Here Is Everything You Need To Know About Mid Back Pain from Sitting, What Causes It, and The Best Way to Treat It
mid back pain at work, at a desk, or when watching TV is a very common symptom. It may be caused from poor posture, from a strained muscle, or it can be referred pain from the neck. People who sit for long periods of time, or individuals with arthritis in the cervical (neck) region can also be affected. Conservative care, including physical therapy, can help reduce symptoms. A physical therapist can help alleviate the acute neck and arm symptoms that result from the condition, as well as improve general strength and function. Most cases of cervical radiculopathy are resolved with physical therapy and do not require surgery.
What are common causes of mid back pain from sitting?
Cervical radiculopathy occurs when a nerve root coming off the spinal cord becomes compressed. The compression can occur for various reasons. In younger people, it may occur when a cervical disc herniates due to trauma. In older individuals, it commonly occurs spontaneously as a result of arthritis or decreased disc height in the neck region.
The cervical spine consists of 7 cervical vertebrae (the bones that form the neck region). Each vertebra is separated by a gel-like disc. The discs provide shock absorption for the spine. The spinal cord travels through a canal in the cervical vertebrae. Spinal nerve roots extend from the spinal cord and branch off going to specific locations in the arm. The spinal nerves send signals to our muscles for movement as well as sensations that we feel in the entire arm. The spinal cord is like a tree trunk, and the spinal nerves are like the tree branches. If an impingement or abnormal pressure is placed on a branch near the trunk, everything along that branch will be affected.
Spinal nerves can be impinged by:
- Arthritis or disc wear-and-tear with age
- Herniated or bulging discs from trauma or degeneration
- Spinal stenosis, which is a narrowing of the spaces in which the nerves travel
- Tumor, which can be benign or malignant, impinging the nerve root
When the spinal nerves are impinged, they cannot properly send messages to the muscles from the brain, nor receive proper sensation from the specific arm location the nerve travels. Everywhere the spinal nerve travels will be affected. That is why a pinched nerve in the neck can cause pain, weakness, and loss of sensation in the arm, even though the pinch is in the cervical region.
Where does it hurt?
In most cases of sitting mid back pain, patients report a dull ache or burning right in their middle back area in between their shoulder blades or slightly lower. Usually it is worse with sitting and when at work. Sometimes, the neck can cause pain to radiate into the mid back area. Because of this, it’s possible to feel pain of an injury in other parts of your body. This is called referred pain. Understanding the root cause of your pain is fundamental to treating your pain in the long run & will decrease your dependence on painkillers or treatment that only addresses the symptoms.
What are common symptoms of mid back pain from sitting?
Symptoms of cervical radiculopathy vary depending on the nerve root involved, and commonly occur on the same side of the body as the affected nerve. The symptoms may include:
- Pain in the neck, shoulder blade, shoulder, upper chest, or arm, with pain possibly radiating into the fingers following the path of the involved nerve root.
- Pain described as “sharp” or “pins-and-needles” or “popping sensation” in cervical or mid back region.
- General dull ache or numbness anywhere along the pathway of the nerve.
- Weakness in the shoulder, arm, or hand.
- Pain that worsens with certain neck movements.
- Pain that improves when the arm is lifted over and behind the head (relieving tension on the spinal nerve).
Can mid back pain from sitting be treated?
What if mid back pain from sitting goes untreated? What can I expect from treatment?
Yes, sitting middle back pain can be treated and with great results. Even better, many times it can be treated conservatively without needing injections, pain medications, or surgeries if you catch it early enough. The key to treatment is to solve the root cause of your pain so you can get the best results and a long-term outcome.
Some root causes of sitting mid back pain can be:
Decreased shoulder blade range of motion
Poor posture in sitting
Rounded shoulders with impingement
Weak mid back and shoulder blade muscles
Overload to the shoulder joint with active motions
Tight neck and mid back
Poor biomechanics causing impingement
Decreased mid-back rotation
Tight rotator cuff muscles
Poor workplace ergonomics
If you have failed multiple treatment approaches already, your clinician missed the real root cause of your pain and was just chasing the symptoms. The pain or symptom is the effect, not the cause. What do I mean by this? Say your fire alarm goes off in your house. Its purpose is to protect you and make you aware that something is wrong, i.e., that there is a fire in your house. The “alarm” is like your pain (your body’s way of telling you something is wrong) and the “fire” is the root cause. When the fire alarm goes off, you don’t run upstairs and just turn it off, right? You run through the house with the fire extinguisher, trying to find the room where the fire is at. You try to find out what caused the alarm to go off so you can put it out. Once the fire is out, then the fire alarm can go off. Solve the “root” cause of your pain, and then the pain (“the effect”) eventually goes away.
