The pain in the middle of the lower back above the spinous process may be caused by interspinous ligament injury, supraspinous ligamentitis or lumbar muscle strain. 1. Injury to the interspinous ligament: If the interspinous ligament is injured due to lumbar spine trauma, it may lead to pressure and pain points on the spinous processes or between the spinous processes, thus causing pain in the middle of the waist above the spinous processes. 2. Supraspinous ligamentitis: If the patient has supraspinous ligamentitis due to prolonged sitting posture or excessive bending and weight bearing, it will cause pain in the middle of the lumbar region above the spinous process, but the range of pain is usually smaller. 3. Lumbar muscle strain: If the patient suffers from lumbar muscle strain due to chronic strain or improper treatment of acute lumbar sprain, it may lead to pressure and pain points above the spinous process, thus causing pain above the middle lumbar spinous process. Patients who have pain in the middle of the lumbar region above the spinous process should consult a doctor for examination and treatment under the guidance of the doctor to avoid delaying the condition of the body.