest pain, pain in the middle back is also a growing concern among seniors. Chronic pain has resulted in reduced mobility, depression, and even isolation in this age group(9).
- The American Association of Neurological Surgeons defines middle back pain as discomfort in the area between the upper back and the lower back(1).
- Pain in the middle back may have several causes, ranging from poor posture and a herniated disc to osteoarthritis and even incorrect sleeping positions(2-5).
- Seniors who experience middle back pain should observe their condition as it may lead to other possible complications, like cancer(6).
- This article serves as a guide and should not be used for self-diagnosis. Health Report encourages elderly persons with back pain to consult with their physician.
- If you are looking for help reducing some of the pain it is worth trying out low impact mid back stretches.
Reports also stated that chronic pain was detrimental to older adults’ functionality and quality of life.
Health Report aims to cover everything seniors need to know about middle back pain— from its common causes and symptoms to the treatment options available.
This guide on middle back pain has been developed to help the elderly manage their condition so they can get back to their routine and do the things they used to enjoy doing.
Understanding Middle Back Pain
Middle back pain is characterized by discomfort in the region between the upper and lower back (also known as the thoracic spine). It is less common than:
This section of the spine is more rigid and less mobile(10).
The thoracic spine comprises 12 vertebrae, discs separating the bones from each other and absorbing shock, and ligaments and muscles that hold the spine together.
Though less common, middle back pain can be short-lived or longer-lasting, mild or severe, depending on the condition(11).
Middle Back Pain Causes
Several causes may give rise to middle back pain, including the following:
Injuries and Muscle Strain
Overused, strained, or injured ligaments, muscles, and discs supporting the thoracic spine may contribute to middle back and even upper back pain(12).
Here are some incidents that may affect the middle back(13):
- A bad fall
- Lifting heavy objects
- Carrying heavy backpacks using one shoulder only
- Being hit hard in the back
- Jolting from a car crash
- Reaching to place objects on a high shelf
- Twisting and bending
- Sneezing or coughing
Spinal Fractures and Injuries
Spinal fractures usually happen in the thoracic spine (middle back), lumbar spine (lower back), or at the junction connecting the two (thoracolumbar junction).
Whether on the thoracic spine or the lumbar spine, these fractures may cause moderate to severe back pain that may worsen with movement (14)
Spinal Diseases
Diseases like thoracic spondylosis may cause middle back pain. This condition is defined as the degeneration of the middle of the spine, resulting in pain and stiffness in the upper and middle back(15).
People with this condition experience pain in the middle back when they move the spine forward or bend backward(16).
Spondylitis, a spinal infection that causes inflammation, may also result in back pain(17).
Other spinal problems that may affect the back is spinal stenosis. This narrowing of the spinal canal rarely occurs in the thoracic spine (mid-back and upper back)(18). However, when it does, spinal stenosis may lead to back pain.
Herniated Disc
Thoracic herniated discs may result in middle back pain, around the level of the disc herniation(19).
Usually, when the disc herniation compresses a thoracic spinal nerve as it travels through the foramen, the pain may be felt around the rib cage. This pain radiates from the back to the upper abdomen or front of the chest.
A foramen refers to an opening allowing the passage of structures from one area to another.
Myofascial Pain
In a study in The Korean Journal of Pain, the researchers observed that myofascial pain syndrome (MPS) prevalence was significantly high among patients with chronic back pain(20).
MPS, or simply muscle pain, is a regional musculoskeletal pain disorder resulting from the muscular irritation of the connective tissues that protect and cover a muscle or a group of muscles(21).
Often, MPS is caused by the overuse or deconditioning of muscles.
In the research, the authors observed that gender may be a significant risk factor for MPS. The female participants were more affected by the condition.
Osteoarthritis
Osteoarthritis is another possible cause of back pain. According to Johns Hopkins Medicine, this degenerative arthritis usually affects the lower back and gradually develops due to wear and tear(22).
As the protective cartilage between the joints breaks down, the individual with the condition experiences inflammation and pain. This pain is more noticeable when the back is twisted or bent.
Lifestyle
The lifestyle of older adults may also affect their back.
