Upper chest pain with breathing is usually related to rib dysfunction
Upper back pain when breathing is usually related to a sprained rib where it keys into the side of the spine. Equally as common is a sharp rib pain when breathing at the front of the chest, although if it's on the left side, it could be heart trouble (particularly if it flows down the left arm). If a cardiac assessment is all clear, pain at the front of the chest is likely to be caused by strain where a rib joins the breastbone, or sternum. (The medical name for this is costochondritis.)
The thoracic spine supports twelve pairs of ribs that slope gently down from the back as they pass around to encase the thorax. The first rib is right up in the angle of the neck and shoulder. It travels around to the front at the level of a necklace worn at the base of the neck. Troubles with the first rib can cause pain in the neck while breathing, especially if the person is a mouth-breather (see later). The eighth rib is approximately at bra level and the twelfth rib dips to high waist level.
Each rib is very heavily invested into the sides of the spine, including to the sides of each disc
The rib-to-spine junctions are very complicated. Each head of rib attaches to the sides of each intervertebral disc, as well as notching into its neighbouring vertebrae above and below. These are called the the costo-vertebral joints. The rib attaches again to the side of the lower vertebra on its way around to the front of the chest. This is called the costo-transverse joint. Several tiny, but very strong ligaments hold the rib tethered firmly in place to all these different moving parts of the spine.
It is significant that the rib attaches directly to the discs. It means that each rib must accommodate to the stretching-and-compressing activity of these dynamic, water-filled pillows as they move and cushion each vertebra. As you will see later, there may be adverse consequences if a rib-to-spine junction gets sprained and the rib stops moving, because this will make the disc stop moving too.
The ribcage is made to be flexible and springy so the lungs can fill and deflate easily
The ribcage is like a large-scale collapsible chicken carcass. It's designed to move with respiration, the ribs rising and lowering with each breath, thus increasing the capacity of the chest cavity while reducing its pressure. Each rib moves like a bucket handle; lifting up off the rim as we inhale and settling down again on the rim as we breathe out. All the ribs do this in unison as the lungs inside inflate with air and empty again. Each rib must be fully mobile and springy so that the lung tissue under doesn't fail to fill ~ or worse, start to collapse. Optimal breathing means optimal gaseous exchange. This in turn means optimal cerebral function, optimal health and fitness, and optimal wellbeing.
Oxygen pulled into the lungs enters the blood stream through the mini raspberry-like alveolar sacs. Carbon dioxide is unloaded here too
The magic thing here is that the ribs continue their physical waxing and waning rhythm whatever else our body is doing. You could be turning over in bed, coughing, or simply glancing over your shoulder. The rib excursions have to keep going, whatever else is happening and come what may. As you might imagine, it is a feat of supreme coordination to keep things running smoothly at all the various nook-and cranny joints, all the time. Being tired, unfit, physically overwrought, or in some other way below par can hamper the streamlined coordination of all the moving parts.
Just as significant in the genesis of upper back pain while breathing is immobility of either of the two vertebrae to which the rib is attached. If a vertebra is stiff, or slightly twisted off-centre in the spine, the rib-to-spine junction doesn't run smoothly.
The diaphragm is like an elasticated umbrella that flattens out as it contracts & descends, reducing the intra-thoracic pressure
and thus drawing air into the lungs
The diaphragm is a dome-shaped muscle under the ribs that separates the thoracic from the abdominal cavity. The diaphragm is the main breathing muscle. As it contracts it lowers, like drawing down the flange of a syringe and this sucks air in passively through the nose, filling right down to the bases of the lungs. An out-breath is brought about by the passive elastic recoil of the diaphragm muscle. As it lets go, it moves up into the thoracic cavity, pushing stale air out through the nose or mouth.
The intercostals are the fine muscles between the ribs. They are more involved in forced expiration and coughing to forcibly shrink the chest and push air out in a gust through the nose and mouth.
The intercostal muscles work to forcibly expel air from the lungs
People come over all misty-eyed about the heart and how valiantly it pumps life through our veins for the duration of our allotted years. Yet the diaphragm, the lungs and the ribcage work just as tirelessly, from the moment of birth to the last gasp ~ with their efforts every bit as awesome. In addition, the ribs have the very real complication of being mechanically tied to the sides of the semi-rigid spinal column, at the human rib-to-spine hinges.
Spasm of the intercostal muscles can make the rib more rigid. The problem rib then feels more prominent
If the head of rib isn't comfortably notched into the small bony recesses either side of its corresponding thoracic disc, because one or the other is slightly twisted or imperceptibly sitting askew, the intercostal muscles at that level will go into an automatic protective mode to hold the rib still. Instead of only working occasionally when you cough or sneeze, they will stay switched on all the time, as a sort of local muscle cramp.
