Mid-Thoracic Back Pain: which trigger points cause it and how to treat them

Interscapular pain is rarely from the spine itself in the absence of clear pathology. Infraspinatus and scalenes are common referral sources, along with rhomboids and serratus posterior superior.

Rectus Abdominis — Mid-back and lower-back pain, urinary urgency-like sensations, abdominal cramps.

Scalene — Anterior chest, upper back between the scapulae, lateral shoulder, posterior arm and forearm, sometimes into the thumb and index finger.

Latissimus Dorsi — Inferior angle of the scapula, mid-back, and down the medial arm to the ulnar fingers.

Iliocostalis Thoracis — Upward referral toward the upper back and shoulder blade, downward referral toward the lumbar region, and wrap-around pain over the lateral chest wall.

Multifidi — Local segmental pain, often felt as a 'spot' the patient can point to.

Rhomboid — Superficial ache between the scapulae, often described as 'burning' along the medial border.

Serratus Posterior Superior — Deep ache under the scapula, often mistaken for cervical or rib pain.

Infraspinatus — Deep anterior shoulder pain (felt 'inside' the joint), spreading down the lateral arm and sometimes into the forearm and radial hand.

Trapezius — Pain refers up the side of the neck to the temple and angle of the jaw, often described as a unilateral tension headache. May also refer to the back of the ear.

Serratus Anterior — Lateral chest and lower scapular border, sometimes mimicking 'side stitch' or breathing pain.

Levator Scapulae — Angle of the neck and shoulder, along the vertebral border of the scapula and into the posterior shoulder.

Work the muscles in the order above. Treat one muscle fully — locate the taut band, hold sustained pressure until the ache eases, then take the muscle through its full range once — before moving to the next. Re-test the painful movement after each muscle so you can tell which one is actually driving the pattern: the muscles most often responsible here are Rectus Abdominis, Scalene and Latissimus Dorsi.

If two or three muscles each give partial relief, that is the normal picture in a long-standing pattern; expect to revisit them over several sessions rather than resolving everything in one.

Myofascial referral is a pattern of muscular origin, and it behaves like one: pressure on a specific spot reproduces the familiar pain, the pain moves with load and position, and it eases after release and movement. Findings that do not behave that way belong to a different problem.

Seek assessment rather than self-treating when pain is constant and unchanged by position, wakes you at night without a mechanical trigger, follows a clear dermatome with numbness or weakness, or comes with fever, unexplained weight loss, or a recent significant injury. The same applies when four to six weeks of consistent self-care produces no change at all.