For instance, adults who engage in repetitive work, mainly work involving bending over prolonged periods, may be at higher risk for pain in the middle or upper back(23).
Weight
Obesity is another cause of back pain.
A 2018 study was conducted on 2,633 participants over 65 years old. The research detailed that more obese older adults (58%) experienced chronic pain compared to those who were overweight or were of average or normal weight(24).
The authors also noted that the obese elderly experienced more frequent pain in their lower back and extremities than their peers.
Though focused on lower back pain, a study in the Scoliosis and Spinal Disorders journal stated that physical activity is associated with persistent lower back pain in seniors(25).
The researchers stated that moderate or vigorous physical activity heightened the risk of pain in the lower back. They also noted that women 65 years and older were at a higher risk of developing persistent lower back pain.
Poor Posture
Regardless of age, postural factors may lead to thoracic spine pain(26).
Individuals who frequently slump or slouch when they sit, stand, or use the computer for a long time usually experience back pain(27).
When one’s posture is good, the vertebrae and spinal curves are balanced and correctly aligned. Meanwhile, when a person is in a slouched position, there is no cervical curve (found in the neck region) and the lumbar curve is reduced(28)
Thus, poor posture may lead to backaches.
Sleeping Position
The position an individual takes when sleeping has an impact on their spine.
A 2019 review of various literature outlined how sleep posture increased or decreased spinal pain(29). It was reported that participants who slept in a supported side-lying position were observed to have fewer symptoms than those in a ¾ side-lying position. It could be argued that this is one of the best sleeping positions for back pain.
Another study on physically active seniors sought to confirm the effects of one’s sleeping position on their back pain(30). The participants were divided into an experimental group and a control group.
The experimental group, which consisted of members that experienced more intense pain compared to the control group, received information on the recommended sleeping position.
At the end of the study, the experimental group reported a lower level of pain. Included in the information shared with them were the following:
- The ideal way to lie down (including recommended sleeping posture and where to position the pillows)
- The correct way to get up
The authors suggested that this added information contributed to the prevention and decrease of pain and discomfort in the spine of physically active older adults.
Symptoms
Here are some of the symptoms of middle back pain that may be caused by problems with soft tissues or muscles(31):
- Throbbing, aching pain
- Weakness
- Spasms
- Sharp pain
Meanwhile, here are the middle back pain symptoms that may be caused by nerve problems:
- Shooting pain
- Numbing or tingling feelings
- Weakness in the area affected by nerves
- Burning
Depending on the cause of the middle back pain, the symptoms an individual has and how long they last may vary.
It is common for people with middle and upper back pain to experience muscle tightness or stiffness and dull, burning pain. However, those who experience numbness in the chest, belly, arms, or legs should seek medical advice as these are more severe symptoms(32). While middle back stretches have been mentioned we would recommend different stretches for upper back pain.
Weakness in the arms or legs and loss of bowel or bladder control are also more severe conditions associated with middle back pain.
Risk Factors
A study published in the Journal of the American Medical Directors Association sought to identify the risk factors for pain in the back area that may lead to restricted activity in the elderly(33).
The researchers studied 731 men and women 70 years and older for 108 months using comprehensive home-based assessments. The authors updated themselves on the candidate risk factors every 18 months. They observed the following:
Gender
Female sex was identified as one factor associated with restricting back pain(34). Multiple studies also showed that women were more likely to report back pain compared to men.
The authors consider several possibilities, including sex differences (sociocultural, psychological, and biological) in the expression, tolerance, perception, and reporting of pain.
Grip and Hip Abduction
Grip and hip abduction were two measures of muscle weakness that the researchers observed(35). The authors saw that muscle weakness is a risk factor for more acute, short-term restricting back pain in older people.
Depressive Symptoms
The study detailed how depression may cause pain in seniors(36). According to the authors, back pain and depressive symptoms were strongly associated with each other.
They said that older people who exhibited symptoms of depression may have a higher risk for the more burdensome subtype of back pain.
They added that poor pain-coping strategies and the perception that back pain is bothersome may contribute to the development of more refractory back pain symptoms.
