Back Pain When Breathing: 12 Possible Causes

According to the Australian Institute of Health and Welfare 1 in 6 Australians experience back pain every year.[1] Additionally, 181,000 Australians are hospitalised with back pain yearly. Each condition will have a different type of trigger. For some, just breathing can lead to further back pain.

Back pain describes any discomfort, aches or soreness around the spine. This can extend from the lumbar spine (lower back pain) to the thoracic spine (upper back pain) to below the cervical spine (neck pain). There are many structures in this area which can cause pain, including muscle, ligaments, tendons, nerves, joints and bones.

Due to the complexity of the back, there are several possible causes of back pain. At times, there may even be multiple conditions.

Breathing is the process where gas enters the lungs. As a result, there are increases and decreases of pressure occurring inside the body. These pressure changes can lead to stress and strain through these areas, particularly if there has already been an injury. Listed below are several conditions that can cause back pain when breathing.

Causes of back pain when breathing

1. Disc Herniation

Disc herniations[2] are conditions of the intervertebral discs found between the vertebrae (bones in the spine). These discs help to absorb impact and shock through the spine. It is primarily made up of the outer layer (annulus fibrosis) and inner contents (nucleus pulposus). During a disc herniation, the inner contents begin to leak outwards. This is comparable to the jelly coming out of a donut.

Disc herniations can occur anywhere along the spine. However, it is especially common in the lumbar spine (lower back). If severe enough, the herniation can compress the nerves and lead to sciatica (nerve pain). When breathing, extra pressure can worsen symptoms from a herniated disc.

Other disc herniations symptoms, include:

• Nerve pain, tingling and pins and needles down the hips, thighs and leg(s)

• Back pain, especially when bending forward

• Difficulty lifting and carrying

• Pain when sitting

• Muscle spasms along the back

• Sudden pains in the back.

Most disc herniations will resolve on their own, however rehabilitation and physiotherapy treatment can help speed recovery.

2. Back Sprain

Back sprains are injuries to the ligament which run along the spine. There are numerous ligaments that span along the length of the spine. Similar to other joints in the body, the ligament(s) provide support between the joints and cartilage. Movements that stress the spine (i.e., expanding lungs) can cause the ligaments along the spine to overstretch, become inflamed and even tear. As ligaments span the whole length of the back, they can occur anywhere between the upper and lower back.

Other back sprain symptoms, include:

• Back pain when lifting, carrying and spinal movement

• Stiffness along the back

• Muscle spasms

• Sudden pains in the back

Similar to other sprains, back sprains will resolve over time. Recovery strategies (e.g. heat, massage and gentle exercises can help ease symptoms.

3. Costovertebral Dysfunction

The costovertebral joints describe the connection between the thoracic spine (mid-back) and the ribs. They are located along the middle-part of the spine and back. Any injury to the connective tissue between this joint can lead to back pain, such as when the lungs are expanding when breathing.

Costovertebral dysfunction is typically caused by sudden movements of the middle back, particularly when twisting (e.g. rowing, turning around). They can occur over time during certain postures, such as sitting or hunching over.

Other symptoms include:

• Mid-back pain and stiffness

• Difficulty twisting and turning

• Radiating pain to the front of the chest

• Chest tightness

• Pain when coughing, sneezing, etc.

Costovertebral dysfunction can be eased through strategies, such as heat and manual therapy (e.g. mobilisations, massage, manipulations).

4. Fractured Vertebrae

The vertebrae are bones that span along the spine which surround the discs. Much like other bones, they can fracture which leads to cracks or separations. These conditions are usually caused by impact and trauma, such as car accidents or falls. People with weak bones, including those who have osteoporosis, are more likely to fracture their vertebrae.

These fractures can often occur between the middle thoracic (middle back) and thoracolumbar spine (middle to lower back).[3] As a result, the lungs expanding during breathing can disturb the fracture(s). Other symptoms associated with fractured vertebrae, include:

• Sudden pains in the back

• Relief when lying down

• Worsen pain when standing or walking

• Back stiffness

• Loss of height.

