A pulled back muscle causing pain when swallowing (odynophagia) is an unusual combination of symptoms that raises concern. While a direct connection between an injured muscle in the upper back and throat pain is highly unlikely, an indirect link is possible due to the body’s interconnected systems. Understanding the anatomy, referred pain, and common causes of painful swallowing helps clarify this complex presentation. The experience is often related to the proximity of spinal nerves and the mechanics of the throat, rather than the back injury directly affecting the esophagus.
Anatomical Proximity of the Upper Back and Esophagus
The esophagus, the muscular tube that transports food from the throat to the stomach, is situated directly in front of the spinal column throughout the neck and chest. Specifically, the cervical segment of the esophagus lies just behind the trachea and is connected to the bodies of the sixth through eighth cervical vertebrae by prevertebral fascia, establishing a close physical relationship with the neck and upper back structures.
The throat and upper back also share sensory nerve pathways running through the spinal cord. The esophagus is innervated by both the vagus nerve and spinal nerves, with the spinal afferents projecting to the dorsal root ganglia from the upper cervical (C1) down to the upper lumbar (L2) segments of the spine. This shared neurological wiring allows signals from internal organs, such as the esophagus, and external structures, such as back muscles, to converge in the spinal cord.
This convergence of nerve signals explains why pain from one area can potentially be perceived in another. The proximity of the esophagus to the cervical and thoracic vertebrae means that any severe musculoskeletal issue, such as a strain or spasm, occurs in a very crowded anatomical space. The deep neck flexors and extensors, which stabilize the cervical spine and are often strained alongside upper back muscles, work in conjunction with muscles involved in the complex act of swallowing.
How Muscular Strain Can Indirectly Affect Swallowing
A pulled back muscle in the upper thoracic or cervical area can indirectly lead to swallowing discomfort through two main mechanisms: referred pain and mechanical tension. Referred pain occurs when the brain misinterprets a pain signal originating from an injured muscle as coming from a different location, such as the throat or chest. For instance, a painful muscle spasm in the upper back or between the shoulder blades, like the trapezius or rhomboids, may be felt along the chest wall because the nerves serving both areas enter the same segment of the spinal cord.
While the pain from a pulled back muscle is typically felt in the back, the shared neural pathways between the muscles and the esophagus can cause the perceived sensation to radiate forward into the throat or chest. This phenomenon can result in a sensation of pain or tightness when swallowing, which is not due to a physical injury to the esophagus itself, but rather a crossed signal in the central nervous system.
Severe upper back or neck muscle spasms can also alter posture and create excessive tension in accessory swallowing muscles, such as the scalenes or sternocleidomastoid. When these muscles are held in a state of hyper-contraction to protect the strained back area, they can mechanically impede the normal movement of the larynx and hyoid bone, which are necessary for the smooth and coordinated process of swallowing. The resulting discomfort is often described as a feeling of a lump in the throat, known as globus sensation, or actual difficulty and pain during the passage of food. A more direct cause of swallowing issues is a spinal problem, such as a herniated disc in the cervical spine, which can directly impinge on nerves that control swallowing function.
Common Non-Musculoskeletal Causes of Swallowing Pain
While a musculoskeletal issue can cause referred pain, it is important to consider that the back pain and swallowing pain may be two separate, coincidental issues. Painful swallowing, or odynophagia, is a common symptom with many causes originating within the throat or digestive tract.
Infections are frequent culprits, including common illnesses like the cold, flu, or sinus infections, which cause a sore throat and irritation. Bacterial infections such as Strep throat or viral infections like Mononucleosis commonly present with a severe sore throat that makes swallowing painful. Inflammation of the tonsils, known as tonsillitis, is another localized infection causing painful swallowing, often accompanied by fever and swollen lymph nodes in the neck.
Conditions related to the digestive system, particularly the reflux of stomach contents, are also common causes of throat and swallowing pain. Gastroesophageal Reflux Disease (GERD) involves stomach acid backing up into the esophagus. This acid can erode the lining and cause inflammation called esophagitis, leading to a burning or squeezing pain when swallowing. Chronic irritation from allergies or post-nasal drip can similarly irritate the throat lining, contributing to discomfort during swallowing.
When to Seek Medical Attention
When experiencing both back pain and painful swallowing, seeking medical attention is the safest course of action to ensure an accurate diagnosis. You should consult a healthcare provider if the painful swallowing lasts longer than a couple of weeks, or if it is accompanied by other concerning symptoms.
Certain warning signs indicate the need for immediate medical evaluation, as they may suggest a serious underlying condition. These signs require prompt attention:
- An inability to swallow liquids or solids (dysphagia).
- Chest pain or pressure, shortness of breath, a high fever, or chills.
- Unexplained weight loss.
- Vomiting blood, or having black or tarry stools.
If the back pain itself becomes constant, moves down the legs, or is associated with weakness or numbness in the limbs, a physician should be consulted to rule out a more serious spinal or neurological issue.