Mid-back pain that worsens with breathing is often localized to the thoracic spine region, between the shoulder blades and the lower ribs. This discomfort arises because the thoracic spine is intimately connected to the rib cage, which must expand and contract with every breath. Consequently, anything that affects the muscles, joints, or organs in this area can cause pain during respiration. While many causes are benign and musculoskeletal, others may point to more serious internal issues, making it important to understand the potential sources of this symptom.
Mechanical and Musculoskeletal Causes
The most common reasons for mid-back pain during breathing involve the muscles and joints that facilitate the respiratory process. The intercostal muscles, which run between the ribs, and the larger back muscles can easily become strained or inflamed. This type of muscle strain often results from sudden, awkward movements, heavy lifting, or intense bouts of coughing that overstretch the soft tissues surrounding the rib cage.
Poor posture is another frequent contributor, as prolonged slouching places unnatural stress on the thoracic spine and its supporting musculature. Over time, this chronic tension can lead to muscle fatigue and localized pain that is aggravated by the expansion of the chest during a deep breath. The mechanical pain often feels sharp or stabbing and typically changes intensity with specific body movements, such as twisting or bending, or when direct pressure is applied to the painful spot.
Conditions affecting the joints and cartilage can also be a source of pain. Costochondritis, for instance, is an inflammation of the cartilage that connects the ribs to the breastbone, though this pain can radiate to the back. Pain may also originate from minor dysfunction in the small joints where the ribs attach to the thoracic vertebrae.
Internal and Systemic Sources of Pain
When mid-back pain with breathing is not purely mechanical, it may be a form of referred pain originating from internal organs or systemic conditions. Since the lungs, heart, and parts of the digestive and urinary systems are in proximity to the thoracic spine, their issues can manifest as back discomfort. This type of pain is often less dependent on movement and is frequently accompanied by other systemic symptoms.
Conditions that cause inflammation of the pleura, the thin lining surrounding the lungs, are a common source of referred pain. Pleurisy, an inflammation of this lining, causes a sharp, stabbing sensation that is characteristically worse when taking a deep breath, coughing, or sneezing. Pneumonia, a lung infection, may also cause pain in the mid-back that is intensified by breathing, particularly because the accompanying cough further strains the chest and back muscles.
Referred pain can also stem from issues lower in the torso, such as the kidneys or gastrointestinal system. Kidney infections or kidney stones can cause pain that radiates from the flank and abdomen to the mid-back, which may feel more pronounced with movement or deep breaths due to the diaphragm’s action. Similarly, inflammation or irritation in the esophagus or stomach, such as from severe gastroesophageal reflux disease (GERD) or peptic ulcers, can sometimes be perceived as discomfort in the upper or mid-back.
Recognizing Emergency Warning Signs
While many causes of mid-back pain with breathing are treatable, certain accompanying symptoms require immediate emergency medical attention. These “red flag” symptoms suggest a potentially life-threatening event such as a pulmonary embolism or a heart attack. A pulmonary embolism, which is a blood clot in the lungs, typically causes a sudden onset of severe, sharp chest or mid-back pain that is exacerbated by breathing.
Any instance of sudden, severe shortness of breath or the inability to take a full breath, especially when combined with back pain, should prompt an immediate call for help. Other symptoms indicating a serious condition include coughing up blood, which may signal a lung issue, or pain that is accompanied by a high fever and chills, which suggests a systemic infection.
Pain that spreads or radiates to the jaw, neck, arm, or shoulder, or is felt as a crushing or heavy sensation in the chest, is highly suggestive of a cardiac event and requires emergency care.
How Doctors Diagnose Mid-Back Pain
Determining the source of mid-back pain connected to breathing begins with a comprehensive patient history and physical examination. The healthcare provider will ask detailed questions about the pain’s nature—whether it is sharp or dull, constant or intermittent, and if it changes with specific movements or positions. Understanding when the pain started and what, if any, other systemic symptoms are present is also crucial for differentiation.
During the physical exam, the doctor will often palpate the spine and the rib cage to check for localized tenderness, which points toward a musculoskeletal cause like a muscle strain or costochondritis. They will also listen to the heart and lungs using a stethoscope to detect abnormal sounds that could indicate an infection or fluid buildup. If a systemic issue is suspected, initial diagnostic tools may include a chest X-ray to visualize the lungs and spine or blood tests to check for markers of infection or inflammation.
Further investigation might involve a CT scan or MRI to look for nerve compression from a herniated disc or to better evaluate the internal organs and vasculature. These advanced imaging techniques provide detailed views necessary for ruling out serious underlying conditions.