Why breathing can hurt your back
Each rib connects to the spine at two small joints. Every breath makes these joints glide slightly, and the muscles between the ribs and along the spine stretch and contract. If a joint becomes stiff or irritated, or a muscle is strained, a deep breath stretches the sore tissue and causes a sharp catch. The lining of the lungs (the pleura) also moves with breathing and is very sensitive, so inflammation there causes pain that is often felt in the back as well as the chest.
Musculoskeletal causes
- Rib joint irritation: sharp, localised pain beside the spine, often after sleeping awkwardly, lifting or twisting.
- Muscle strain: pain in the muscles between the ribs or along the spine; see our guide to a pulled muscle near the shoulder blade.
- Posture and desk work: long periods hunched over stiffen the upper back.
- After coughing: violent coughing during a chest infection can strain muscles and rib joints.
- Rib injury: bruised or broken ribs after a fall or impact.
- Spinal problems: thoracic disc problems or osteoporotic fractures, especially in older adults.
Lung, heart and other causes
- Pleurisy: sharp pain on breathing in, often with a viral illness or pneumonia.
- Pneumonia: cough, fever, breathlessness and pain on breathing.
- Pulmonary embolism: sudden breathlessness and sharp pain, sometimes with coughing blood, more likely after surgery, long travel, pregnancy or immobility.
- Collapsed lung (pneumothorax): sudden one-sided pain and breathlessness, more common in tall young men and smokers.
- Heart and aorta: heart attack or pericarditis can cause back pain; aortic dissection causes sudden tearing pain.
- Kidney and gallbladder problems can cause back pain, though usually not linked to breathing.
- Shingles: burning band of pain followed by a rash.
How to tell muscle pain from something more serious
Musculoskeletal pain tends to be localised, reproduced by pressing a spot or by twisting and bending, and present without breathlessness, fever or feeling unwell. It may have started after a specific movement. Pain from the lungs or heart is more often accompanied by shortness of breath, cough, fever, a racing heart, sweating or general illness, and it is not changed much by pressing the back. These are general patterns, not rules: if you are worried, get checked.
What helps mechanical pain
- Keep moving gently; stiffness worsens with rest.
- Apply heat for 15–20 minutes to relax muscles.
- Take pain relief as advised so that you can breathe deeply; shallow breathing can lead to chest infections.
- Change position often and take breaks from sitting.
- Sleep with a pillow supporting the painful side or between the knees.
- Practise slow, deep breaths several times an hour.
- Avoid heavy lifting and sudden twisting for a few days.
Gentle exercises
- Seated rotations: arms crossed, turn slowly to each side, 10 times.
- Thoracic extension: hands behind head, lean back gently over a chair back, 10 times.
- Cat–cow: on hands and knees, round and arch the spine slowly, 10 times.
- Side stretch: reach one arm overhead and lean to the opposite side, 20 seconds each side.
- Open book: lying on your side with knees bent, rotate the top arm open, 10 times each side.
- Diaphragmatic breathing: hand on your belly, breathe slowly into it for two minutes.
When to see a doctor or physical therapist
See a doctor if pain does not improve after a week, keeps getting worse, wakes you at night, or comes with fever, cough, weight loss or feeling unwell, and seek emergency care for the warning signs above. People with osteoporosis, cancer, a recent fall or long-term steroid use should have new back pain assessed. A physical therapist can treat stiff rib joints and muscles with mobilisation, exercise and posture advice once medical causes have been ruled out. Our guide to lower back strain covers pain lower in the back.
Three common situations
- Woke up with a sharp catch beside the spine: a stiff rib joint is likely; heat, gentle rotation exercises and normal activity usually settle it within days.
- Back pain on breathing during a chest infection: it may be strain from coughing or pleurisy; see a doctor if you are breathless, have a high temperature or the pain is getting worse.
- Sudden pain and breathlessness after a long flight: treat as a possible blood clot and get emergency help.
Key points to remember
- Most back pain on deep breathing comes from rib joints and muscles.
- It is usually localised, movement-related and tender to press.
- Breathlessness, fever, coughing blood or sudden severe pain need urgent care.
- Movement, heat, deep breathing and gentle exercises help mechanical pain.
Questions about back pain when breathing
These answers are general information and do not replace an examination or individual medical advice.
Why does my back hurt when I take a deep breath?
Most often a rib joint beside the spine or a muscle is irritated and stretched by the breath. Lung and heart causes are less common but more serious, especially with breathlessness or fever.
Can anxiety cause back pain when breathing?
Anxiety can cause muscle tension and a feeling of not getting a full breath, which may make the upper back ache. It is still important to rule out physical causes if symptoms are new.
How long does a rib joint problem last?
Usually a few days to two weeks with gentle movement. Recurring or persistent pain benefits from a physical therapy assessment.
Is back pain when breathing a sign of COVID or pneumonia?
It can be, if it comes with fever, cough, loss of smell or breathlessness. In that case seek medical advice.
Should I go to the emergency room for back pain when breathing?
Yes, if it is sudden or severe, or comes with breathlessness, chest pain, coughing blood, fainting or a racing heart.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.