Muscle spasm of the intercostals is painful in itself ~ and more so if you take a deeper breath, as the muscle clench flicks on harder. You can have pain in the upper back when breathing. But you can also have what feels like a hard, permanent band of tightness from the stiffer rib sitting up proud, like a single prominent rung of a ladder. The rib is invariably 'pleasingly painful' to pressure from the hands. (And it feels physically delicious to have it mobilised with knowing hands ~ see Spinal Physiotherapy).
Just as importantly, the intercostal muscles staying switched on sets the problem rib up for being hurt over and over again. By not being free to roll with the punches it becomes a sitting duck to future trauma. Even the most minor action can tweak it and set it off again.
The ribs rise and lower like bucket hands as we breathe
Upper back pain with breathing can be sited in different parts of the back and thorax, depending on which rib-level is involved. Trouble with the second and third rib can give you pain in the back shoulder as you breathe. It can also cause a sharp, high pain that comes through to the front of the chest, made worse by deep breathing. This pain, particularly if it is left-sided, is often misconstrued as angina. What distinguishes it as a mechanical or structural rather than a cardiac problem is that it is a definitely a deep breathing pain.
Apart from the pain, the breathing will feel laboured and as if you are struggling to get a satisfying breath. In reality, this is just exactly what is happening, as the lungs under the affected rib fail to inflate properly.
This is fairly serious in an evolutionary sense, since you'd have a bit of bother fending off marauders or dragging a hairy mammoth home for dinner if part of your lung was closed down. The sharp back pain when breathing is acting like a flag to bring your attention to the rib's function fault, in the hope you'll get something done about it. In essence, that pain is keeping you alive.
Yes, this chest pain may be angina. But if you have a cardiac 'all clear' this chest pain is likely to be coming from a strained rib
The middle and lower ribs can cause a pain that circles around the side of the chest wall to the front, in a girdle distribution following the line of the rib. This pain may feel like a cramp or a 'stitch' and is often related to physical exertion. Here, it may be misconstrued as pain in the diaphragm when breathing. The same pain may also be brought on by side-bending away from the side of pain, to open up the ribs and stretch the intercostals and the side trunk muscles.
Athletes who're always getting the same 'stitch'
often have an undiagnosed lower rib problem
Excruciating pain when breathing is usually related to the vertebrae at the same level also being jammed. As is typical of a stiff spinal segment in the lumbar spine, a chance errant action can catch the spinal coordination mechanism unawares and cause micro-injury of the outer wall of a disc. This causes the vertebra sitting on top of that disc to become more sluggish. It is easily palpated by human hands, like a stiff link in a bicycle chain.
A chance movement may cause a thoracic vertebra to become stuck, twisted imperceptibly on its axis. It may develop a bony kink in the spine that sits up proud, clearly visible for others to see. On the other hand, a problem thoracic vertebra may become recessed, like a piano key that won't come up. You can read more about this originating neo-pathology in the webpages 'Micro-trauma of the outer disc wall' rather than repeating it again here.
A stiff spinal segment in the thoracic spine may also cause upper back pain, the distribution depending on which vertebral level is involved. However, there will not be upper back pain when breathing unless the rib is also implicated.
In some cases of advanced osteoporosis, and more so with the elderly, it is possible to develop spontaneous spine compression fractures which are a potent source of pain.
An imperceptibly twisted rib can cause excruciating back pain when breathing. Chest pain too!
With a vertebra not moving properly, it's easy for the neighbouring rib to become roped in and lose mobility too. However, this sequence can also happen in reverse. A rib wrenched afresh by a chance awkward action is locked up by protective muscles and this locks the attached vertebrae out of action. The multifarious rib-to-spine junctions become more laboured and this starves the disc of its ability to suck-and squirt a fluid exchange through (to move nutrients and waste products in and out). The disc starts to dehydrate and shrivel. If it loses height (disc thinning) there's the added complication of the roof coming down on all the moving parts. You start to get pain from the bunched down disc wall in addition to inflammation of both the costo-vertebral and costo-transverse joints of the rib. Upper back pain when breathing cycle intensifies.
The discs at the very top of the picture are very much thinner, bringing the roof down on the working ribs at those spinal levels
Upper back pain when breathing may be brought on by repeated coughing fits as part of a chest infection, even though you may feel nothing at the time. Acute bronchitis, bronchiectasis, pneumonia, or just a bad case of the flu' often involves severe bouts of coughing which may leave you with one (or more) strained ribs. But if you plain unlucky too, it can happen with a chance errant action that is seemingly absurdly trivial. That said, an incident like this is often associated with being in some way slightly below par: a sub-clinical viral illness, extreme tiredness, a stressful (emotional) period, or when you're just running on empty.
