What is Mid Back Strain

A strain is a stretch or tear in a muscle or the strong cords of tissue that attach muscle to bone (tendons). Strains of the mid-back (thoracic spine) occur between the neck and the lower back.

A strain occurs when muscles or tendons are torn or are stretched beyond their limits. The muscles may become inflamed, resulting in pain and sudden muscle tightening (spasms). A strain can happen suddenly due to an injury (trauma), or it can develop gradually due to overuse.

There are three types of strains:

• Grade 1 is a mild strain involving a minor tear of the muscle fibers or tendons. This may cause some pain but no loss of muscle strength.
• Grade 2 is a moderate strain involving a partial tear of the muscle fibers or tendons. This causes more severe pain and some loss of muscle strength.
• Grade 3 is a severe strain involving a complete tear of the muscle or tendon. This causes severe pain and complete or nearly complete loss of muscle strength.

What are the causes?

This condition may be caused by:

• Trauma, such as a fall or a hit to the body.
• Twisting or overstretching the back. This may result from doing activities that require a lot of energy, such as lifting heavy objects.

What increases the risk?

The following factors may increase your risk of getting this condition:

• Playing contact sports.
• Playing sports that put stress on the middle back, including:
  • Gymnastics.
  • Rowing.
  • Golf.
  • Horseback riding.

What are the signs or symptoms?

Symptoms of this condition may include:

• Sharp, dull, or spreading pain in the middle back that does not go away.
• Stiffness.
• Limited range of motion.
• Inability to stand up straight due to stiffness or pain.
• Muscle spasms.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
  • Your health care provider may push on certain areas of your back to determine the source of your pain.
  • You may be asked to bend forward, backward, and side to side to assess the severity of your pain and your range of motion.
• Imaging tests, such as:
  • X-rays.
  • MRI.

How is this treated?

Treatment for this condition may include:

• Applying heat and cold to the affected area.
• Medicines to help relieve pain and to relax your muscles (muscle relaxants).
• NSAIDs to help reduce swelling and discomfort.
• Physical therapy.

When your symptoms improve, it is important to gradually return to your normal routine as soon as possible to reduce pain, avoid stiffness, and avoid loss of muscle strength. Generally, symptoms should improve within 6 weeks of treatment. However, recovery time varies.

Follow these instructions at home:

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area during the first 24 hours after your injury.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• If directed, apply heat to the affected area as often as told by your health care provider. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
  • Place a towel between your skin and the heat source.
  • Leave the heat on for 20–30 minutes.
  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.

Activity

• Rest and return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid activities that take a lot of effort (are strenuous) for as long as told by your health care provider.
• Do exercises as told by your health care provider.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you have questions or concerns about safety while taking pain medicine, talk with your health care provider.
• Do not drive or operate heavy machinery until you know how your pain medicine affects you.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Avoid:
  • Being physically inactive for long periods at a time.
  • Exercising or playing sports when you are tired or in pain.
• Use correct form when playing sports and lifting heavy objects.
• Use good posture when sitting and standing.
• Maintain a healthy weight.
• Sleep on a mattress with medium firmness to support your back.
• Make sure to use equipment that fits you, including shoes that fit well.
• Be safe and responsible while being active to avoid falls.
• Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics. Try a form of exercise that takes stress off your back, such as swimming or stationary cycling.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
  • Cardiovascular fitness.
  • Endurance.

Contact a health care provider if:

• Your back pain does not improve after 6 weeks of treatment.
• Your symptoms get worse.

Get help right away if:

• Your back pain is severe.
• You are unable to stand or walk.
• You develop pain in your legs.
• You develop weakness in your buttocks or legs.
• You have difficulty controlling when you urinate or when you have a bowel movement.

Mid Back Strain Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

This exercise warms up your muscles and joints and improves the movement and flexibility of your back and shoulders. This exercise also help to relieve pain.

Exercise A: Chest and spine stretch

1. Lie down on your back on a firm surface.
2. Roll a towel or a small blanket so it is about 4 inches (10 cm) in diameter.
3. Put the towel lengthwise under the middle of your back so it is under your spine, but not under your shoulder blades.
4. To increase the stretch, you may put your hands behind your head and let your elbows fall to your sides.
5. Hold for __________ seconds.