Fractured vertebrae will require treatment depending on the severity of the injury. Milder injuries may require rest and/or bracing, while severe fractures may need surgery. Rehabilitation will be required afterwards to prevent long-lasting weakness and stiffness.

5. Strained Muscles Along the Back

Muscles span along the whole length of the back. Their role is to support and move the spine during day-to-day movements, such as lifting, carrying or bending. Strains can occur during sudden movements, such as twisting or lifting. This can lead to overstretching or tears of the muscles surrounding the spine.

Given the numerous muscles that surround the spine, there are many areas where the back pain can occur (i.e. lower back, between the shoulder blades). Breathing in and out can cause stress along these muscles which can cause extra discomfort. Rhomboid pain is the most likely to lead to back pain when breathing.

Other symptoms, include:

• Muscle spasms

• Back stiffness

• Pain when moving (e.g. lifting, bending, twisting)

• Pain in multiple locations along the back.

6. Fractured Rib

The ribs are long curved bones which extend out from the thoracic spine (mid-back). Most humans have 12 pairs of ribs which form the rib cage. This cage extends from the spine to help protect the organs, including the lungs, heart, liver, etc. Direct impact or trauma to the rib cage (e.g. tackles, car accidents) can cause the rib(s) to break or crack.

The middle of the ribcage is usually the region where fractures most often.[4] The lungs expanding while breathing can cause the fractured rib(s) to pull which can lead to extreme pain. Other rib fracture symptoms, include:

• Shortness of breath

• Swelling along areas of the rib

• Bruising

• Worsening pain when breathing deeply

• Crunchy sensation along the ribcage

7. Scoliosis

Scoliosis is a condition which causes deformity of the spine. Those with scoliosis have a rotated and curved spine in the shape of the letter ‘S’ when facing backwards. This condition typically develops over time, particularly between the ages of 11-18 years where growth is the fastest.[5] Up to 5.2% of Australians[6] will have some form of scoliosis.

While many people have scoliosis, many will not have any symptoms (particularly those with mild to moderate curvatures). Those with more severe scoliosis (as determined by a medical X-ray) are more likely to experience back pain when breathing. The misalignment of the spine and ribcage can restrict the ability for the lungs to breathe. Symptoms related to scoliosis can include:

• Uneven posture

• Muscle spasms

• Shortness of breath

• Pain along the back and spine

• Stiffness

• Right side lower back pain

• Left side lower back pain

Scoliosis is often treated depending on the severity of the curve. Physiotherapy plays an integral part in slowing down the curve and easing pain in those with significant scoliosis.

Other internal causes

While there are many musculoskeletal (physical) conditions that cause back pain when breathing, there are also internal causes. Internal refers to the body parts inside the spine and muscles, such as the organs. Examples of these causes include:

• 8. Heart attack
• 9. Lung infections
• 10. Pleurisy (inflammation of the thin film surrounding the lung)
• 11. Pulmonary embolism (clots in the lung(s))
• 12. Lung cancer

While seeing a physiotherapist can help assist with diagnosing these conditions, involving your doctor and/or GP will ensure that the appropriate investigations and treatment is received.

What should you do next?

If your back pain when breathing continues to persist, ensure that you consult your physiotherapist and/or GP. They will be able to help with diagnosis, referring for investigations and providing a treatment plan for recovery.

If your pain has occurred due to trauma, seek immediate medical attention by visiting your GP immediately, hospital or calling the ambulance.

Key Takeaways

There are many causes of back pain when breathing. Conditions can range from muscle strains, fractures and even heart attacks. Seeking medical attention with your physiotherapist and/or GP is crucial for early diagnosis.

Typically, soft tissue injuries such as strains and sprains may require short to medium term physiotherapy to speed recovery. On the other hand, more traumatic injuries, like fractures, may need to fully heal before rehabilitation with physiotherapy.

Internal causes of back pain when breathing (e.g. heart attacks, lung infections, etc.) will require input from a medical doctor.