Breathing problems are becoming more commonplace
Sometimes upper back pain when breathing is less of a problem than a rising sense of panic about getting enough air. Trying to get that satisfying 'king breath' becomes ever more elusive, especially when a sharp inhalation stretches the affected intercostal muscles, making them lock down harder. Apart from having a sharp rib pain with breathing, there's pain too from the sudden stretching of the muscles.
Of course, this is often exacerbated by sedentary lifestyles, where hours are spent hunched over a desk, computer, steering wheel, sewing machine, or any number of highly-focused work hours. Back pain and breathing trouble is frequently brought about by habitually using a computer when propped up in bed (just like as I'm doing right now)!
Using the emergency or 'accessory muscles of respiration' can cause a pain in the neck while breathing
As the cycle of 'air hunger' intensifies breathing becomes more panicky. Over time, the tightness of the ribs spreads across the entire chest, with the result that all-round mobility gradually closes down. Increasing shortness of breath can lead to all sorts of unwelcome medical ailments ~ from asthma to panic attacks, sleep apnoea and cardiac assessments; all to do at source with the lungs' inability to fill fully and quietly from the bases up.
With increasing breathing difficulty it's inevitable to switch to mouth breathing using the 'accessory muscles of respiration' in the neck trying to get a properly satisfying breath. Many chronic neck problems are brought about by chronic mouth breathing. Indeed, one keeps the other going.
Using the neck muscles to breathe usually means you mainly aerate the upper lobes of the lungs
Over-activity of the scaleni and sternomastoid muscles at the sides of the neck give the neck a strained, buttress-root look. The tension in the neck also makes it look thicker and shorter as the shoulders are permanently hoisted up. Apart from the neck becoming increasingly stiff and painful to turn, there's also commonly pain in the neck while breathing, worse on deep breathing.
Proper, relaxed diaphragmatic breathing has to be re-learned so that the neck muscles can switch off. This is a large topic in itself and unsuitable for discussion here.
Mobilising pressures with the thumbs to 'dig in' to to the rib-to-spine junction and mobilising the rib angle is ideal
It is easy for experienced hands to fell a problem rib. Depending whether it is twisted at the front or back of the chest, the rib will feel palpably raised, like a cable around a barrel. One assumes it is pushed up proud by the clenching contraction of the intercostal muscles.
Pressure by experienced thumbs to depress the rib elicits a 'sweet' pain. Patients say it feels a good pain, as if it's a relief to have it found. (This is another example of a good pain that releases endorphins, as opposed to a bad pain). Mobilising pressures from an experienced physiotherapist or masseuse will help loosen the rib.
There are many exercises that you must do yourself to mobilise the thoracic spine and the stuck ribs. Here I recommend you read the entire 'Thoracic Spine' section of one of my books:
Body in Action from Amazon USA (5 readers reviews) or: the same book, with the title Keep Your Joints Young is available on the UK Amazon (25 readers' reviews).
Both sites have the book available in Kindle. Or, you can buy the book through the Products page on this site and we will send it to you from our office here in Sydney. It is cheaper via Amazon!
The Thoracic BackBlock
Using the BackBlock under the thoracic spine is one of the best ways to mobilise the spine and the ribs. It pulls the spinal segments apart and help free the rib investments.
You can also watch my video where I explain the benefits of this exercise and demonstate the best technique for using the thoracic back block. Click on the image below.
Bridging through the Ribs
Rolling up the spine through the thoracic spine is a way of actively mobilising the ribs yourself.
You can tip to the left or the right, whichever is your problem side, and once you have found the trouble-maker, you can rock backwards and forwards minutely to mobilise it.
Isolating and pressuring the rib will give you a 'sweet' pain as you roll over it.
Click here to read more about Pelvic Bridging, which although not quite the same (this section is about spinal fusion) shows you what's entailed.
Many people who suffer from from curvature of the spine suffer upper back pain when breathing.
In this condition, the lateral curving and buckling of a spine (that should be straight) make it especially difficult for the ribs to key into the sides of the spine
If this is you, I suggest you read these pages on Spinal Scoliosis
If you're not in Australia, buying the books through Amazon.com is a whole lot faster and cheaper than buying through us!
Sarah's newest ebook, 'Be Careful about Back Surgery' is now available on Kindle for only $4.95
Australian and New Zealand buyers can buy the books from
(videos not downloadable on iPad and iPhone - see The Back App for downloading to these devices)
Sign up for our newsletter and receive:
The Trouble with Sitting
Our free downloadable and printable document will tell you all you need to know about sitting, why it can be bad for you and what to do about it. Learn how to reverse the damaging effects of sitting slumped in front of your computer all day!
All you have to do to receive this free resource is fill in your email address below.
You will also receive our newsletter which we send out from time to time with news of our latest pages, articles and products. You can unsubscribe any time you like, and don't worry, your email address is totally safe with us.