A sudden, sharp pain in the middle back caused by a simple cough can be alarming. Although coughing is a respiratory reflex, it is a forceful, whole-body action that creates significant mechanical stress on the trunk. This sudden burst of air involves a rapid contraction of the diaphragm and core muscles, generating a spike in both intra-abdominal and intrathoracic pressure. This pressure increase transmits force directly to the spinal column and surrounding soft tissues in the thoracic area, often highlighting a pre-existing vulnerability.
Understanding Musculoskeletal Strain
The most frequent cause of middle back pain from coughing is an acute strain of the surrounding muscles and ligaments. A severe or prolonged coughing fit creates a repetitive motion that can overstretch the paraspinal muscles running alongside the spine. This overuse leads to microscopic tears and inflammation, resulting in pain described as a dull ache or a sharp spasm when the action is repeated.
The smaller intercostal muscles, located between the ribs, are especially vulnerable because they are directly involved in the forced exhalation of a cough. When these muscles are strained, the pain is sharp and localized, and it intensifies with deep breaths, sneezing, or further coughing. Pre-existing poor posture can contribute by keeping the thoracic muscles in a weakened or tense state, making them more susceptible to injury from the sudden force.
Another mechanical cause involves the rib joints, where the ribs connect to the thoracic spine vertebrae. A forceful cough can sometimes cause a minor misalignment of these costovertebral joints, known as rib subluxation. This subtle shift can irritate the joint capsule and nearby nerves, causing a distinct, sharp pain exacerbated by the mechanical movement of the chest wall during a cough.
Pain Originating from Spinal Structures
Pain aggravated by coughing can signal a deeper problem involving the structures of the spinal column. The sudden increase in intra-abdominal pressure acts like an internal piston, pushing outward against the abdominal contents and stressing the spinal column. This pressure can exacerbate damage to the spinal discs and joints.
A thoracic disc herniation, though less common than in the lower back, can be intensely painful when aggravated by a cough. The increased pressure pushes the disc’s inner material further into the outer layer, potentially compressing a nearby spinal nerve root. This nerve irritation, known as radiculopathy, causes a sharp, shooting pain that radiates along the affected nerve’s path.
Other structural issues, such as facet joint arthritis or degenerative disc disease, are also susceptible to this pressure spike. The loss of cushioning and smooth joint surfaces means that the increased force from a cough causes painful friction or compression within the joint. In older individuals, a forceful cough can, in rare cases, cause a vertebral compression fracture if osteoporosis has weakened the thoracic vertebrae.
Causes Stemming from Internal Organs and Illness
Sometimes, the pain felt in the middle back when coughing is referred pain from internal organs or a sign of a systemic illness. This occurs because the nerves supplying the internal organs share pathways with the nerves supplying the back muscles and skin. A common example is pleurisy, which is inflammation of the pleura, the lining surrounding the lungs.
When the pleura becomes inflamed, the expansion and contraction of the lungs during a cough causes the two layers of the lining to rub painfully against each other. This sharp, stabbing pain is often referred to the mid-back area. Respiratory infections like pneumonia or severe bronchitis can lead to persistent, deep coughing, resulting in inflammation and secondary back discomfort.
Infections or issues in the kidneys can also manifest as pain in the flank and mid-back area, and the jarring motion of a cough can increase this discomfort. Conditions such as a kidney infection or kidney stones may cause pain that is felt in the back and is sensitive to movement. Because the kidneys are positioned deep in the abdomen, the pressure changes from coughing can temporarily intensify the visceral pain they produce.
Identifying Warning Signs and Seeking Care
While most back pain from coughing is due to temporary muscle strain, certain accompanying symptoms should prompt immediate medical evaluation. Fever, chills, or shortness of breath coupled with back pain may indicate a serious underlying infection like pneumonia or a kidney issue. Pain accompanied by sudden weakness, numbness, or tingling in the legs suggests potential nerve compression.
Other warning signs include unexplained weight loss, constant pain that does not improve with rest, or difficulty controlling bladder or bowel function. For mild muscle strain, initial self-care involves gentle rest, applying ice or heat, and using over-the-counter anti-inflammatory medications. However, because the cause can range from a simple muscle pull to a structural or systemic problem, an accurate diagnosis requires a medical professional.