Mid Back Pain That Keeps Coming Back? Why Sitting Up Straight Isn’t the Answer

If you’ve got a knot between your shoulder blades that always comes back to the same spot, you’re in good company. We see mid back pain at BSPC pretty much every day, and the story rarely changes: a spiky ball, a foam roller or the back of the chair to crack it, and a massage that feels great for a day or two… but it KEEPS coming back.

Most of these people have also been told to sit up straight. Here’s why that often makes it worse, and what to do instead.

What causes mid back pain that keeps coming back?

Most recurring mid back pain is mechanical. The joints of the thoracic spine, and the rib joints beside them, get stiff and lose rotation, and the small stabilising muscles stop holding them in a good position. Loosening the area gives relief, but unless you restore rotation and stability, the pain drifts back to the same spot.

Your thoracic spine has 12 vertebrae, and each rib joins it at two extra joints (the costovertebral and costotransverse joints). That’s why mid back pain often feels like a pinch just beside the spine. Those spinal joints are relatively flat and built for rotation, so your mid back does most of your trunk’s twisting.

FUN FACT: You even use it with every step you walk!

How common is mid back pain?

More common than most people think. A systematic review found that between about 15% and 35% of adults report mid back pain in a given year, with higher rates in women and teenagers.¹ Unlike neck and low back pain, it has no clear clinical guidelines, and researchers call it under-researched.²

Teenagers aren’t immune either. A study that followed almost 1,400 high school students for a year found 38% reported mid back pain at both the start and the end. It was more likely in girls, in students using a phone or tablet for three or more hours a day, and in those using devices while semi-lying on their stomach.³

Should you sit up straight to fix mid back pain?

Not rigidly. Recent research suggests that moving and changing position is likely more important than posture itself.⁴

Forcing yourself bolt upright can also jam the thoracic joints at the end of their range.

Try this. Bend one finger back as far as it goes and hold it there. It starts to ache quickly. That’s a close-packed position: the joint surfaces jammed together at end of range. Pulling your shoulders back hard and holding it at your desk does a version of the same thing to your mid back. Aim for a balanced middle position and change it often.

How can you test your mid back at home?

1. Sit on a chair, feet flat, hands together in front of you.
2. Turn as far as you comfortably can each way.
3. Both sides should be roughly even, ideally 60 degrees or more.

Remember your result, because you’ll retest after Step 2.

3 exercises for mid back pain (in this order)

1. Decompress

Take the pressure off before anything else. Skip arching over a foam roller, which pushes you further into extension. Instead, do a downward dog, or a side reach: hold a stair railing with one hand low and one high, and lean away. Take three slow, deep breaths in position, then swap sides. The breath expands the ribs from the inside and moves the rib joints.

2. Restore rotation

Stand on one end of a light resistance band and hold the other end with both hands by that hip. Pull up and across your body in a diagonal, like drawing a sword. Do 15–20 reps each side, then retest your rotation. Has it improved?

3. Build stability

Anchor a band above head height, stand tall without arching, and pull down with both hands. Work up to 30 reps at a light load.

The high anchor means the reaction force pushes up, so you stay decompressed while you load. Going heavy is the most common mistake: it hands the job to the big muscles instead of the small spinal stabilisers.

Why the order matters: if you strengthen a stiff spine, you build strength around the restriction. If you mobilise without stabilising, it drifts back. A 2024 review of the trials found hands-on treatment alone was no better than placebo for mid back pain, but combined with exercise it looked promising.⁵ The evidence is scarce, but it matches what we see: hands-on work opens the window, and exercise keeps it open- our EXACT approach we use here for example with our Clinical Pilates model of management.

When should you see a physio for mid back pain?

See a physio if your pain keeps returning despite these exercises, or if you can’t tell which movements set it off. See a GP promptly if any red flags below apply. Occasionally, pain in this area comes from the heart, lungs or abdomen rather than the spine.

• It started after a fall or a significant knock, or you have osteoporosis
• It’s constant, wakes you at night, or doesn’t change with movement
• It comes with fever, unexplained weight loss, or a history of cancer
• It comes with pins and needles, numbness or weakness in the legs, or changes in bladder or bowel control

At our Balwyn clinic, we assess thoracic and rib movement as standard, so we can find the missing piece, whether that’s a stuck rib joint, your desk or car setup, or your training load.

Book online or call 03 9836 7000. For more on back and neck pain, read our guide to managing spinal pain.

Frequently asked questions

Is it bad to crack your own back?

A gentle self-crack isn’t usually harmful, but the relief tends to be brief. If you need to do it several times a day, the stiffness and lack of control behind it haven’t been dealt with.

Can a massage ball or foam roller fix mid back pain?

They can ease it for a while, but they don’t restore rotation or stability, so the pain tends to return. Arching back over a foam roller also pushes the thoracic joints further into extension. Use them as a warm-up, then do the three steps.

Why do I get pain between my shoulder blades at my desk?

Usually it’s long stretches without moving, whether you’re slumped or held bolt upright. Change position often and add a few rotation movements through the day.

Can mid back pain come from the ribs?

Yes. Each rib joins the spine at two joints, and stiffness there often feels like a pinch just beside the spine. Occasionally, pain in this area comes from the heart, lungs or abdomen, which is why red flags matter.

Can teenagers get mid back pain from their phones?

A study that followed almost 1,400 high school students for a year linked ongoing mid back pain with three or more hours a day on a phone or tablet, and with using devices while semi-lying on the stomach. That’s an association, not proof of cause, but regular movement breaks are a sensible start.

References

1. Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77. https://doi.org/10.1186/1471-2474-10-77

2. 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. https://doi.org/10.1016/j.msksp.2018.11.006

3. De Vitta A, Noll M, Monfort-Pañego M, Miñana-Signes V, Maciel NM. Thoracic spine pain in high school adolescents: a one-year longitudinal study. Healthcare. 2023;11(2):196. https://doi.org/10.3390/healthcare11020196

4. Smythe A, Jivanjee M. The straight and narrow of posture: current clinical concepts. Aust J Gen Pract. 2021;50(11). https://doi.org/10.31128/AJGP-07-21-6083

5. Souza AISO, Baumgärtner M, Brecht P, Barbosa da Silva J, Ballenberger N, Armijo-Olivo S. Effectiveness of physiotherapy, medication, and education on thoracic spine pain: systematic review. IASP 2024 World Congress on Pain, poster WE615 (conference abstract, not a full paper). https://posters.worldcongress2024.org/poster/effectiveness-of-physiotherapy-medication-and-education-on-thoracic-spine-pain-systematic-review/

6. Finucane LM, Downie A, Mercer C, et al. International framework for red flags for potential serious spinal pathologies. J Orthop Sports Phys Ther. 2020;50(7):350–372. https://doi.org/10.2519/jospt.2020.9971