Arthritis and Other Chronic Conditions
According to the study, people who had two or more chronic conditions, also known as multimorbidity, and arthritis were more likely to develop persistent back pain(37).
The authors believed that several comorbid conditions and higher illness burden may result in more significant psychological, social, and emotional vulnerability. They also said that this vulnerability may render older individuals more prone to restricting back pain.
It was reported that there is an increased risk of activity limitation, poorer mental health and overall self-ratings, and higher healthcare in older adults with back pain and arthritis compared to those who had back pain or arthritis alone.
Smoking
In another study in the journal Cureus, findings suggested that exposure to cigarette smoking may be associated with back pain in American adults(38).
The research suggested that current smokers who smoked more cigarettes per day had a higher prevalence of back pain
Possible Middle Back Pain Complications
Middle back pain, especially in the elderly, should be given medical attention. If untreated, middle back pain may give rise to several complications.
This type of pain may also signal other problems and be a symptom of more pressing conditions, including the following:
Cancer
According to Johns Hopkins Medicine, dull pain in the upper abdomen and the middle or upper back that comes and goes is a common pancreatic cancer symptom(39).
A tumor in the body or the pancreas’ tail may cause middle back pain as it can press on the spine. Individuals with this cancer type report that the pain starts in the middle abdomen and radiates to the back.
Lying down exacerbates the pain, and leaning forward is one way to relieve it. Note that pancreatic cancer is different for each individual. Thus, a consultation with medical professionals is essential.
Gallbladder Problems
Gallstones may cause pain in the middle back. These hardened deposits of digestive fluids that form in the gallbladder may lodge in a duct and cause blockages.
Such an occurrence may result in sudden and rapidly intensifying pain in the upper right portion of the abdomen and the center of the abdomen, below the breastbone(40).
It can also cause back pain between the shoulder blades.
Infection
Severe back pain may signal other conditions, including spinal infection. Individuals with vertebral osteomyelitis, intervertebral disc space infections, and spinal canal infections often experience back pain, sometimes with a fever(41).
Vertebral osteomyelitis is the most common vertebral infection. It can come from infections in areas surrounding the spine, bacteria from the blood that spreads to a vertebra, and direct open spinal trauma.
Meanwhile, intervertebral disc space infections refer to infections in the space between adjacent vertebrae.
Spinal canal infections vary. They may include a spinal epidural abscess, an infection of the space around the dura.
Dura refers to the tissues surrounding the nerve root and spinal cord.
Osteoporosis
According to Mayo Clinic, osteoporosis, a condition that causes the bones to become brittle and weak, may be an underlying cause of back pain(42).
Fractures in the spine that result from osteoporosis are also known as compression fractures.
The weakening of the vertebrae (to the point of crumpling) may lead to back pain.
Treatment for Middle Back Pain
There are various options seniors may choose from to help treat or manage their pain. These approaches range from medical treatments, stretches for mid back pain, home remedies to major procedures, such as surgeries.
Medications
According to Harvard Health Publishing, here are the following medications that may help with back pain(43):
- Nonsteroidal anti-inflammatory drugs (like ibuprofen and naproxen)
- Muscle relaxants
- Antidepressants
- Opioids
However, individuals with back pain, especially seniors, are advised to adopt alternative treatments as the pain-relieving drugs are designed for short-term relief only.
Home Remedies
Using ice packs or heating pads to reduce stiffness and middle back pain is recommended.
Applying ice helps with the swelling. Harvard Health Publishing recommends the use of cold compresses first(44). Forty-eight hours after the onset of back pain, it is recommended to apply heating pads to the back to soothe aching muscles and increase blood circulation.
Note that heat therapy is helpful during the first week of the backache only.
Exercise
Through physical activity, the muscles become less prone to injury(45). Exercise also reduces pain, strengthens muscles, and improves posture.
Notable exercises beneficial for seniors with middle back pain include:
Floor Back Extension
This exercise is done with a pelvic tilt to strengthen muscles and relieve back pain(46). To do this, seniors should:
- Lie face-down on the floor.
- Extend the left arm straight overhead, such that it aligns with the body. Keep the other arm at the side.
