Experiencing pain in your upper back with each breath can be disconcerting—and rightfully so. It’s not always simply a strained muscle from sleeping in an awkward position or a day spent staring at your computer screen. Indeed, upper back pain that aggravates with deep breathing can signal several different conditions—some benign, others serious.
Let’s deconstruct the most common causes of this type of pain and when to take it seriously.
1. Muscle Strain or Tension
Often, it is a strained or pulled muscle. Going too hard at the gym, lifting something incorrectly, or even sleeping in a funny position can make your back muscles sore and stiff. When you take a deep breath, your ribcage moves outward, pulling on those sore muscles and aggravating the pain. This type of pain usually gets better with rest, gentle stretching, and cold or heat treatment. But if it persists or worsens, it’s a good idea to have it checked out.
2. Spinal Problems: Scoliosis, Osteoporosis, and More
Spine problems are another potential cause. Conditions such as scoliosis (a lateral curve of the spine) or kyphosis (severe rounding of the upper back) may press against your ribcage and lungs, and cause pain on deep breathing. Osteoporosis, for example, makes bones thinner and leads to fractures in the spine, while spinal stenosis (spinal canal narrowing) and herniated disks can cause inflammation of surrounding nerves. These conditions usually lead to ongoing pain that worsens with motion or deep breathing.
3. Pulmonary Embolism (Medical Emergency)
A pulmonary embolism occurs when a clot of blood moves to your lungs and obstructs blood flow. This is an emergency. The discomfort is usually sharp and sudden and is exacerbated with deep breaths. Other symptoms may be difficulty breathing, coughing up blood, dizziness, or a fast heartbeat. If you think you have a pulmonary embolism, get emergency treatment right away.
4. Heart Attack and Other Cardiac Issues
Not all heart attacks come with dramatic chest pain. Sometimes, the pain spreads to the upper back, jaw, or arms and can worsen with deep breathing. Other red flags include tightness in the chest, nausea, lightheadedness, sweating, and shortness of breath. If something feels off—especially if you’re in a high-risk group—don’t wait to get help.
5. Pneumonia or Lung Infections
An infection such as pneumonia can result in inflammation of the lungs and covering tissues, resulting in pain that is triggered by deep breathing or coughing. If the infection is carried to the pleura (the lining that surrounds the lungs), it can result in acute pain in the chest or upper back. Watch for symptoms such as fever, chills, weakness, coughing, and loss of appetite. Early treatment is crucial, particularly if there is increasing difficulty breathing.
6. Pleurisy and Other Pleural Disorders
Pleurisy is an inflammation of the pleura, and it can make every breath hurt. This pain may spread from your chest to your upper back or shoulders. Pleurisy may result from infection, autoimmune diseases such as lupus, or even injuries to the chest. It usually worsens with breathing, coughing, or sneezing.
7. Collapsed Lung (Atelectasis or Pneumothorax)
A collapsed lung is responsible for severe, sharp upper back or chest pain with worsening on breathing. With atelectasis, a section of the lung doesn’t expand fully, and pneumothorax occurs when air enters the area surrounding the lung. Both need immediate medical care and are sometimes associated with shortness of breath and an increased rate of breathing.
8. Obesity and Overweight
Excess weight around the chest or midsection can impact your breathing mechanics. It is an added stress to your back and diminishes lung volume, which makes it harder to breathe and can even be painful at times. Obesity also contributes to poor posture and decreased muscle tone, both of which tend to exacerbate upper back pain.
9. Lung Cancer
Although frequently asymptomatic in the initial phases, lung cancer may occasionally result in pain in the upper back or chest that worsens with breathing. Other potential symptoms are chronic cough, coughing up blood, hoarseness, frequent respiratory infections, and unintended weight loss. If you experience these, particularly if you are a smoker or have been exposed to irritants affecting the lungs, seek medical care.
10. Intercostal Neuralgia
This syndrome involves the nerves between your ribs. This can produce stabbing, sharp, or burning pain that worsens with deep breathing, coughing, or twisting your body. Intercostal neuralgia results from shingles, injury, or damage to a nerve, and treatment is based on its cause.
When to See a Doctor
Upper back pain that appears when you inhale may appear harmless, but occasionally it’s your body telling you more is amiss. It’s particularly necessary to see a doctor if your pain:
- Is worsening or severe
- Occurs with shortness of breath, dizziness, or pressure in your chest
- Occurs along with a fever or recurring cough
- Involves tingling, numbness, or weakness
- Occurs after a fall or accident
- Accompanied by a cough or unexpected weight loss
Your physician might order imaging studies such as X-rays, CT scans, or MRIs, in combination with blood tests or lung function tests, to determine the cause.
Pain in your upper back upon breathing isn’t something you should disregard. While it may be due to a tight muscle or incorrect posture, it may also indicate something more severe, such as a lung condition, heart ailment, or spinal issue. Paying attention to your body and the correct diagnosis can make all the difference.