Additionally, there is a common root cause which many clinicians misdiagnose. They treat the mid back pain with a cookie cutter approach, hoping it will work and treat it as a simple muscle problem. They tend to rely on stretching, ultrasound, massage, and focus treatment directly on the mid back. However, often the root cause is missed and the symptoms return. If you can normalize shoulder and thoracic range of motion and biomechanics, you should be able to decrease your pain and increase the range of motion. So many healthcare clinicians treat pain like this and thus show poor treatment outcomes which results in the pain coming back. Why? They missed the root cause of your mid back pain. This is also the case when patients turn to injections, nerve blocks and other surgeries which are still not effective because the actual problem still is not solved, their treatment was just chasing the pain.
The first step in treatment is to identify the root cause of your pain. A specific and individualized treatment approach for your type of pain can lead to a successful outcome for you and resolve your symptoms for the long term. This is why you can’t rely on a standard cookie cutter approach; you need a customized and individualized treatment approach specifically for your type of middle back pain.
What happens if it goes untreated?
Minor case – If it is a minor case of sitting mid back pain, research shows that many acute cases of pain may spontaneously go away in 4-8 weeks. The key is to solve the root cause of what is causing the actual mid back pain? But who wants to wait 8 weeks to get pain free? Let’s try to solve the root cause of your pain in 2-3 weeks and address all of the risk factors present (so it never returns!) and get you back to your favorite activities faster! We still recommend that you get it checked out by one of our board-certified physical therapists to ensure that it is just a minor case, to solve all risk factors, and to get the optimal outcome in the fewest visits needed. Most minor cases resolve on their own in time or get better with some stretching and strengthening. But, the sooner you take action, the sooner you are pain-free. (And research supports this!)
Severe case – If it’s more of a severe and chronic case of mid back pain, your pain will probably start to worsen and increase because the root cause of the pain is not being treated. Many people turn to pain medication at this time but this only blocks the pain for short term. You may not feel the pain when taking pain medications, but the underlying problem is still there. Many people say after the pain medication is stopped, then usually the pain returns and sometimes it returns even worse. This is when you will get increased muscle tightness, muscle burning from overload, chronic trigger points in postural mid-back muscles, and it may start to get painful at rest. Even though it’s more chronic now, we can still help. Once the root cause and all risk factors are addressed, then we can start decreasing your pain, regardless of how chronic and severe the pain is. This is the crucial first step. It just may take more time to recover from a chronic case. Usually with chronic and severe cases, the longer you have your pain and injury, the longer it takes to resolve.
What outcome can you expect from treatment?
As we’ve discussed, the first step is to solve the root cause of your sitting mid back pain. This is the most essential step to plan a treatment specialized for you and your unique type of pain. Your root cause will guide your treatment and dictate what is the best way to treat your pain. This, along with identifying risk factors that may be predisposing you to have your pain and injury, will allow you to start getting pain free again. The next step is to start decreasing pain, modifying activities, and start addressing all of the impairments causing your pain which we discovered during your evaluation. With each session, pain should start to decrease and you should start to regain range of motion with less pain and symptoms. Any radicular and referred pain should resolve fast as well. At this point, we begin light and basic strengthening only if it does not increase pain. Treatment will consist of a lot of manual therapy and light exercises.
The next step is to achieve full range of motion, (which should correlate to being pain free) and now we can start progressive strengthening. Strengthening the muscles is crucial and research shows that this gives you the best long-term outcome! As you start to get stronger and maintain your mobility, your pain will continue to decrease if it is not already gone. Your increased strength will allow you to perform more activities and prevent flare ups. This usually does take up to 4 weeks. As you clear our goals, then we can start easing you back into sport, golf, running, and whatever your favorite activities are. This is when we start winding down treatments and getting you back into functional strengthening, sport specific training, return to run programs, golfing, and whatever your goals are. At the end, we reassess everything, making sure we achieved all of our goals, your goals, that all risk factors are gone, and finalize your long term home exercise program. There are many factors which can influence your outcome, but 85-90% of our patients respond well to our treatment approach and achieve a successful outcome when completing their plan of care.
How is it diagnosed?
When you seek the help of a physical therapist, the physical therapist performs a comprehensive evaluation and asks questions about your pain and your daily activities. These may include:
- How and when the pain started: Did the pain begin spontaneously or was there any trauma or popping experienced in the cervical region?
- Where are the symptoms located, and have they changed location or intensity since the onset?
- What makes the symptoms better or worse?
- What type of work do you perform?
- What hobbies or household activities do you regularly perform?