- Lift the left arm and right leg off the ground slowly while counting to two.
- Keep the leg and arm at the same height.
- Pause, then slowly lower the arm and leg back to the ground while counting to four.
Repeat the steps above 10 times for one set. Then, for another 10 repetitions, switch to the right arm and left leg.
Remember to rest for one to two minutes, then do the next set of 10 repetitions after.
Pelvic Tilt or Rock
Another exercise designed specifically for the lower part of the back is the pelvic tilt or rock(47).
- Lie on the side with the hips and knees bent. For added support, seniors may use a pillow underneath their side.
- Lower the pelvis towards the heels.
- Raise the pelvis towards the ear.
- Move slowly, smoothly, and in a controlled manner.
When doing this exercise, seniors should feel a stretch, not pain.
Partial Sit-Ups
This activity may help with middle back pain relief(48). Seniors should follow these steps:
- Lie on the back with knees bent and feet flat on the floor.
- Do a pelvic tilt.
- Put the hands behind the head or under the chin in a fist position.
- Tuck the chin and raise the shoulder blades off the floor.
- Lower the shoulders and arms to the floor and release the pelvic tilt.
- Relax, then do diagonal sit-ups.
- Repeat, rotating to the right first, then to the left side.
These exercises are recommended for older adults who need help with their back pain. However, it is still advised to speak to a physical therapist or a physician before starting an exercise program.
Excellent exercise regimens usually include strength training, flexibility exercises, and aerobic activities(49).
Diet Changes
Highly inflammatory diets, like ones high in refined sugars, processed food, and trans fats, may contribute to chronic back pain(50). A healthy weight also helps reduce pressure on the spine and the likelihood of developing back pain.
Seniors should ask for a physician’s or nutritionist’s help in developing a diet appropriate for them.
Ample Bed Rest
Doctors discourage excessive bed rest as they believe constant movement helps treat back pain(51). However, bed rest is still useful, especially if it hurts to stand or sit due to severe pain.
A few hours of bed rest at a time, for no more than one or two days, is recommended.
Alternative Therapies
According to Harvard Health Publishing, other therapies to complement the treatments discussed may include spinal manipulation via chiropractors, acupuncture, therapeutic massage, and various movement therapies, like tai chi for seniors and yoga(52).
Surgery
Surgery of the thoracic spine may help with middle back pain(53). However, seniors should consider this option only if the more conservative and non-operative treatments have been exhausted.
Some procedures that can be done on the thoracic spine include:
- Mini-thoracotomy
- Laminectomy
- Fusion
Thoracic spine surgery equipment and techniques are similar to those of the lumbar spine procedure. However, surgeries done on the thoracic spine take longer to heal because of the manipulation of major abdominal organs and the rib cage.
Thus, non-surgical options should first be considered before discussing surgical procedures with a medical professional.
Diagnosing Middle Back Pain
To determine if a senior has middle back pain, doctors conduct physical examinations(54). During these tests, they may ask about symptoms the older adult may be experiencing and their daily physical activities.
If necessary, diagnostic imaging examinations, like MRI (magnetic resonance imaging), CT scan (computed tomography scan), or X-ray, may be recommended.
These procedures help find the underlying cause of the back pain, such as a pinched nerve or an orthopaedic condition.
Some people may have difficulty distinguishing between back pain and kidney pain. Compared with back pain, kidney pain is deeper and higher up the back(55).
Kidney pain is often felt on the sides or in the middle to upper back. This pain radiates from under the ribs to the right or left of the spine, where the kidneys can be found.
If not given medical attention, the pain may progress to other regions of the body, like the groin and the abdomen.
Swelling or kidney stones, which cause blockages in the urinary tract or kidneys, may result in kidney pain. Usually, other symptoms, like vomiting, painful urination, and fever, accompany these conditions.
Thus, it is essential to speak to a doctor when experiencing unbearable middle back pain. Self-diagnosis is highly discouraged.
Middle Back Pain Prevention
Middle back pain prevention is easier than treatment(56). Here are some ways to prevent the condition:
Increase Vitamin D and Calcium Intake
Calcium and vitamin D help prevent osteoporosis and strengthen the bones. Weak bones eventually break and may lead to back pain.
