Breathing should be automatic and painless. But if you’re feeling back pain when you breathe, it can be startling—and sometimes frightening. While it may be a temporary muscle strain, this symptom can also be a sign of something more serious, including issues with your lungs, spine, or even your heart.
So, why does your back hurt when breathing? In this comprehensive guide, we’ll explore the possible causes, how to tell if it’s something serious, and what you can do about it.
Understanding the Anatomy of Back Pain and Breathing
To understand why breathing can trigger back pain, it helps to first understand what’s going on inside your body.
When you breathe in:
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Your diaphragm contracts and moves downward.
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Your ribcage expands, moving the intercostal muscles (muscles between your ribs).
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Your lungs inflate, shifting nearby organs and tissues.
This natural motion affects the spine, muscles, and even nerves—any of which can be the source of pain if injured or inflamed.
Common Causes of Back Pain When Breathing
Several conditions—ranging from minor to life-threatening—can cause this symptom. Let’s break them down by category.
1. Musculoskeletal Causes
These are the most common and generally less dangerous causes.
a. Muscle Strain
Overexertion from exercise, poor posture, or awkward sleeping positions can cause inflammation or strain in the back muscles. Breathing deeply can aggravate the sore area.
Signs:
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Localized back pain
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Pain increases with movement or deep breaths
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Tenderness to the touch
b. Costochondritis
This is inflammation of the cartilage connecting the ribs to the breastbone. Although the pain is usually in the chest, it can radiate to the back.
c. Spinal Issues
Conditions like herniated discs, vertebral fractures, or arthritis in the thoracic spine (middle back) can cause pain that worsens with movement, including breathing.
Signs:
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Sharp or radiating back pain
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Pain worsens with deep inhalation or twisting
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May involve tingling or numbness
2. Lung-Related Causes
Breathing pain is sometimes related to conditions affecting the lungs or the surrounding pleura (lining around the lungs).
a. Pleurisy
Pleurisy occurs when the pleural membranes become inflamed, often due to viral or bacterial infections. The result is sharp, stabbing pain during breathing.
Signs:
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Pain in the back or chest
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Worse with deep breathing or coughing
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May come with fever or shortness of breath
b. Pulmonary Embolism (PE)
A PE is a blood clot that travels to the lungs and blocks blood flow. This is a medical emergency.
Signs:
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Sudden sharp back pain when breathing
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Shortness of breath
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Rapid heartbeat
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Lightheadedness or fainting
c. Collapsed Lung (Pneumothorax)
A collapsed lung can cause air to leak into the space between the lung and chest wall, leading to sudden chest or back pain with breathing.
3. Heart-Related Causes
Though not always the first suspect, heart issues can cause pain that radiates to the back, especially in women.
a. Pericarditis
Inflammation of the pericardium (the sac around the heart) may cause sharp pain that worsens with inhaling, coughing, or lying down.
b. Aortic Dissection
This is a rare but life-threatening condition where the inner layer of the aorta tears. It can cause sudden, severe pain in the chest and back.
Signs:
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Sudden, intense back or chest pain
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Feeling of “ripping” or “tearing”
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Blood pressure differences in each arm
4. Gastrointestinal and Other Causes
Some digestive system issues can cause back pain due to nerve overlap or organ positioning.
a. Acid Reflux (GERD)
Stomach acid backing into the esophagus can cause chest and back discomfort, especially when lying down or breathing deeply.
b. Gallstones or Pancreatitis
Inflammation or blockage in the gallbladder or pancreas can cause referred pain to the mid-back that may feel worse with deep breaths.
When to Worry: Signs It Could Be Serious
While many cases of back pain when breathing are benign, you should seek immediate medical attention if you experience:
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Sudden and severe back pain when inhaling
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Shortness of breath
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Chest tightness or pressure
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Dizziness or fainting
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Rapid heart rate
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Fever or unexplained weight loss
These may point to pulmonary embolism, heart problems, infection, or other medical emergencies.
Diagnosis: How Doctors Identify the Cause
Your healthcare provider will start with a full history and physical exam, then order tests as needed. These may include:
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Chest X-ray – to check for pneumonia, lung collapse, or rib injury
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CT Scan or MRI – for detailed views of the spine, lungs, or chest cavity
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EKG or Echocardiogram – to evaluate heart function
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Blood Tests – to rule out infection, inflammation, or clotting disorders
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D-dimer test – often used to screen for pulmonary embolism
A precise diagnosis is key to getting the right treatment—and peace of mind.
Treatment Options
Treatment depends entirely on the root cause of your back pain while breathing. Here’s a breakdown of common approaches:
For Muscle Strain or Injury
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Rest and Ice/Heat Therapy
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Over-the-counter NSAIDs (like ibuprofen)
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Gentle stretching or physical therapy
For Lung or Chest Infections
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Antibiotics (for bacterial infections)
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Antivirals (if applicable)
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Anti-inflammatory medications
For Pulmonary Embolism or Serious Conditions
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Hospital admission
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Blood thinners or clot-dissolving drugs
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Surgery (in rare or emergency cases)
For Chronic Conditions (like Arthritis or GERD)
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Long-term medication
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Lifestyle modifications (e.g., weight loss, diet change)
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Physical therapy or specialist referrals
Frequently Asked Questions
Is back pain when breathing a sign of COVID-19?
Yes, in some cases. COVID-19 can cause inflammation of the lungs (pneumonia or pleurisy), which may lead to chest or back pain with breathing. If you also have fever, cough, or fatigue, get tested.
Can anxiety cause back pain while breathing?
Absolutely. Anxiety can lead to shallow breathing or hyperventilation, which tightens chest and back muscles and may cause pain.
Is it normal to feel a “catch” or sharp pain when taking a deep breath?
This can happen occasionally due to minor muscle irritation or poor posture. However, recurring or severe pain should be evaluated by a doctor.
Can poor posture cause back pain with breathing?
Yes. Slouching or sitting for long periods can weaken muscles and restrict breathing mechanics, contributing to pain when inhaling deeply.
Final Thoughts
Back pain while breathing is not something to ignore. While it may stem from something as simple as a strained muscle or poor posture, it could also be your body’s way of signaling a more serious condition—especially if it’s sudden, severe, or accompanied by other symptoms.
Understanding the range of possible causes can help you determine your next steps. When in doubt, consult your doctor. Early evaluation can lead to early treatment—and that’s key to both relief and peace of mind.
Take the First Step Towards Pain-Free Living Today
