Upper back pain when coughing is a common symptom. While often not indicative of a serious underlying condition, it typically arises from the forceful movements of coughing, which can strain various structures in the upper back and chest. Understanding the potential reasons can help individuals manage their symptoms and know when to seek medical advice.
Understanding the Causes
Upper back pain during coughing can stem from several sources. Muscle strain, particularly affecting the intercostal muscles between the ribs or larger upper back muscles like the rhomboids or trapezius, is a frequent cause. Forceful coughing can overwork these muscles, leading to micro-tears, inflammation, and pain that intensifies with each cough.
Another common culprit is costochondritis, an inflammation of the cartilage connecting the ribs to the breastbone. This condition typically causes chest pain that can radiate to the back, often exacerbated by deep breaths, sneezing, or coughing. Physical strain, including severe coughing, is a potential trigger. Similarly, a rib subluxation, where a rib slightly shifts from its normal alignment, can cause sharp back or chest pain that worsens with coughing. Violent coughing can misalign ribs, irritating surrounding muscles, ligaments, or nerves.
More serious causes include respiratory infections such as bronchitis or pneumonia, which can inflame the lungs or their lining, referring pain to the back during coughing. Bronchitis often causes a persistent cough, chest soreness, and body aches, including back pain. Pneumonia-related back pain is often a dull ache or sharp stabbing sensation in the middle or upper back, worsening with movement or deep breathing due to inflamed lung tissue.
Rarely, issues with thoracic (upper and middle back) spinal discs can be involved. A thoracic disc herniation, where disc material protrudes, can compress nearby nerves and cause localized upper back pain that may intensify with coughing. This condition is less frequent in the thoracic spine compared to the neck or lower back. Compression fractures, often linked to osteoporosis or trauma, can also cause severe, localized back pain aggravated by coughing.
How Coughing Aggravates Back Pain
Coughing is a powerful reflex involving complex muscle coordination and creating significant internal pressure. When coughing, muscles in the diaphragm, abdomen, and intercostal muscles contract forcefully. This expels air rapidly from the lungs. Rapid muscle contractions and increased intra-abdominal/intrathoracic pressure stress the spine, ribs, and supporting ligaments and muscles.
This force, while essential for clearing airways, can worsen existing conditions or create new discomfort. If upper back muscles, ligaments, or joints are already inflamed, strained, or misaligned, coughing’s added pressure can intensify pain. The sudden jarring motion can further irritate compromised nerves or tissues, sharply increasing pain. Even without an underlying condition, repeated severe coughing can cause muscle fatigue and soreness.
Strategies for Home Relief
Managing upper back pain from coughing often involves rest and targeted home care strategies. Resting affected muscles and tissues, and avoiding pain-worsening activities, is beneficial. Over-the-counter NSAIDs like ibuprofen or naproxen can reduce pain and inflammation. Acetaminophen can also provide pain relief. Topical pain creams may also provide localized comfort.
Applying heat or cold therapy can soothe discomfort; ice packs are generally recommended for initial inflammation to reduce swelling. After this, or for muscle relaxation, a heat pack or warm bath can be beneficial. For coughing-related pain, adopting a proper technique, like hugging a pillow against the chest and upper back, can provide support and reduce strain. Staying hydrated and using a humidifier can thin mucus, potentially reducing cough intensity and frequency. Avoiding irritants like smoke that trigger or worsen a cough is also advised.
When Professional Medical Help is Needed
While most cases of upper back pain with coughing resolve with home care, certain symptoms indicate a need for medical evaluation. Persistent or worsening pain not improving after a few days of home treatment should be assessed. Severe, debilitating pain interfering with daily activities also warrants medical attention.
Accompanying symptoms are important. If back pain is accompanied by fever, chills, shortness of breath, wheezing, or a persistent cough with colored phlegm, it could suggest a respiratory infection requiring diagnosis and treatment. Neurological symptoms like numbness, tingling, or weakness in the arms or legs, or loss of bladder/bowel control, are serious “red flags” requiring immediate medical attention, as they may signal nerve compression or urgent spinal issues. Unexplained weight loss or a history of trauma (e.g., a fall) alongside back pain should also prompt a doctor’s visit. Individuals with underlying health conditions like osteoporosis, cancer, or a weakened immune system should seek medical advice for back pain with coughing to rule out more serious causes.