- Experiencing back pain when you breathe can be a symptom of a strained muscle in your chest.
- Pneumonia may also cause a similar pain in addition to fever, fatigue, weakness, and more.
Back pain is common — nearly 40 percent of adults reported having back pain in 2019 — and it's often caused by everyday issues like poor posture or strained muscles.
But if you have back pain that's triggered each time you take a breath, this may be a sign of something more serious like pneumonia or a blood clot.
Here are seven reasons you may have back pain while breathing and when you should see a doctor.
1. Strained muscle
Strained muscles occur when your muscles are stretched too much, causing tears in the muscle fibers or tendons.
"There are small muscles between the ribs, front and back, that help expand and contract your chest as a normal part of breathing," says Dr. Kate Rowland, a family medicine doctor and professor at Rush University.
These muscles can get pulled or strained through activities like heavy lifting or prolonged coughing. When this happens, "the muscle strain can get re-aggravated with each breath you take," Rowland says.
Some other signs that you may have a strained muscle are:
- Swelling
- Bruising
- Loss of strength in the muscle
- Pain when twisting
To treat a strain, you'll need to rest your muscles for at least a day. If you have swelling, you can ice the area for 10 to 15 minutes every few hours.
Also, "people often say it feels better with an anti-inflammatory drug like ibuprofen or naproxen," Rowland says.
2. Pleurisy
Pleurisy is a condition that occurs when the tissue between your lungs and your chest wall becomes inflamed.
When you take a breath, your lungs press the swollen tissue against your chest, which can trigger pain.
This pain often starts in your chest but can spread throughout your back, shoulders, and abdomen.
There are many possible causes of pleurisy, including:
- The influenza virus
- Pneumonia
- The Epstein-Barr virus
- A staph infection
- An injury
- Lung cancer
- A blood clot in the lungs
- Cancer treatment like chemotherapy
If you think you have pleurisy, see your doctor as soon as possible so they can determine the underlying cause and plan your treatment.
3. Pneumonia
Pneumonia is an infection in your lungs that's generally caused by bacteria or a virus like the flu.
A pneumonia infection irritates the lining of your lungs, which can trigger pleurisy and cause back pain when you breathe.
"The pain of pneumonia can be sharp or a dull ache, especially when taking a deep breath," says Dr. Megan Boysen Osborn, a professor of emergency medicine at the University of California, Irvine.
The pain also tends to get worse if you're coughing a lot, says Dr. Jessica Oswald, an emergency medicine and pain specialist.
Some of the other symptoms of pneumonia include:
- Fever and chills
- Fatigue
- Coughing up yellow, green, or bloody mucus
- Loss of appetite
- Shortness of breath
- Weak and achy muscles
If you think you may have pneumonia, see your doctor as soon as possible. If the infection is caused by bacteria, you'll need to take antibiotics, while a viral infection usually goes away on it's own.
4. Lung cancer
Lung cancer is relatively rare, but it's much more common if you smoke — around 90 percent of lung cancer cases are linked to cigarette smoking.
"Most small and focal lung cancers are painless, but the lesions can erode into ribs, nerves and lining of the chest wall," Oswald says.
This erosion can cause sharp pain that gets worse with breathing or coughing.
The pain often appears in your chest, but if the lesions are on the back of the chest wall, you might have back pain as well, Oswald says.
Some other signs of lung cancer include:
- Shortness of breath
- A cough that won't go away
- Coughing up blood
- Weight loss
- Hoarse voice
Your doctor can diagnose lung cancer by taking scans or samples of your tissue. Depending on how advanced the cancer is, your doctor may treat it with surgery, chemotherapy, radiation, or other cancer treatments.
5. Pulmonary embolism
A pulmonary embolism is a type of blood clot that occurs in one of the blood vessels of your lung.
A pulmonary embolism can cause chest or back pain, depending on where it appears in your lung.
"The pain can be felt anywhere in the back or chest, as high as the clavicles/neck and as low as the bottom of the rib cage," Osborn says.
Besides pain, other symptoms of pulmonary embolism include:
- Sudden shortness of breath
- Coughing, possibly with blood
- Dizziness or fainting
- Racing or irregular heartbeat
- Sweating
- Feeling anxious
You're at greater risk of developing a pulmonary embolism if you:
- Take hormonal birth control pills
- Have had a recent surgery
- Have recently taken a long plane flight
- Have a family history of blood clots
- Smoke cigarettes
Your doctor can diagnose a pulmonary embolism by looking at scans of your chest. They can then decide how to treat you — some common treatments include blood-thinning medications, using a catheter to break up the clot, or surgery for severe cases.
6. Certain heart conditions
The two main heart conditions that can cause back pain with breathing are pericarditis and myocarditis, says Osborn.
- Myocarditis occurs when your heart muscle becomes inflamed, which reduces your heart's ability to pump blood. This can trigger back pain with breathing,
The are many possible causes of myocarditis, including:
- Viral infections like COVID-19
- Bacterial infections like staphylococcus or Lyme disease
- Infections from parasites or fungi
- Certain medications like cancer drugs and antibiotics
- Inflammatory disorders like lupus or arthritis
Along with chest and back pain, some of the different symptoms of myocarditis are:
- Shortness of breath
- Fatigue
- Swelling in legs, feet, and ankles
- Fast or irregular heartbeat
- Flu-like symptoms
- Pericarditis occurs when the pericardium, the thin tissue surrounding your heart, becomes irritated and inflamed.
Pericarditis causes some of the same symptoms as myocarditis as well as:
- Low-grade fever
- Cough
Pericarditis may also be caused by an infection or inflammatory disorder, as well as:
- Injury to your heart or chest
- Cancer
- Kidney disease
If you develop the symptoms of either condition, you should get medical help as soon as possible. Severe forms of myocarditis can damage your heart or may even be fatal.
Your doctor will determine what type of treatment you need, which may include corticosteroids, blood thinning medications, or various surgeries.
7. Broken or bruised rib
Broken or bruised ribs generally happen after you've had an injury or accident. "So usually people know when they have that kind of thing happen, and the pain starts right away," Rowland says.
"Broken ribs are usually very painful and hurt like crazy with every breath because the fracture moves a little with each one," Rowland says. If the break is on the back of your rib, you'll feel this pain in your back.
But even if you're in pain, "it is important for patients to take deep breaths to avoid getting pneumonia after a broken rib," Osborn says.
Along with pain, some common symptoms of broken or bruised ribs are:
- Swelling or tenderness around the ribs
- Visible bruising on the skin
- Feeling or hearing a crack in the rib
Broken or bruised ribs generally heal on their own, but you should still see your doctor to confirm that you have a break and make sure there aren't any complications like a punctured lung.
Insider's takeaway
There are many different reasons you might feel back pain when you breathe. "Anything that causes irritation to the chest wall can cause pain while breathing; this could be a serious cause or a not serious cause," Osborn says.
It's important to see your doctor if you have any back pain that:
- Doesn't go away
- Happens after a fall, injury, or blow to the chest
- "Comes with other symptoms, especially shortness of breath, chest pains, fevers, sweating, or fatigue/malaise that started at the same time," Rowland says.