Your physical therapist will gently test the movement of your neck and arms. The therapist will check your tendon reflexes and strength, and conduct special tests on your neck and upper extremity to determine which spinal nerve root(s) may be involved, and to rule out other conditions. To provide a definitive diagnosis, your therapist may collaborate with an orthopedist or other health care provider. The orthopedist may order further tests, such as magnetic resonance imaging (MRI) or electromyography (EMG). An MRI can show soft tissues, including the spinal cord and nerve roots. This test can determine what is causing the compression on the nerves, including disc bulges or disc herniation. An EMG measures the nerve and muscle function. This test can tell how well your spinal nerves are communicating to your muscles.
Do you need an X-ray and MRI imaging for sitting mid back pain?
For most common orthopedic cases, imaging is not needed and the diagnosis can be made with a simple physical therapy evaluation. No need to waste thousands of dollars on unwarranted diagnostic imaging. We also have clinical tests which we can perform to help rule in and rule out pathologies that correlate to MRI findings (which is WAY cheaper than an MRI!). An expensive MRI may just tell us what we already know. Also, often times the positive findings found on x-rays, MRIs, and EMGs may not actually be the root cause of your pain. What does that mean? Many positive findings on an MRI are also found in asymptomatic (pain-free) individuals, so diagnostic imaging may not be able to tell us what is actually causing your pain. For example: many people have a herniated disc in their low back but do not have any low back pain. So if herniated discs can cause no pain, just because someone with low back pain has a herniated disc does not mean that is what’s causing their pain. The key is to find out if your clinical evaluation findings during your evaluation at Pursuit match the MRI findings. If so, then we can decide what is the best way to treat it.
How can a Physical Therapist treat it?
Physical therapy is an effective treatment for cervical radiculopathy, and in many cases, it completely resolves symptoms. Your physical therapist will develop an individual treatment plan based on the findings of your initial evaluation. The treatment plan may include:
Pain Management. The first goal is to reduce the pain and inflammation in the area. Ice packs applied to the neck and scapular (shoulder blade) region during the first 24 to 48 hours following the onset of pain, help reduce inflammation. Moist heat can be used after this time period to help the surrounding muscles relax. Your physical therapist may advise you to wear a soft cervical collar at times throughout the day, to allow the neck to relax. A cervical contoured pillow may be recommended to properly support the neck, and allow you to sleep more comfortably.
Manual Therapy. Your physical therapist may use manual therapy techniques, such as manual cervical traction, to relieve pressure in the cervical (neck) region. This procedure can provide immediate relief of pain and numbness radiating into the arm. Gentle massage may also be performed on the muscles of the cervical spine and scapular (shoulder blade) region. This technique helps the muscles relax and improves circulation to the area, promoting healing and pain relief.
Posture Education. Posture education is an important part of rehabilitation. Your physical therapist may suggest adjustments to your workstation and work habits, to promote good posture to protect your neck. In the early stages of recovery this may mean sitting only 15 to 20 minutes at a time. You will also receive instructions on how to bend, reach, and lift throughout the day in safe positions that place minimal pressure on your spinal discs.
Range-of-Motion Exercises. Your physical therapist will teach you gentle cervical mobility exercises to relieve your symptoms, and allow you to return to normal movement. In the beginning stages of recovery, it is important that none of these exercises increase the pain radiating down into your arm. It is important to communicate your symptoms accurately to your physical therapist. If you spend many hours sitting at a desk during your workday, your neck may become stiff. Your therapist will teach you neck stretches to take pressure off of your neck from extended periods of sitting, to help improve your mobility.
Strengthening Exercises. Your physical therapist will help you determine which muscle groups need to be strengthened based on which spinal nerves are involved in your particular case. When pain no longer radiates down your arm, you may begin more aggressive strengthening exercises. Neck stability (strengthening) exercises will also be performed. You will receive a home-exercise program to continue strengthening your neck, shoulder, arm, and upper back long after your formal physical therapy has ended.
Functional Training. As your symptoms improve, your physical therapist will work on functional exercises to help you return to your job, sport, or other daily activities. For example, if your job duties require overhead reaching, pushing, pulling, and long periods of sitting, you will be taught ways to perform these tasks to reduce undue stress to the neck.
How can it be prevented?
Your physical therapist will educate you on the best ways to prevent cervical radiculopathy from recurring, including:
- Maintaining proper posture. Use a supportive pillow and proper posture when sitting at a desk or in the car.
- Setting up your workstation to minimize undue forces on the spine. You may be advised to use a hands-free phone, or adjust your computer monitor to avoid excessive twisting or extending of your neck in repetitive directions during the workday.
- Continuing with regular exercise to maintain spinal muscles flexibility and strength, including the upper body, middle back, and core muscles.
- Keeping a healthy weight to minimize unnecessary forces on the spine.