A thoracic spine assessment can help identify upper-back, rib and movement-related pain triggers.

Thoracic pain is pain or stiffness in the middle and upper back, often between the shoulder blades or around the ribs. It may feel like an ache, tightness, burning discomfort or sharp pain. Symptoms may worsen with sitting, twisting, lifting, gym work, coughing or deep breathing.

The cause often involves a combination of muscles, thoracic joints, rib joints, posture, breathing mechanics or a sudden change in physical load. Because the thoracic area sits close to the neck, shoulders, ribs and chest, several conditions can produce similar symptoms.

What Is Thoracic Pain?

Thoracic pain affects the middle section of the spine between the neck and lower back. The thoracic spine contains 12 vertebrae. Each level connects with ribs, while muscles and other soft tissues support movement, breathing, shoulder function and trunk control.

Pain may come from the thoracic joints, rib joints, muscles around the shoulder blades, chest-wall tissues or nearby structures. Some people mainly feel stiffness. Others notice sharp pain during turning, reaching, coughing or deep breathing.

The thoracic spine normally moves less than the neck and lower back because the rib cage provides added stability. Even so, repeated loading, long periods in one position or a sudden movement can irritate local structures.

What Causes Thoracic Pain?

Thoracic pain commonly develops when the load placed on the upper back exceeds the current capacity of its joints, ribs or muscles. The trigger may be sudden, such as a fall or awkward lift. Alternatively, symptoms may build gradually through repeated work, sport, gym training or prolonged sitting.

• Thoracic joint irritation: the small joints at the back of the spine may become painful or stiff, particularly with turning or arching.
• Rib-joint irritation: the joints connecting the ribs to the spine may hurt with rotation, coughing, sneezing or deep breathing.
• Muscle overload: muscles between the shoulder blades and around the ribs may become sore after repeated lifting, pulling, throwing or prolonged postures.
• Sudden loading changes: a quick increase in gym volume, work demands or sport can overload tissues that have not adapted to the new demand.
• Direct trauma: falls, collisions or blows to the chest or back may affect the ribs, muscles or spine.
• Postural fatigue: staying in one position for too long may increase discomfort, particularly when strength and movement variety are limited.
• Spinal shape or mobility: scoliosis, Scheuermann’s disease or age-related change may affect loading and fatigue.
• Inflammatory or bone-health conditions: osteoporosis and inflammatory spinal conditions can change the assessment and management pathway.

Why Does My Upper Back Hurt Between the Shoulder Blades?

Pain between the shoulder blades may come from thoracic joints, muscles, ribs, the neck or shoulder-blade loading. Prolonged sitting, repeated reaching, lifting and training fatigue are common triggers. Symptoms may also be referred from nearby neck or shoulder structures.

The location of pain alone cannot confirm the diagnosis. Assessment becomes more important when pain keeps returning, spreads, affects breathing or does not respond to simple load changes.

Why Does Thoracic Pain Hurt When I Breathe?

Breathing moves the ribs and the joints where they connect with the thoracic spine. Irritated rib joints, intercostal muscles or chest-wall tissues may therefore hurt during a deep breath, cough or sneeze.

Some breathing-related pain is musculoskeletal. However, chest pain, sudden breathlessness, faintness, sweating or symptoms that feel unlike your normal back pain require urgent medical assessment.

Can Sitting and Screen Work Cause Thoracic Pain?

Long periods of sitting can contribute to thoracic pain by reducing movement variety and increasing muscle fatigue. Symptoms may build when screen work combines with limited breaks, low shoulder-blade endurance, poor workstation setup or stress-related muscle tension.

Changing position regularly often helps more than forcing one rigid posture. Short walking breaks, gentle thoracic movement and a workable desk setup may reduce accumulated load.

Can Gym Training Cause Thoracic Pain?

Gym training may trigger thoracic pain when exercise volume, weight, range or frequency increases faster than your body can adapt. Heavy pressing, rowing, pull-ups, deadlifts and repeated rotation can load the thoracic spine, ribs and surrounding muscles.

