It can be scary to experience back pain when breathing. The good news is that most of the time, it's nothing to worry about. It's usually due to a musculoskeletal issue, like a pulled back muscle, reassures Steven Goostree, PT, DPT, OCS, a physical therapist at Hinge Health. In these cases, back pain while breathing usually gets better with conservative management such as rest, over-the-counter medication, physical therapy, and basic strengthening and stretching exercises, says Dr. Goostree.

But it's important to understand all the causes behind back pain when breathing. There are times when something serious can trigger pain while breathing, including infections, injuries, or heart or lung problems. Shortness of breath and chest pain can also indicate a heart attack or pulmonary embolism, both of which require emergency medical attention.

Here, learn more about possible musculoskeletal (MSK) causes of back pain when breathing, and how to treat them, especially with exercises from our Hinge Health physical therapists.

The Link Between Back Pain and Breathing

Your lungs occupy a fair amount of your chest cavity. They're also connected with the muscles and nerves in your back and the middle portion of your spine known as the thoracic spine. "This is the longest and most complex region in the spine - it's like the poor middle child," explains Dr. Goostree. "It's prone to stiffness. Since it's attached to your ribs, it can cause strain in surrounding muscles, which leads to pain when you breathe."

Causes of Back Pain When Breathing

Here are some of the most common MSK-related reasons you may experience back pains while you breathe:

Back strains and sprains. These can occur if you lift something heavy or twist or bend. It can result from a sudden injury or gradual overuse. Other symptoms include pain that radiates into your buttocks, stiffness, and muscle spasms. They may also cause pain in both your chest and back when breathing.

Disc problems. Over time, the spinal discs that act as shock absorbers in your spine break down. This can lead to small cracks and tears in the discs, as well as bulging. All of these can contribute to back pain with breathing and moving.

Osteoarthritis. You may think of osteoarthritis as only affecting the knee or hip, but it commonly affects the spine, too. This breakdown of the cartilage that cushions joints affects the facet joints, which connect your spinal vertebrae (bones) to each other. This can cause back pain that may worsen with breathing.

Soft tissue injuries. If you've experienced some form of back trauma - for example, a car accident - the surrounding tissue can swell, which can make it painful to breathe, notes Dr. Goostree.

Certain sleeping positions. If you sleep on your stomach, it can be very hard on your thoracic spine. If you wake up stiff and achy, you may notice that your back pain worsens with breathing.

Scoliosis. This sideways curvature of the spine can put more pressure on the ribcage and lungs, which can make breathing painful.

Kyphosis. Weak spinal bones - often seen in older adults - can lead to an exaggerated rounding of the upper back. This can cause associated pain.

Use of harnesses. Back braces and posture T-shirts are popular now, but they can worsen back pain, and potentially cause back pain while breathing. "These may be fine for short term use - say a week or two - but if you rely on them too much, the postural muscles that are supposed to hold you upright can weaken," notes Dr. Goostree. A 2019 review published in the Scandinavian Journal of Pain also concluded that there is no evidence that posture-correcting shirts relieve musculoskeletal pain.

Chronic Conditions 

Chronic health issues that affect your heart or lungs can potentially lead to back pain while breathing. This includes chronic pneumonia, chronic obstructive pulmonary disorder (COPD), congestive heart failure, and lung cancer. 

When to See a Doctor

If you have back pain while breathing that lasts for more than a week, see your doctor to rule out an underlying cause. They may also prescribe physical therapy to help strengthen your back muscles. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

You should see your doctor sooner if you notice sharp pain in your back with breathing, or if your back pain is accompanied by:

• Tingling or numbness in your legs or buttocks

• Fever, weight loss, or bowel or bladder problems

Head to the emergency room, or call 911 if you experience:

• Shortness of breath or difficulty breathing

• Chest pain that's sharp and prevents you from being able to take a deep breath

• Coughing up blood

These can be signs of a pulmonary embolism (a blood clot in the lungs) or a heart attack.

Treatment Options

If you experience musculoskeletal-related back pain while breathing, there are steps you can take to soothe a sore back. They include:

- Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful. It's important to make sure that you are safely able to take these medications, based on your medical history.

- Ice or heat. If your back pain is due to a recent strain or injury, ice the area for up to 20 minutes every two hours for the first 48 hours. After that, use heat to soothe sore back muscles (either an electric heating pad or moist heat like a steamed towel).

- Core-strengthening exercises to provide more spine stability.

- Aerobic exercise. Focus on swimming, stationary cycling, or brisk walking. None of these put extra stress on your back.

- Lift correctly. Squat to lift a heavy object. Don't bend and lift. Stand on a stool to reach things above shoulder level.

- Maintain good posture. When you stand, keep one foot forward and your knees slightly bent to take pressure off of your back. Sit with your hips slightly higher than your knees.

- Stop smoking. It's been linked to back pain, including degenerative disc disorders.

- Stay at a healthy weight. If you are overweight, especially around your abdomen, it can put strain on your back.

- Sleep on your side with a pillow between your knees to reduce pressure on your back. If you're a back sleeper, keep in mind that this position puts pressure on your spine. Reduce it by placing a couple of pillows underneath your knees.

Exercises for Back Pain 

One of the best ways to treat back pain with breathing is through stretching and strengthening exercises, says Dr. Goostree. "You want to make sure your back and core muscles are as fit and supple as possible," he explains. Here are a few gentle exercises from Hinge Health that are commonly used to prevent and treat back pain.

PT Tip: Mind Your Stress

“I’ve seen thousands of folks who, when they’re stressed, tense up all their spine muscles, including their diaphragm and secondary neck muscles,” says Dr. Goostree. “This can lead to pain with breathing.” Research supports this: Severe stress has been associated with nearly a three-fold increase in risk of chronic low back pain, according to a 2021 study published in the medical journal ScientificReports. If this kind of back pain is a problem for you, consider stress management techniques like mindfulness meditation or a form of talk therapy known as cognitive behavior therapy (CBT). Both have been shown to improve back function and pain, according to a 2016 study in the Journal of the American Medical Association (JAMA).

Learn More About Hinge Health for Back Pain Relief

Our digital programs for back and joint pain are offered for free through benefit providers. Click here to see if you’re eligible. This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Palsson, T. S., Travers, M. J., Rafn, T., Ingemann-Molden, S., Caneiro, J. P., & Christensen, S. W. (2019). The use of posture-correcting shirts for managing musculoskeletal pain is not supported by current evidence – a scoping review of the literature. Scandinavian Journal of Pain, 0(0). doi:10.1515/sjpain-2019-0005

2. Scoliosis - Symptoms and causes. (2022, May 4). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716

3. Kyphosis - Symptoms and causes. (2022, June 18). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/kyphosis/symptoms-causes/syc-20374205

4. Wheeler, S. G., Wipf, J. E., Staiger, T. O., Deyo, R. A., & Jarvik, J. G. (2022, May 26). Evaluation of low back pain in adults. UpToDate. Retrieved from https://www.uptodate.com/contents/evaluation-of-low-back-pain-in-adults

5. Low Back Strain and Sprain – Symptoms, Diagnosis and Treatments. (n.d.). American Academy of Neurologic Surgeons. Retrieved from https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Low-Back-Strain-and-Sprain