Pain in the middle of the spine is mainly related to the bones of the spine and the ligaments and joint capsule of the spine, as follows: 1. Pain in the spine may be caused by overexertion and excessive physical exercise. 2. It may also be caused by external injuries, prolonged standing of the patient, which requires appropriate massage of local muscle tissue to promote local blood circulation, and also physical therapy as well as acupuncture and moxibustion to reduce local pain. 3. Injuries to spinal ligaments and joint capsules, which are more common in adolescents, can lead to supraspinous ligamentitis or edema of the joint capsule, which can cause pain in the middle of the spine. 4. Spinal degeneration, spinal osteophytes, spinal stenosis, herniated discs and spinal cysts and tumors, which are more common in middle-aged and elderly people, cause pain in the middle of the spine. It is recommended to avoid getting cold, rest in bed and reduce strain.