Experiencing pain in the middle of your back when breathing can be concerning. This sensation is common and stems from various causes. These range from minor issues like muscle strain to more complex conditions. Understanding these origins can help individuals navigate their symptoms.
Musculoskeletal Explanations
Muscle strain is a frequent cause of middle back pain exacerbated by breathing. Breathing engages back, rib, and abdominal muscles, which can be overworked or injured from activities like heavy lifting, falls, or intense coughing. When these muscles are strained, a deep breath or twisting motion can cause sharp discomfort or aching. Poor posture can also contribute by putting pressure on the spine and its supporting muscles, restricting rib cage movement and making breathing painful.
Rib joint dysfunction can also lead to pain in the middle back with breathing. This involves mechanical problems affecting the costovertebral or costotransverse joints, where ribs connect to the thoracic spine. When these joints become irritated or misaligned, the smooth gliding motion is disrupted, resulting in sharp or stabbing pain that worsens with movement and breathing. This pain is often localized to the affected rib and can be accompanied by muscle spasms and tenderness.
Facet joint irritation is another musculoskeletal explanation. Facet joints are the connections between spinal bones, and inflammation in these joints can cause sharp, localized pain in the mid-back. This discomfort may intensify with deep breaths, coughing, sneezing, or bending to one side. The pain often feels worse after periods of inactivity, such as upon waking, but may lessen with activity throughout the day.
Respiratory and Other Medical Conditions
Beyond musculoskeletal issues, middle back pain with breathing can signal other medical conditions, including respiratory problems. Pleurisy, an inflammation of the pleura (the tissue layers separating lungs from the chest wall), is a notable cause. When inflamed, these layers rub against each other with each breath, leading to sharp chest pain that can radiate to the back and worsen with deep inhalation, coughing, or sneezing.
Pneumonia, an infection that inflames the air sacs in one or both lungs, can also cause back pain alongside symptoms like cough, fever, and difficulty breathing. Similarly, bronchitis, an inflammation of the bronchial tubes, may lead to persistent coughing that strains back muscles and causes referred pain to the middle back. While less common, severe asthma exacerbations can cause significant respiratory effort, leading to muscle fatigue and pain in the back.
Gastrointestinal issues can also cause referred pain in the middle back, sometimes influenced by breathing. Conditions like gastroesophageal reflux disease (GERD), stomach ulcers, or gallstones can cause pain in the upper abdomen that radiates to the back. The diaphragm’s movement during deep breaths can sometimes trigger or worsen this referred pain, making it feel connected to the act of breathing.
Cardiovascular Conditions
Certain cardiovascular conditions, though less common for isolated mid-back pain with breathing, warrant consideration. Angina, a type of chest pain caused by reduced blood flow to the heart, can sometimes radiate to the back, arms, or jaw. Aortic dissection, a serious condition involving a tear in the body’s main artery, typically presents with sudden, severe chest or back pain. These conditions usually involve additional, more prominent symptoms like chest tightness, shortness of breath, or dizziness.
Other Causes
Other less common causes of referred back pain include kidney stones, which can cause severe pain that radiates from the flank to the back. Shingles, a viral infection, can cause a painful rash along nerve pathways, sometimes affecting the back and intensifying with movement or pressure.
When to Seek Medical Attention
While many instances of middle back pain with breathing are benign, some symptoms warrant immediate medical evaluation. Seek prompt medical attention if the pain is severe, rapidly worsening, or accompanied by other alarming signs. This is particularly true if the pain is sudden and intense, especially if it spreads to your arms, neck, or jaw, or is accompanied by a feeling of tightness or heaviness in the chest.
Additional “red flag” symptoms include shortness of breath, significant difficulty breathing, dizziness, or fainting. Consult a healthcare provider if you experience a high fever, chills, a persistent cough producing phlegm, or signs of infection like redness or swelling around your ribs. Numbness, tingling, or weakness in the limbs, unexplained weight loss, or pain following trauma or injury should also prompt a medical visit. Any back pain that does not improve with rest or basic home care after a few days to a week should be assessed by a doctor to rule out more serious underlying conditions.
Home Management Strategies
For mild to moderate middle back pain with breathing, and without “red flag” symptoms, several home management strategies can offer relief. Rest is often beneficial, meaning avoiding aggravating activities to allow muscles and joints to recover. Modifying daily movements to minimize strain on the back and rib cage can also be helpful.
Applying heat or cold therapy to the affected area can reduce discomfort. For acute pain or recent injuries, ice packs applied for 15-20 minutes every few hours for the first 48 hours can help reduce inflammation. After this initial period, or for more chronic aching, moist heat from a heating pad or warm bath can soothe tight muscles. Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, or acetaminophen, can also help manage pain and inflammation. Always follow dosage instructions and consider potential interactions with other medications or health conditions.
Gentle stretching and exercises focused on posture correction can support recovery and prevent recurrence. Simple stretches that involve the upper back and rib cage, such as a “dynamic hug” or thoracic side bends, can help restore flexibility and improve rib mobility. Practicing diaphragmatic breathing, where the focus is on deep breaths that expand the abdomen rather than just the chest, can also promote more efficient and less painful respiration. Using supportive pillows during sleep, particularly those that maintain spinal alignment, can reduce pressure on the back and contribute to better rest.