Mid Back Pain: Symptoms, Causes, Risk Factors, Healing Cycle & Treatment 

What is mid back pain? 

The vertebral column of the human body is responsible for supporting the nervous system and the physical structure of the body. The vertebral column is made of 33 vertebrae including cervical (7), thoracic (12), lumbar (5), sacral (5), and coccygeal (4) vertebrae. The unique structure of the vertebral column facilitates bending and rotation movements. Intervertebral discs are made of the nucleus pulposus and annulus fibrosus. The intervertebral disc mediates cushioning between the adjacent vertebrae. (1) The spine-related pathology that is the prime focus of this article is mid back pain or thoracic spine pain. The incidence of mid back pain is similar to that of low back pain in children and adolescents. (2)

Symptoms of Mid Back Pain

The symptoms of mid back pain or thoracic spine pain are as follows. 

  1. Sensation of numbness or tingling 
  2. Stiffness of the back
  3. Decrease in the range of motion of the back
  4. Loss of sensation 

Causes and Risk Factors of Mid Back Pain

The causes and risk factors associated with the development of mid back pain or thoracic spine pain are as follows. 

  1. Herniation of the intervertebral disc
  2. Degenerative disc disease 
  3. Facet joint syndrome
  4. Whiplash injury involving strain and sprain
  5. Poor posture of the spine such as kyphosis 
  6. Diseases including osteoarthritis and rheumatoid arthritis 
  7. Poor lifting body mechanics 

Normal Healing Cycle

The stages of wound healing include hemostasis, inflammation, proliferation, and maturation. All of these stages must occur in a sequential fashion and must occur within a proper time duration. The description of each phase of the healing cycle is mentioned as follows. (3)

Homeostasis

The first stage of wound healing is hemostasis, which is characterized by vasoconstriction. The platelets are subjected to aggregation, degranulation, and the development of a thrombus or a blood clot to limit blood loss. 

Inflammation

The next major phase of the healing cycle is inflammation. During this phase, the inflammatory cells such as neutrophils arrive at the site of injury. These cells release mediators to recruit the immune cells. Loss of function, increased temperature, redness, pain, and swelling are the cardinal signs of inflammation. 

Proliferation

The third stage of wound healing is proliferation at the site of injury. Processes that occur during this stage of wound healing include angiogenesis or the formation of new blood vessels, formation of extracellular matrix, synthesis of collagen, and re-epithelization at the site of injury. Muscle spasms, fascia restrictions, trigger points, and scar tissue arise during this stage of the healing cycle. 

Maturation 

The last stage of the healing cycle is the maturation or resolution stage. In this stage, collagen undergoes remodeling and the blood vessels are subjected to vascular maturation and regression.

Chronic Conditions and Healing Cycle 

In chronic conditions, the healing cycle fails to resolve and oscillates between the inflammation phase and the proliferation phase of the healing cycle. The healing cycle fails to progress to the maturation stage, therefore, persists for longer durations. (4)

Ineffective Treatments of Mid Back Pain

Individuals may opt for different therapeutic strategies for relieving mid back pain. These therapeutic measures are common yet ineffective. Following is a list of treatments that are ineffective for relieving mid back pain resolution.

  1. Application of heat and ice
  2. Electrical stimulation of the site of pain or injury
  3. Use of foam roller and massaging on the site of pain or injury
  4. Stretching of the back 
  5. Mobilization of the back 
  6. Strength exercises during the inflammatory stage of the wound healing cycle 

Effective Treatments of Mid Back Pain

Effective treatment strategies for mid back pain are listed as follows.

