Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung condition that restricts airflow, making breathing increasingly difficult over time. While the primary symptoms involve the respiratory system, back pain is a frequently reported physical complaint for those living with the disease. This pain is not merely a coincidence of aging; it is a direct consequence of the body adapting to the chronic struggle for air. The structural changes in the chest and the physical effort required to breathe and cough create a significant strain on the musculoskeletal system.
Structural Changes from Altered Breathing Mechanics
The chronic hyperinflation of the lungs, a hallmark of COPD, causes a significant change in the body’s mechanics, beginning with the diaphragm. In a healthy state, the diaphragm is dome-shaped, but trapped air pushes it downward, leading to a flattened and weakened position. This severely reduces its ability to contract effectively, forcing the body to rely heavily on muscles not designed for continuous respiration.
The accessory muscles of breathing, primarily located in the neck, shoulders, and upper chest, must constantly work overtime to lift the rib cage and facilitate inhalation. This chronic overuse of muscles like the scalenes and sternocleidomastoid creates persistent tension. This leads to myofascial pain that radiates into the upper and mid-back, often felt as a deep, persistent ache.
The change in lung volume also alters the shape of the thoracic cage, causing the ribs to become elevated and relatively fixed in an expanded position. This stiffness reduces the mobility of the costovertebral joints, where the ribs meet the vertebrae in the mid-back. The resulting lack of flexibility in the thoracic spine contributes to mid-back discomfort and limits the range of motion.
Many people with COPD instinctively adopt a forward-leaning or “tripod” posture to optimize the function of their accessory muscles. This compensatory posture can lead to an exaggerated rounding of the upper back, known as increased thoracic kyphosis. This postural change shifts the mechanical load onto the spine, placing excessive stress on the vertebrae and supporting ligaments of the upper and lower back.
Back Strain from Chronic Symptoms
Separate from the structural changes, the day-to-day symptoms of COPD impose acute strain on the back muscles. A chronic cough is a common symptom, and the forceful, repeated expulsion of air generates immense pressure within the chest and abdomen. Each bout of coughing causes a sudden, intense contraction of the abdominal and back muscles, which can lead to painful muscle strains, spasms, or minor muscular tears.
The physical force of a prolonged coughing fit can strain the attachments of the ribs to the spine, aggravating the already stiff costovertebral joints and causing sharp, localized pain. This repetitive action makes the back muscles sore and tender, compounding the chronic tension from altered breathing.
The increased energy expenditure required for breathing, combined with the avoidance of physical activity due to breathlessness, often leads to generalized muscle deconditioning. This reduction in muscle mass and strength, medically termed sarcopenia, leaves the spinal column with less muscular support and stability. A weakened core and back musculature are more susceptible to injury and fatigue, making even simple tasks or prolonged sitting a source of back pain.
Managing Pain Related to COPD
Effective management of back pain associated with COPD requires a coordinated approach addressing both the underlying lung condition and the resulting musculoskeletal strain. Pulmonary Rehabilitation (PR) is a comprehensive program highly effective for this purpose, combining tailored exercise, education, and breathing retraining. PR includes physical therapy that focuses on strengthening the core and postural muscles to counteract the effects of kyphosis and accessory muscle overuse.
Specific exercises can gently stretch tight accessory muscles, such as the upper trapezius and pectoralis major, which often pull the shoulders forward and increase upper back tension. Learning techniques like diaphragmatic breathing and pursed-lip breathing can improve respiratory efficiency. This reduces the burden on the neck and shoulder muscles, helping lessen the mechanical stress that causes back pain.
For managing the strain from coughing, bracing or splinting the abdomen can be helpful. This involves pressing a pillow or using the hands against the stomach during a cough to stabilize the core and reduce the forceful impact on the back muscles. Additionally, utilizing heat or cold therapy, such as a heating pad, can provide non-pharmacological relief for localized muscle soreness and spasms.
Proper sleeping posture, often involving positioning the head slightly propped up, can alleviate strain on the diaphragm and accessory muscles, promoting better rest. It is important to communicate any new or worsening back pain to the healthcare team, which may include a pulmonologist and a physical therapist, to ensure interventions align with the overall respiratory treatment plan.