The sensation of pain in the upper back that intensifies with the simple act of inhaling or exhaling can be deeply unsettling. This discomfort often localizes in the thoracic spine region, which runs from the base of the neck down to the bottom of the rib cage. Because breathing is an automatic and fundamental process, any pain associated with it naturally raises concerns about the lungs or heart. This article will explore the wide range of possibilities behind this symptom, from common muscle strains to more serious internal conditions that warrant medical attention.
Common Musculoskeletal Causes
Pain in the upper back during breathing often originates from the surrounding muscles, bones, and joints rather than internal organs. This area is susceptible to strain because it supports the neck and head while anchoring the ribs. The muscles between the shoulder blades, such as the rhomboids and trapezius, are frequently involved in this type of pain.
Muscle strain often results from poor posture, especially prolonged periods of slouching or working at a desk with a forward head position. Repetitive motions, heavy lifting, or even sleeping in an awkward position can cause microscopic tears in the muscle fibers. When these strained muscles contract or stretch during a deep breath, they produce a sudden, sharp, or aching sensation.
Another common source of mechanically induced pain is dysfunction in the costovertebral or costotransverse joints. These small joints are where the ribs connect to the vertebrae of the spine. When these joints become inflamed or slightly misaligned, the normal expansion of the rib cage during inhalation can cause significant irritation.
This rib joint dysfunction typically presents as a sharp, localized pain that worsens with deep breathing, coughing, or twisting movements of the torso. The pain can feel like a deep ache situated just to one side of the spine between the shoulder blades. Unlike a lung issue, this type of pain is usually consistently reproducible with specific movements of the upper body.
When Pain Signals Internal Issues
While musculoskeletal problems are common, pain in the upper back during breathing can also signal that an internal system is being affected. These causes involve the lungs, spine, or even distant organs, and they require a medical diagnosis. The distinction between a muscle issue and an internal problem is often based on accompanying symptoms and the quality of the pain.
Pulmonary Concerns
One recognized internal cause is pleurisy, which is inflammation of the pleura—the thin layers of tissue surrounding the lungs and lining the chest cavity. Normally, fluid allows these layers to glide smoothly past one another during respiration. When inflamed, the layers rub together, causing a sharp, stabbing pain that radiates to the back or shoulder, especially upon deep inhalation or coughing.
Pleurisy is frequently caused by infections, such as viral illnesses or bacterial infections like pneumonia. In pneumonia, the air sacs in the lungs fill with fluid, and the resulting inflammation and persistent cough can strain surrounding tissues and irritate the pleura. A pulmonary embolism (PE), a blood clot lodged in the lung arteries, is a less common but critical pulmonary cause. A PE causes pain because it blocks blood flow, leading to tissue distress and pressure buildup, and it is usually accompanied by sudden, severe shortness of breath.
Spinal Nerve Issues
The thoracic spine houses the nerves that branch out to the rib cage and chest wall. A herniated or bulging thoracic disc, while less common than in the neck or lower back, can compress these spinal nerves. This nerve compression can cause a deep, persistent ache or sharp pain that wraps around the chest wall or intensifies with movement, including the slight movement involved in breathing. This nerve-related pain, known as radiculopathy, can also present as numbness, tingling, or weakness in the upper back or chest area.
Referred Pain
Referred pain occurs when the brain interprets pain signals from an internal organ as originating from a distant, often musculoskeletal, location. Conditions affecting the abdomen, such as gallbladder disease, can sometimes refer pain to the area between the shoulder blades. Similarly, a heart attack can occasionally present with back pain, especially in women, rather than the typical chest pressure, due to the shared nerve pathways between the heart and the upper back.
Urgent Warning Signs Requiring Immediate Care
Certain combinations of symptoms signal a medical emergency that requires immediate attention. If the pain in your upper back when breathing is accompanied by severe or sudden symptoms, seek emergency medical care immediately.
The most concerning “red flag” symptoms include a sudden, crushing chest pain or pressure that radiates to the jaw, arm, or shoulder. A high fever, chills, or night sweats accompanying the back pain and breathing difficulty may indicate a severe infection like pneumonia.
Any instance of coughing up blood, even small flecks, requires immediate medical evaluation. Severe difficulty breathing, feeling breathless at rest, or a bluish tint to the lips or nails (cyanosis) indicate a lack of sufficient oxygen and are emergency signs.
Initial Steps for Temporary Relief
If the pain is mild, has a clear mechanical cause, and none of the urgent warning signs are present, initial steps can be taken for temporary comfort. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce localized pain and inflammation in strained muscles or irritated joints.
Applying a heating pad to the affected area for 15 to 20 minutes can help relax tight muscles and ease spasms, while an ice pack may be useful to reduce acute inflammation from a recent strain. Gentle movement, such as slow and controlled thoracic rotation stretches or cat-cow poses, may help mobilize stiff spinal joints and reduce muscle tension.
Focusing on diaphragmatic breathing, where the abdomen rises and falls rather than the chest, can temporarily reduce the movement of the upper rib cage and accessory breathing muscles. This technique can lessen the strain on the injured muscles or joints during respiration, providing a brief period of relief. These strategies offer temporary comfort and are not a substitute for a professional diagnosis.