Hiatal Hernia and Pain in the Middle of the Back

You can have hiatal hernia if the upper part of your stomach pushes upward through hiatus, an opening in the diaphragm where the esophagus goes down through to the stomach. It may bulge up into your chest, which could be large enough to cause a number of symptoms. Does it also cause pain in the middle of the back?

Hiatal hernia pain

Hiatal hernia usually has no symptom. Even some people don’t realize they have the condition until it’s incidentally discovered during X-ray or certain tests for another condition. Most often if the pain occurs, it’s caused by GERD (gastroesophageal reflux disease).

GERD is a condition when the stomach contents (including stomach acid) back up into the esophagus. It is common in people with hiatal hernia. This is quite reasonable because hiatal hernia will weaken the lower esophageal sphincter (LES), the flexible muscle ring that’s responsible to allow foods to flow into your stomach and prevent acidic stomach from moving upward into the esophagus.

Sometimes GERD could be quite painful. It is often described as a feeling of burning chest pain, typically felt behind the breastbone. Also, it may make you have a feeling of having foods coming back into your throat leaving a bitter-acid taste.

And it is usually mild and often relieves with a few lifestyle measures (won’t need treatment). However in a few cases, it becomes chronic and medications are required.

Furthermore, it’s important to ensure that your pain is not caused by something else. For instance, if exercise makes the pain worse, it may be caused by heart problems. Hiatal hernia pain associated with GERD is less likely aggravated with physical activity.

Hiatal hernia may also become large enough to cause other symptoms, such as: shortness of breath, dysphagia (difficulty swallowing), abdominal /chest pain, or gastrointestinal bleeding (passing of black-tarry stools /vomiting of blood). See also warning signs and symptoms of hiatal hernia getting worse!

Does hiatal hernia cause middle back pain?

Pain in the middle of the back (above the bottom of rib cage and below the neck) is less common than lower back pain. It could be dull or sharp. Depending on the underlying cause and how severe it is, it may come up with some of the following symptoms;

  1. Muscle stiffness or tightness.
  2. Numbness or tingling in the belly, chest, legs, or arms.
  3. Chest pain.
  4. Poor for controlling bladder or bowel.

Middle back pain can occur for various reasons, such as:

  1. Problems affecting structures that support your back such as; muscle strain, overuse, or injury to discs, muscles, and ligaments of your spine.
  2. Poor, bad posture. Repeated pressure on the back increases the risk of back pain, this is particularly true if you have poor posture. With poor posture, the structures of your spine need to work harder to keep you balanced. The challenges mount if you’re obese.
  3. A vertebrae fracture. Back pain associated with this fracture usually gets worse with physical activity (when you move).

Furthermore, middle back pain could be probably caused by certain health conditions. The common ones include herniated disk (it can drive more pressure on your spinal nerves), osteoarthritis (having this arthritis can make a vertebrae fracture more likely), and myofascial pain (a disorder affecting the connective tissue of muscles).

How about hiatal hernia?

Back pain, including pain in the middle of the back, is not a specific symptom of hiatal hernia. But this doesn’t mean that it’s impossible to have back pain with the disease.

Here are a few factors associated with hiatal hernia that might contribute to cause back pain.

Acid reflux (heartburn)

As mentioned, heartburn is common in people with hiatal hernia since the condition is often associated with GERD. Although heartburn pain is typically felt behind the breastbone, it could be painful enough to radiate elsewhere in the body such as the neck, throat, or even the back.


Being obese can factor into many types of hernia, including hiatal hernia. And if you’re being obese, this can put you at high risk of having back pain!

Abdominal or chest pain

Hiatal hernia pain felt in the abdomen or chest, though not common, could also be severe enough to affect the back.

Be careful, back pain with chest pain may signal heart problems, especially if you experience anything that might be heart-related such as abnormal sweating, uneven-fast heartbeats, and shortness of breath. If you’re in such a case, see a doctor without delay!

For other possible causes of back pain in people with hernia, find out more in this previous post!

What helps with hiatal hernia and middle back pain?

If the pain does have to do with your hiatal hernia symptoms, controlling or treating the condition is a must. For accurate diagnosis, seeing your doctor is recommended – particularly if your symptoms get worse or don’t relieve with lifestyle measures.

Here are a few lifestyle approaches and home remedies that may help cope with the two conditions:

  1. Take a rest, especially when the pain flares up. But it’s also important to avoid excessive bed rest, because ‘too much’ could be counterproductive for your recovery.
  2. Avoid prolonged activities that provoke the pain (e.g. sitting for long hours during the work day). Instead, practice good posture to make the pain ease up. Take a break for every 20-30 minutes from your office chair, and make sure to sit or stand properly so your back will not get hurt afterwards – don’t slouch and slump!
  3. Maintain a healthy-body weight! Being at your best scale is also important pillar for your overall health, isn’t it!
  4. Do exercises that help strengthen the structures of your back! Moreover, exercise is a good way for weight control, so helpful to prevent your hernia from worsening.
  5. Avoid foods that provoke your hiatal hernia symptoms!
  6. Stop smoking! Tobacco smoke can hurt your esophagus. Also, a few studies showed that smokers are more likely to have back pain than non-smokers.
  7. Have a good stress management. In fact emotional stress can affect you physically, making the pain worse and inhibiting your recovery!

What are treatment options? Acid-suppressing medications are often used to help deal with hiatal hernia symptoms (especially for acid reflux and heartburn). These include antacids, H-2-receptor blockers, and proton pump inhibitors. Surgery is rarely used, but if the condition gets worse or if you have strangulated hernia, it can help.