How to tell whether your mid back pain is desk related or worth investigating
Nicola Tik
Mid back pain is common, and the large majority of it is driven by the same combination of sustained sitting, postural load, stress, and muscle tension that affects the rest of the spine. But the mid back occupies a particular anatomical position that makes the question of whether pain there is MSK-related or worth investigating slightly more nuanced than the equivalent question for the neck or lower back. Understanding the difference between the two tends to reduce both unnecessary anxiety and unnecessary delay in getting appropriate attention.
The thoracic spine sits in close proximity to several internal organs, including the kidneys, the digestive system, and the heart. Pain originating in any of these structures can refer into the mid back area in ways that can feel similar to musculoskeletal pain at first, particularly when the person is not aware that non-spinal sources of mid back pain exist.
This does not mean mid back pain is usually something other than MSK. It almost always is MSK in origin, and the same loading patterns, postural habits, and stress-related tension that affect the rest of the spine are the most common drivers of mid back discomfort. But it does mean that the characteristics of the pain are worth paying more attention to in the mid back than they might be in the neck or lower back, because the distinction between musculoskeletal and non-musculoskeletal sources is more clinically relevant in this region.
Desk-related mid back pain tends to have a recognisable pattern that reflects its mechanical origins. A few characteristics tend to indicate that pain is MSK in nature and driven by the demands of desk work and daily loading.
The pain has a clear relationship to posture and activity. It tends to build during or after prolonged sitting, improve with movement and position change, and feel worse at the end of a long desk day than at the beginning. It may be accompanied by stiffness that takes a few minutes to ease after getting up from a sustained sitting position.
The pain is located in the muscles and joints of the mid back, typically felt as a broad, diffuse aching or tightness across the upper back between the shoulder blades, or along the sides of the thoracic spine. It may be tender to touch in specific muscle areas, and it tends to feel like tension or compression rather than a sharp or stabbing sensation at rest.
The pain responds to the approaches covered in the chronic mid back articles. Gentle movement, fuller breathing, warmth, and reducing sustained sitting all tend to produce some improvement. A difficult week, poor sleep, or a period of sustained stress tends to make it worse.
A few characteristics of mid back pain are worth paying attention to because they do not fit the typical desk-related pattern and may point towards something worth getting assessed.
Pain that is present at rest and does not clearly improve with movement or position change is less typical of MSK pain, which tends to have a clear relationship to loading and activity. Mid back pain that feels the same whether sitting, standing, lying down, or moving is worth mentioning to a healthcare professional.
Pain that is significantly worse at night and consistently disturbs sleep, particularly if it does not ease with position change, is worth getting assessed. Night pain that is present regardless of position tends to be a less typical feature of MSK pain and is worth investigating.
Pain that is accompanied by other symptoms that seem unrelated to the musculoskeletal system, such as changes in digestion, difficulty breathing, unexplained fever, or a general sense of feeling unwell, is worth getting assessed promptly. These accompanying symptoms are the clearest signal that the mid back pain may have a non-musculoskeletal component worth investigating.
Pain that radiates around the ribcage towards the front of the chest or abdomen in a band-like pattern, rather than spreading into the back muscles in the way that referred muscle tension typically does, is worth getting assessed.
Pain that developed without a recognisable trigger and has been getting progressively worse over weeks without any improvement is worth getting assessed, particularly if it is accompanied by unexplained weight loss or persistent fatigue.
Setting aside the non-MSK considerations above, there are also situations where mid back pain that is clearly MSK in origin is worth getting professional support for rather than continuing with self management alone.
Pain that has not shown meaningful improvement after four to six weeks of consistent self management is worth having assessed by a physiotherapist. A more tailored approach than general guidance can identify specific factors prolonging the episode and provide targeted support.
Pain that is getting progressively worse rather than fluctuating or gradually improving over the first few weeks is worth having looked at sooner. Progressive worsening without explanation benefits from assessment rather than further self management.
Pain that is significantly affecting daily function, sleep, or work for more than two to three weeks is worth getting support for, because the impact on quality of life at that point warrants more than self management alone can offer.
Recurring episodes that follow a similar pattern each time tend to benefit from professional input to identify and address the underlying factors contributing to recurrence.
A useful framework for deciding what to do combines the nature of the pain, its relationship to activity and posture, the presence or absence of accompanying symptoms, and the direction of travel.
If the pain has a clear relationship to desk work and posture, improves with movement, has no accompanying symptoms that seem unrelated to the musculoskeletal system, and is gradually improving, self management is the appropriate approach with patience and consistency.
If the pain does not clearly relate to activity or posture, is present at rest and at night, is accompanied by symptoms that seem unrelated to the musculoskeletal system, or is getting progressively worse, getting it assessed is the appropriate response regardless of how long it has been present.
If the pain is clearly MSK in origin but has not improved after four to six weeks of self management, professional support is worth seeking.
Your VIDA pain check-in is a useful tool for tracking patterns over time, making it easier to see whether the pain is following the typical desk-related pattern or whether the characteristics described above are present and worth acting on.