Upper back pain that intensifies with breathing is a frequently reported symptom of COVID-19. This experience can be unsettling, as it suggests a problem with the respiratory system, the primary target of the SARS-CoV-2 virus. The discomfort is often a complex interplay of inflammation, muscle strain, and postural changes, rather than a sign of severe lung damage. Understanding the cause involves examining how the viral infection affects the chest wall and surrounding structures.
The Link Between COVID-19 and Respiratory Pain
The SARS-CoV-2 infection triggers a systemic inflammatory response as the immune system fights the virus. This widespread inflammation, driven by signaling proteins called cytokines, causes general muscle aches and body pains, known as myalgia. These aches often manifest in the back and joints, similar to other viral illnesses.
The lungs themselves contain very few nerve endings capable of sensing pain. However, the tissue layers and muscles surrounding the lungs and chest cavity are highly sensitive. The inflammatory process triggered by COVID-19 can irritate these nearby structures, causing pain perceived as radiating into the upper back.
When the virus infects the respiratory tract, it causes irritation and inflammation that affects the mechanics of breathing. This irritation strains the chest wall and the associated muscles necessary for inhalation and exhalation. The resulting discomfort is often tied directly to the act of breathing, coughing, or sneezing.
Specific Mechanisms Causing Upper Back Pain
One distinct mechanism for upper back pain when breathing is pleurisy, or inflammation of the lung lining (the pleura). The pleura consists of two layers of tissue with fluid between them to allow smooth movement. When inflammation occurs, the layers rub against each other, creating a sharp, stabbing pain. This pain is localized, dramatically worsened by deep breaths or coughing, and often felt in the corresponding area of the upper back.
A more common cause is musculoskeletal strain resulting from persistent, forceful coughing. Coughing requires the rapid and intense contraction of the abdominal, intercostal, and thoracic muscles. Sustained bouts of coughing lead to fatigue and micro-trauma in these muscles, which radiates pain to the upper back and between the shoulder blades. The overuse of accessory muscles, such as those in the neck, to assist with labored breathing also contributes to this tension.
Illness-related positional strain can also compound the discomfort. People with COVID-19 often spend extended periods resting in restrictive or hunched positions. This reduced mobility and prolonged poor posture can worsen existing muscular tension, leading to spasms and upper back pain. Furthermore, the fatigue and weakness accompanying the infection compromise spinal stability, making muscles more susceptible to pain from normal breathing movements.
Distinguishing Serious Symptoms from Mild Discomfort
While upper back pain with breathing is often musculoskeletal or inflammatory, it can also signal a more serious complication. It is important to watch for specific “red flag” symptoms suggesting significant respiratory compromise or systemic emergency. A sudden onset of sharp, localized chest or back pain, especially coupled with severe shortness of breath, requires immediate medical attention.
Other signs of a potentially severe condition, such as pneumonia or a pulmonary embolism, include a persistent feeling of pressure or crushing pain in the chest, not just a muscular ache. Emergency indicators reflect a dangerous drop in oxygen levels and should prompt an emergency call. These symptoms include new confusion, the inability to wake up or stay awake, or a change in skin color where the lips, face, or nail beds appear pale, gray, or blue.
A general back ache or muscle soreness that is mild-to-moderate and feels like a cramp or spasm is less concerning. If the pain is the primary symptom and lacks severe breathing difficulty or emergency warning signs, it is likely related to virus-induced myalgia or muscle strain from coughing. However, any persistent or worsening pain lasting more than a few weeks should be evaluated by a healthcare professional.
Strategies for Symptom Relief and Management
Managing upper back pain associated with COVID-19 involves at-home remedies aimed at reducing inflammation and muscle tension. Over-the-counter pain relievers, such as acetaminophen or NSAIDs like ibuprofen, can help alleviate both general body aches and localized pain. These medications target the inflammatory pathways that contribute to the discomfort.
Gentle movement and strategic positioning are beneficial for relieving muscle-related pain. Applying a heating pad to the affected area helps relax strained muscles and increase blood flow, while cold compresses reduce local inflammation. When resting, lying on your side with a pillow between your knees or adopting an upright posture helps take pressure off the thoracic spine and respiratory muscles.
Controlled breathing techniques can also minimize strain on the chest wall and improve lung function. Practicing diaphragmatic breathing, where the abdomen expands on inhalation rather than the chest, reduces the overuse of accessory muscles that contribute to upper back pain. Simple, gentle stretching of the shoulders and upper back helps maintain flexibility and release tension built up from coughing or prolonged rest.