The exercise itself may not be the main problem. Training history, recovery, technique, total weekly load and other activities all influence tissue tolerance.

How Is Thoracic Pain Assessed?

A thoracic pain assessment aims to identify whether symptoms behave like a muscle, joint, rib, nerve or non-musculoskeletal problem. Your physiotherapist will consider how the pain began, what aggravates it, whether breathing affects it and whether any warning signs need medical review.

The physical assessment may include:

• thoracic rotation, bending and extension
• neck and shoulder movement where symptoms overlap
• rib and breathing movement
• posture and position tolerance
• shoulder-blade control and muscle endurance
• strength and functional tasks
• neurological screening when numbness, tingling or weakness is present
• work, gym or sporting movements that reproduce symptoms

Medical imaging is not necessary for every episode of thoracic pain. Your physiotherapist or doctor may recommend further investigation when trauma, neurological changes, low bone density or another health concern changes the clinical picture.

How Can Physiotherapy Help Thoracic Pain?

Physiotherapy can help by identifying the main pain drivers and building a plan that restores comfortable movement and physical capacity. Treatment depends on the diagnosis, symptom irritability, work demands, sport and personal goals.

Your plan may include:

• Education and load management: adjusting aggravating tasks without unnecessarily stopping all activity.
• Thoracic mobility exercises: restoring comfortable rotation, extension and movement variety.
• Rib and breathing exercises: improving chest-wall movement when clinically appropriate.
• Strength and endurance: developing the mid-back, shoulder-blade and trunk muscles.
• Manual therapy: hands-on treatment may provide short-term symptom relief or improve movement when combined with active rehabilitation.
• Workstation and task changes: reducing repeated loading and improving position variety.
• Graded return to activity: rebuilding tolerance for work, lifting, gym training and sport.

Should You Keep Moving With Thoracic Pain?

Gentle movement is often more helpful than complete rest when thoracic pain behaves like a muscle, joint or rib problem. The aim is to keep moving within a tolerable range while temporarily reducing activities that repeatedly produce sharp or escalating pain.

Related Thoracic and Upper-Back Conditions

The following conditions can produce thoracic, rib or upper-back symptoms. A physiotherapist can help determine which pattern best matches your presentation.

When Is Thoracic Pain Worth Assessing?

Arrange an assessment when thoracic pain keeps returning, limits movement, affects sleep or makes work, driving, breathing, lifting or sport more difficult. Early review may also help when you are unsure whether symptoms come from the spine, ribs, muscles, shoulder or chest wall.

Assessment is particularly useful when:

• pain has not started improving as expected
• symptoms return whenever you increase activity
• you cannot take a comfortable deep breath
• pain affects work, sleep, exercise or daily tasks
• you have pins and needles, numbness or weakness
• pain began after trauma
• you have osteoporosis or another condition affecting bone strength

When Should You Worry About Thoracic Pain?

Most thoracic pain is not caused by a serious condition, but some symptom combinations need prompt medical assessment. Thoracic pain sits close to the chest and may occasionally reflect a problem outside the muscles, ribs or spine.

Thoracic Pain FAQs

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References

1. Maselli F, Palladino M, Barbari V, Storari L, Rossettini G, Testa M. The diagnostic value of red flags in thoracolumbar pain: a systematic review. Disabil Rehabil. 2022;44(8):1190-1206. doi:10.1080/09638288.2020.1804626.
2. Risetti M, Gambugini R, Testa M, Battista S. Management of non-specific thoracic spine pain: a cross-sectional study among physiotherapists. BMC Musculoskelet Disord. 2023;24(1):398. doi:10.1186/s12891-023-06505-8.
3. Storari L, Piai J, Zitti M, Raffaele G, Fiorentino F, Paciotti R, et al. Standardized definition of red flags in musculoskeletal care: a comprehensive review of clinical practice guidelines. Medicina (Kaunas). 2025;61(6):1002. doi:10.3390/medicina61061002.