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What Causes Back Pain and Shortness of Breath?

By: Ali Ganjei, MD, Physiatrist
Published: 6/27/2019

Having back pain and trouble breathing can be particularly concerning, especially if
you’re unsure about the cause. Here are some potential reasons why back pain and
shortness of breath may occur together, as well as when to see a doctor.

Intercostal muscle strain

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If one or more of the intercostal muscles are strained, breathing may become more di6cult as
the pain can worsen while the rib cage expands and contracts. Read: Upper Back Pain from
Intercostal Muscle Strain

The intercostal muscles run between adjacent ribs and play an important role in
expanding and contracting the rib cage when breathing. If one or more of these muscles
are strained along the back, the symptoms can range from a mild tenderness or stiYness
to intense, sharp back pain. Breathing may also become more diZcult as the pain can
worsen while the rib cage expands and contracts.
 See Intercostal Muscle Strain Symptoms and Diagnosis

An intercostal muscle can be strained in various ways, such as:

Overuse/overexertion. Doing an excessive amount of an activity that uses the

intercostal muscles, such as rowing, can cause a muscle to overstretch and
develop small tears. A sudden or awkward movement can also strain a muscle.

Direct trauma. A collision or fall that directly impacts the ribs and connecting
muscles could injure one or more of the intercostal muscles.

See Causes of Intercostal Muscle Strain

An intercostal muscle strain typically starts to feel better within a few days and fully heals
within 6 to 8 weeks. To help manage the initial pain, which may be severe, some people
]nd relief from ice, heat packs, or over-the-counter pain medications. It is also advised to
modify or reduce activities for a few days to protect the strained muscles from further
injury. If the pain is severe, prescription medication may be required after evaluation by a
physician.

See Treating Intercostal Muscle Strain

Severe kyphosis

If one or more of the intercostal muscles are strained, breathing may become more di6cult as
the pain can worsen while the rib cage expands and contracts. Read: Upper Back Pain from
Intercostal Muscle Strain

A healthy thoracic spine (upper back) is slightly curved forward, which is called a kyphotic
curve or kyphosis. However, if the thoracic spine is curved at least 50 degrees, it is
considered hyperkyphosis, also commonly referred to as kyphosis.

If a patient is still growing, kyphosis is commonly treated with a brace in an eYort to

prevent it from progressing to the point of causing troubles with breathing, walking, and
other basic functions. Special exercises to improve posture may also be advised to help
prevent kyphosis from worsening. If kyphosis has progressed to the point of causing
breathing troubles, surgery may be needed.

See Kyphosis Causes and Treatment

Other potential causes

Some other causes of back pain with breathing troubles include:

Rib displacement or fracture. When a rib becomes fractured or displaced, the

pain can potentially become quite sharp or intense, especially when breathing or
taking deep breaths. Sometimes a rib displacement or fracture can be
accompanied by an intercostal muscle strain, which can also contribute to pain
while breathing.

See Thoracic Vertebrae and the Rib Cage

Severe scoliosis. The abnormal sideways twisting and rotation of the spine, called
scoliosis, can in rare cases become severe enough to aYect breathing. Sometimes
both scoliosis and kyphosis are present together.

See Scoliosis: Symptoms, Treatment and Surgery

Allergic reaction. Some people may be at risk for developing an allergic reaction
to some medications for back pain, such as muscle relaxants. Several troubling
signs and symptoms could indicate an allergic reaction to back pain medication,
such as diZculty breathing, chest tightness, swelling in the throat (or arms or legs),
and/or hives.

See Side EYects and Risks of Muscle Relaxers

Other potential causes of back pain and breathing problems that can be quite serious
include infection and/or blood clots.

When to see a doctor

Any unexplained shortness of breath or breathing problems need to be evaluated by a
medical professional. Additionally, seek medical attention if back pain does not go away
on its own within a couple weeks or if other troubling signs are present, such as pain that
radiates to the chest, or any tingling, numbness, or weakness that persists.

Learn more:
Upper Back Pain Symptoms

All About Upper Back Pain

Dr. Ali Ganjei is a physiatrist and the Medical Director of the Inova
Spine Program. For more than 30 years he has evaluated and treated
spine conditions, specializing in electrodiagnostic medicine.

This site is for educational purposes only; no information is intended or implied to be a substitute for
professional medical advice. The information is produced and reviewed by over 200 medical
professionals with the goal of providing trusted, uniquely informative information for people with
painful health conditions.

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