Repeat exercise __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your back and your shoulder blade muscles. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Alternating arm and leg raises

1. Get on your hands and knees on a firm surface. If you are on a hard floor, you may want to use padding to cushion your knees, such as an exercise mat.
2. Line up your arms and legs. Your hands should be below your shoulders, and your knees should be below your hips.
3. Lift your left leg behind you. At the same time, raise your right arm and straighten it in front of you.
   1. Do not lift your leg higher than your hip.
   1. Do not lift your arm higher than your shoulder.
   1. Keep your abdominal and back muscles tight.
   1. Keep your hips facing the ground.
   1. Do not arch your back.
   1. Keep your balance carefully, and do not hold your breath.
4. Hold for __________ seconds.
5. Slowly return to the starting position and repeat with your right leg and your left arm.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Straight arm rows (shoulder extension)

1. Stand with your feet shoulder width apart.
2. Secure an exercise band to a stable object in front of you so the band is at or above shoulder height.
3. Hold one end of the exercise band in each hand.
4. Straighten your elbows and lift your hands up to shoulder height.
5. Step back, away from the secured end of the exercise band, until the band stretches.
6. Squeeze your shoulder blades together and pull your hands down to the sides of your thighs. Stop when your hands are straight down by your sides. Do not let your hands go behind your body.
7. Hold for __________ seconds.
8. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Shoulder external rotation, prone

1. Lie on your abdomen on a firm bed so your left / right forearm hangs over the edge of the bed and your upper arm is on the bed, straight out from your body.
   1. Your elbow should be bent.
   1. Your palm should be facing your feet.
2. If instructed, hold a __________ weight in your hand.
3. Squeeze your shoulder blade toward the middle of your back. Do not let your shoulder lift toward your ear.
4. Keep your elbow bent in an “L” shape (90 degrees) while you slowly move your forearm up toward the ceiling. Move your forearm up to the height of the bed, toward your head.
   1. Your upper arm should not move.
   1. At the top of the movement, your palm should face the floor.
5. Hold for __________ seconds.
6. Slowly return to the starting position and relax your muscles.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Scapular retraction and external rotation, rowing

1. Sit in a stable chair without armrests, or stand.
2. Secure an exercise band to a stable object in front of you so it is at shoulder height.
3. Hold one end of the exercise band in each hand.
4. Bring your arms out straight in front of you.
5. Step back, away from the secured end of the exercise band, until the band stretches.
6. Pull the band backward. As you do this, bend your elbows and squeeze your shoulder blades together, but avoid letting the rest of your body move. Do not let your shoulders lift up toward your ears.
7. Stop when your elbows are at your sides or slightly behind your body.
8. Hold for __________ seconds.
9. Slowly straighten your arms to return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Posture and body mechanics

Body mechanics refers to the movements and positions of your body while you do your daily activities. Posture is part of body mechanics. Good posture and healthy body mechanics can help to relieve stress in your body’s tissues and joints. Good posture means that your spine is in its natural S-curve position (your spine is neutral), your shoulders are pulled back slightly, and your head is not tipped forward. The following are general guidelines for applying improved posture and body mechanics to your everyday activities.

Standing

• When standing, keep your spine neutral and your feet about hip-width apart. Keep a slight bend in your knees. Your ears, shoulders, and hips should line up.
• When you do a task in which you lean forward while standing in one place for a long time, place one foot up on a stable object that is 2–4 inches (5–10 cm) high, such as a footstool. This helps keep your spine neutral.

Sitting

• When sitting, keep your spine neutral and keep your feet flat on the floor. Use a footrest, if necessary, and keep your thighs parallel to the floor. Avoid rounding your shoulders, and avoid tilting your head forward.
• When working at a desk or a computer, keep your desk at a height where your hands are slightly lower than your elbows. Slide your chair under your desk so you are close enough to maintain good posture.
• When working at a computer, place your monitor at a height where you are looking straight ahead and you do not have to tilt your head forward or downward to look at the screen.

Resting

When lying down and resting, avoid positions that are most painful for you.

• If you have pain with activities such as sitting, bending, stooping, or squatting (flexion-based activities), lie in a position in which your body does not bend very much. For example, avoid curling up on your side with your arms and knees near your chest (fetal position).
• If you have pain with activities such as standing for a long time or reaching with your arms (extension-based activities), lie with your spine in a neutral position and bend your knees slightly. Try the following positions:
• Lying on your side with a pillow between your knees.
• Lying on your back with a pillow under your knees.

Lifting

• When lifting objects, keep your feet at least shoulder-width apart and tighten your abdominal muscles.
• Bend your knees and hips and keep your spine neutral. It is important to lift using the strength of your legs, not your back. Do not lock your knees straight out.
• Always ask for help to lift heavy or awkward objects.