Keep a Good Posture
Caregivers of the elderly should ensure that seniors keep an excellent posture. Here are some tips to help improve one’s posture(57):
- When sitting or standing, do not slouch.
- Sit up straight with the back against the back of the chair and the feet flat on the floor. It is ideal if the knees are slightly higher than the hips.
- Stand tall with the head up and the shoulders back.
- If possible, switch between sitting and standing. Avoid being in the same position for an extended period.
- Observe the correct posture when sitting in front of the computer.
Older adults should ask their family members or caregivers to help them if they need to lift heavy objects.
If this is not possible, when lifting, they should bend their knees and keep their back straight to ensure that their leg muscles do the bulk of the work.
Work With a Physical Therapist
Through physical therapy, the elderly can join exercise programs to strengthen their back muscles and improve their flexibility and balance(58).
These exercises may help make the spine more resilient.
When to See a Doctor for Middle Back Pain
Back pain in the elderly is prevalent(59). Thus, it may be hard to distinguish if back pain is already a serious condition that requires medical attention.
Here are factors to consider when deciding if a senior citizen should already see a doctor for their middle back pain(60):
Back Pain With Numbness, Weakness, or Tingling
If the older adult experiences back pain accompanied by weakness, tingling, and numbness, they should immediately check with their physician. These symptoms point to nerve irritation or damage, which may result in permanent disability if left untreated.
Observe if the pain does not subside even after taking over-the-counter medication.
Sudden Weight Loss
There is more to back pain when a senior suddenly loses weight without any diet or lifestyle changes. This abrupt physical change may signal a tumor or infection.
Persistent Pain
Ideally, back pain goes away after a few days. However, if the pain continues for over a week, checking in with a doctor may be best.
Additional examinations may be required to find out the bigger problem before it causes more health issues.
Urination and Bowel Problems
Regular back pain should not come with the loss of bowel or urination control. If this happens, ensure that the senior is brought to the emergency room as soon as possible.
This condition is a major symptom of equina syndrome, which is characterized by the paralysis of the nerves in the lower spine.
Despite being rare, equina syndrome may induce permanent nerve damage if not treated. Usually, individuals with this condition experience back pain, urine or bowel problems, and numbness in the legs.
Once medical experts confirm this condition, the older adult may need to undergo surgery to decompress the nerves and preserve the nerves’ overall function.
Post-accident Back Pain
Seniors who experience back pain after an accident should seek medical attention immediately. Whether they get into a car accident, sustain a sports injury, or experience a mishap while doing daily activities, they should inform their physician as soon as possible.
If treated immediately, bigger health issues, like fractures, may be addressed or prevented.
Back Pain With Fever
If an older adult runs a fever while experiencing back pain, over-the-counter medicines should be taken. However, if the fever does not subside, there may be a severe infection requiring the doctor’s attention.
Antibiotics and a few days of rest are usually prescribed for infections.
Pain Radiates to Other Body Parts
Senior citizens with severe back pain should observe their condition. If the pain travels to other parts of the body, such as shooting pain down the leg, seeing a doctor is encouraged.
Pain in the back and down the leg are symptoms of sciatica, which affects the sciatic nerve and many people wonder how long does sciatia last?
The earlier the condition is treated, the better for the older adult.
Pain Radiates to Other Body Parts
Senior citizens with severe back pain should observe their condition. If the pain travels to other parts of the body, such as shooting pain down the leg, seeing a doctor is encouraged.
Pain in the back and down the leg are symptoms of sciatica, which affects the sciatic nerve. Often, this condition results from a herniated disc.
The earlier the condition is treated, the better for the older adult.
Pain Worsens When in Certain Positions
When an older adult experiences sudden pain when they are in certain positions while sleeping, they may have to bring the issue up with their doctor.
This occurrence is a sign of a more serious condition. The bigger health issue may range from a fracture and a nerve compression to infection and even cancer.
Seniors and their caregivers may use this guide on middle back pain to learn more about the condition. However, Health Report still recommends seeing a doctor for any pain involving the back.
