A cough is a sudden, forceful expulsion of air designed to clear irritants and mucus from the respiratory passages. Because this reflex is a violent physical event, it is common to experience discomfort or chest pain when coughing repeatedly. The pain can stem from simple muscle strain or indicate inflammation within the lungs or chest lining. Understanding the source of the pain, which ranges from mechanical stress to underlying inflammatory conditions, is the first step toward finding relief.
The Mechanics of Pain: How Coughing Stresses the Chest
The act of coughing involves a powerful sequence of muscle contractions and pressure changes within the chest cavity. It begins with a deep, rapid intake of air, followed by the closure of the vocal cords. The diaphragm and abdominal muscles then contract forcefully against this closed airway, rapidly increasing the pressure inside the chest.
This compression phase builds up enormous pressure, with intrathoracic pressures potentially reaching 300 millimeters of mercury. When the vocal cords suddenly open, the air is expelled at high speeds. This extreme, explosive effort inherently pulls, pushes, and strains the structures of the rib cage and surrounding musculature.
The massive pressure change and rapid movement put an immense, sudden load on the muscles that stabilize the chest and control breathing. A severe or prolonged coughing fit subjects the chest wall to forces far exceeding normal respiration. This intense, repeated physical stress forms the foundation for the most common cause of pain associated with coughing.
Musculoskeletal Strain and Irritation
The most frequent cause of temporary chest pain from coughing is the overuse and injury of the muscles surrounding the rib cage. These muscles, known as the intercostal muscles, are located between the ribs and help expand and contract the chest during breathing.
During a severe or chronic cough, these intercostal muscles contract suddenly and violently, which can lead to a strain, or “pulled muscle.” This pain is sharp, localized between the ribs, and worsens when coughing, sneezing, or twisting the torso. Since the pain relates directly to muscle movement, pressing on the strained area often causes tenderness.
Another musculoskeletal cause is costochondritis, which involves inflammation of the cartilage connecting the ribs to the breastbone (sternum). Repetitive or hard coughing is a known trigger because the violent motion stresses and irritates these costosternal joints. The resulting pain is sharp or aching, often increasing when taking a deep breath or moving the chest wall.
Underlying Respiratory Conditions Causing Inflammation
Pain that feels deep, sharp, or stabbing and is severely aggravated by coughing may indicate inflammation within the chest cavity, independent of muscle strain. This pain is often a symptom of an underlying respiratory condition affecting the lungs or their surrounding structures. This inflammation makes the mechanical action of a cough intensely painful.
Pleurisy (or pleuritis) is a condition where the pleura—the two thin layers of tissue lining the lungs and the chest wall—become inflamed. Normally, fluid allows these layers to glide smoothly past each other during breathing. When inflamed, the layers painfully rub against one another, causing a sharp, localized, knife-like pain that is worsened by a deep breath, sneeze, or cough.
Conditions like acute bronchitis and pneumonia also cause pain by irritating the airways and lung tissue. Acute bronchitis is inflammation of the bronchial tubes, causing chest soreness and excess mucus production. Pneumonia, a more serious infection, inflames the small air sacs (alveoli), causing them to fill with fluid or pus. The deep-seated inflammation from pneumonia produces a sharp, stabbing chest pain intensely felt when coughing applies forceful pressure to the infected tissue.
When Chest Pain Requires Medical Attention
While most chest pain from coughing is due to temporary muscle strain, certain symptoms require immediate medical evaluation. A medical consultation is recommended if the pain persists for more than a few days or worsens despite rest and over-the-counter relief.
You should seek urgent or emergency medical care if the chest pain is accompanied by specific red flag symptoms.
Red Flag Symptoms
- Pain that feels crushing or centralized in the chest.
- Pain that radiates to the jaw, shoulder, or arm, or lasts for 15 minutes or longer.
- Sudden shortness of breath or difficulty breathing.
- A high fever or shaking chills.
- Coughing up blood.
These combinations of symptoms may indicate a severe infection, such as pneumonia, or a life-threatening event like a pulmonary embolism or cardiac issue.