  1. One shall maintain a proper posture. 
  2. One shall adapt to proper lifting body mechanics.
  3. One shall ensure core stabilization.
  4. One shall stay active and engage in pain-free activities. 
  5. One shall perform pain-free back exercises.
  6. The resolution of the inflammation stage of the healing cycle in mid back pain involves the following therapeutic strategies.
    1. Magnetic therapy is an important aspect of the treatment of mid back pain. The magnetic fields have different mechanisms related to wound healing including collagen, angiogenesis, and proteoglycans. The MagnaHeal device comprises a neodymium magnet coated with anti-inflammatory substances. MagnaHeal 1 is useful for mild inflammation whereas MagnaHeal 2 is useful for severe inflammation. The devices have a magnetic force length of 2 inches and 3 inches respectively. (5, 6)
    2. The consumption of an anti-inflammatory diet is also useful for the resolution of inflammation in mid back pain. Anti-inflammatory contains greater fish, whole grains, vegetables, unsaturated fats, and fruits and lesser refined grains, sugary foods, and processed meat. (7)
    3. Another important measure for promoting the resolution of the inflammation is to address the nutrient deficiencies. (8)
  7. The resolution of the proliferation stage of the healing cycle in mid back pain involves the following therapeutic strategies. The fascia is made of superficial and deep fascia layers. The deep fascia is further divided from superficial to deep into aponeurotic fascia, epimysium, perimysium, and endomysium. Fascia separates the muscles, provides strength and stability, and encloses the organs. (9)
    1. The ASTR A1 Tool is developed to be used for releasing the fascia restrictions in the upper two fascia layers. These are superficial fascia and aponeurotic fascia. 
    2. The ASTR A3 Tool is developed to be used for releasing the superficial muscle knots or the muscle trigger points. This tool is also useful for releasing superficial scar tissue. 
    3. The ASTR A5 Tool is developed to be used for releasing muscle trigger points, scar tissue, as well as fascia restrictions. The tool releases fascia restrictions in the endomysium, epimysium, and perimysium; releases the deep muscle trigger points; and also releases deep scar tissue.  

Conclusion

Mid back pain or thoracic spine pain is less common than neck pain and lower back pain, except in children and adolescents, in which the incidence is similar. Mid back pain may hinder proper mobilization and make the quality of life poor. Effective treatment strategies for alleviation of mid back pain are based on the resolution of the inflammation and proliferation stages of the healing cycle. 

References 

  1. DeSai C, Reddy V, Agarwal A. Anatomy, Back, Vertebral Column. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525969/
  2. Wirth, B., Potthoff, T., Rosser, S., Humphreys, B. K., & de Bruin, E. D. (2018). Physical risk factors for adolescent neck and mid back pain: a systematic review. Chiropractic & manual therapies26, 36. https://doi.org/10.1186/s12998-018-0206-y
  3. Guo, S., & Dipietro, L. A. (2010). Factors affecting wound healing. Journal of dental research89(3), 219–229. https://doi.org/10.1177/0022034509359125
  4. Wilkinson, H. N., & Hardman, M. J. (2020). Wound healing: cellular mechanisms and pathological outcomes. Open biology10(9), 200223. https://doi.org/10.1098/rsob.200223
  5. Yuksel, C., Ankarali, S., & Yuksel, N. A. (2018). The use of neodymium magnets in healthcare and their effects on health. Northern clinics of Istanbul5(3), 268–273. https://doi.org/10.14744/nci.2017.00483 
  6. Henry, S. L., Concannon, M. J., & Yee, G. J. (2008). The effect of magnetic fields on wound healing: experimental study and review of the literature. Eplasty8, e40.
  7. Dragan, S., Șerban, M. C., Damian, G., Buleu, F., Valcovici, M., & Christodorescu, R. (2020). Dietary Patterns and Interventions to Alleviate Chronic Pain. Nutrients12(9), 2510. https://doi.org/10.3390/nu12092510
  8. Oz H. S. (2017). Nutrients, Infectious and Inflammatory Diseases. Nutrients9(10), 1085. https://doi.org/10.3390/nu9101085
  9. Gatt A, Agarwal S, Zito PM. Anatomy, Fascia Layers. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526038/