Back pain correlated with the act of breathing is often referred to as pleuritic or mechanical chest wall pain. This pain signals irritation or strain in the structures involved in respiration, including muscles, bones, nerves, and organs within the thoracic region. While many causes are benign musculoskeletal issues, this symptom can also indicate a serious condition affecting the lungs or spine. This overview explores the most common and the most serious reasons why your back might hurt every time you take a breath.
Muscular and Skeletal Sources of Pain
The most frequent causes of back pain with breathing originate in the mechanical structures of the chest wall and rib cage. The thoracic cage is highly mobile, relying on muscles and joints to expand and contract with every breath, so any irritation is immediately felt upon inhalation or exhalation.
A common culprit is intercostal muscle strain, affecting the muscles that run between the ribs. These muscles lift and lower the rib cage, and forceful movements like a sudden twist, heavy lifting, or a violent cough can overstretch or tear them. This strain results in a sharp, localized, or stabbing pain that is worsened by taking a deep breath, coughing, or sneezing. The pain is typically felt directly over the affected rib area, sometimes radiating into the back.
Another source of mechanical pain is rib subluxation or rib dysfunction. This occurs when the head of a rib slightly shifts out of its normal position where it connects to the thoracic vertebrae. When the rib is misaligned, it can irritate nearby nerves and restrict the smooth movement of the rib during respiration. This dysfunction causes sharp, sometimes constant, back pain that feels worse with deep inhalation.
Inflammation of the cartilage that joins the ribs to the breastbone, called costochondritis, can also refer pain to the back. Although the inflammation is located at the front of the chest, the pain can radiate to the back or shoulder due to the interconnected nature of the rib cage. The discomfort is described as a sharp ache that increases with a deep breath because the inflamed cartilage is stretched. This condition is usually not serious but can mimic urgent cardiac or pulmonary issues.
Conditions Affecting the Lungs
When back pain accompanies breathing, it may signal an issue with the lungs or the surrounding protective membranes. Pain from lung-related issues is often described as “pleuritic” because it involves the pleura, the two thin layers of tissue that surround the lungs and line the inner chest wall. Normally, these layers glide smoothly over one another as you breathe.
Pleurisy involves inflammation of these pleural layers, causing them to rub against each other, which generates a sharp, stabbing pain. This pain is most noticeable upon deep inhalation, coughing, or sneezing, and can spread to the shoulder or back. Pleurisy is often a complication of an underlying condition like pneumonia, a viral infection, or a bacterial infection.
A pneumothorax, or collapsed lung, occurs when air leaks into the pleural space, causing pressure that can collapse the lung fully or partially. This condition causes sudden, sharp chest pain that worsens with deep breathing and often radiates to the back or shoulder. The pain is usually accompanied by a sudden onset of shortness of breath, which requires immediate attention.
A pulmonary embolism (PE), a blockage in one of the pulmonary arteries in the lungs, is a cause of pain with breathing. A PE often causes sharp chest or upper back pain that worsens with deep breathing, due to irritation of the pleura or tissue damage. This pain is usually sudden and is accompanied by other severe symptoms like unexplained shortness of breath, a rapid heart rate, or coughing, sometimes with blood.
Spinal and Neurological Causes
The thoracic spine, located in the middle of the back, provides attachment points for the ribs and houses the spinal cord and nerves. Issues originating here can cause pain that wraps around the torso or is felt intensely in the back upon breathing.
Costovertebral joint dysfunction refers to the irritation or slight misalignment of the joints where the ribs meet the vertebrae. Since these joints must move with every breath, any stiffness or inflammation causes a dull ache or sharp pain in the mid-back that is exacerbated by deep breathing or trunk rotation. The discomfort is felt near the shoulder blade and on one side of the spine.
A thoracic herniated disc is a less common spinal issue where the soft center of a disc pushes out and compresses a spinal nerve or the spinal cord. This compression causes radiating pain, known as radiculopathy, which travels along the nerve’s path, often wrapping around the chest wall from the back. The mechanical movement of the spine and ribs during breathing can intensify this pain.
Intercostal neuralgia involves pain along the path of the intercostal nerves, which run between the ribs. This neuropathic pain can be constant or intermittent, manifesting as a sharp, burning, or aching sensation in the ribs or back. Since the nerves are located along the rib cage, their irritation is often worsened by any movement that stretches or compresses the chest wall, including the simple act of breathing.
When to Seek Immediate Medical Help
While many instances of back pain with breathing are due to minor muscle or joint issues, certain signs indicate a potential medical emergency. Seek immediate emergency medical attention if the pain is sudden and severe.
Back pain with breathing accompanied by severe shortness of breath, chest pressure, or tightness should prompt an emergency room visit. Other severe symptoms include:
- A rapid or irregular heartbeat, dizziness, lightheadedness, or fainting.
- A high fever or chills.
- Coughing up blood.
- Signs of a blood clot in the leg, such as swelling, warmth, or redness.
Never attempt to self-diagnose severe or rapidly worsening chest pain; prompt medical evaluation is necessary to rule out life-threatening conditions like a pulmonary embolism or heart attack.