“It hurts to breathe.” Have you ever said these words? Did you mean them literally, or were you trying to say that you carried out something grueling, like an ass-kicking workout, or that you worked your third restaurant shift in a row, or even after you were injured from a fall or car crash? Sometimes our bodies feel so sore and beat-up that it seems like they will ache doing just about anything, even breathing. But having pain on breathing can mean something significant, maybe even serious. So it’s a good idea to be aware of the possibilities so that you might make the right decision if ever you find yourself in the situation.
Painful breathing has many potential causes, so it is important that you pay attention to any associated symptoms. You will also need to be aware of what you have been doing – activities, work, sport – as this will give you (or a doctor) a good idea of what could be causing your pain. Most importantly, though, if you are having shortness of breath, pain radiating into an arm or jaw, or a blue discoloration to your fingers, you will need to visit an emergency room (ER) right away.
As a chiropractic doctor, my focus is on musculoskeletal issues – that is, pain emanating from the joints, muscles, or nerves primarily. These are the elements I treat, where I am able to help a client directly. However, because it is not uncommon for more serious issues to mimic musculoskeletal pain, I do encounter from time to time patients who have more serious underlying issues that need medical attention. Saying that, I will address here briefly some potential non-chiropractic situations to help guide you in the right direction if a medical or ER visit is warranted, but then I will spend the bulk of this article on one predominant musculoskeletal condition that can cause pain on breathing, refer you to a previous article for a second condition, and prepare you for a third which I will cover in my next article.
A number of tissues, organs and structures could be responsible for painful breathing. The lungs and heart are two of the more serious origins of this type of pain and would be imperative to get you into emergency care. While the lungs do not have pain receptors themselves, the pleura – tissue surrounding the lungs and chest cavity lining – do, and thus pain emanating from the lungs is usually pleural in origin. When the pleura inflame, it is called pleuritis or pleurisy. Its main symptom is a sharp pain on deep inspiration or coughing. Things which can lead to pleurisy are infection, heart and lung issues (like heart attack or pulmonary embolism), autoimmune disorders, cancer, hemothorax (bleeding due to injury), and even certain drugs, both prescription and illicit. I will keep it simple – if you have a distinct, sharp pain on deep inspiration along with cough, choking, loss or decreased level of consciousness, chest tightness or pain, severe shortness of breath, blue skin, fingers, or nails, excessive sweating, or sudden dizziness, then go to the ER immediately. Further, if you have fever or coughing along with sharp, stabbing, or burning chest pain on breathing, coughing, sneezing or laughing, then you will also need to go to the ER immediately.
As I have already mentioned, the number of potential dangers that would lead to pain on breathing are many – I have only brought up a few here; but I have addressed the major symptomatology that should be a warning signal for you to seek emergency care. But many cases of painful breathing do not have those associated symptoms – what about them? Typically, when painful breathing is without extra symptoms, it comes from the musculoskeletal tissue – joint, cartilage, or muscle. The first would be spinal and muscular origin, like that which I discussed in my last article on shoulder blade pain. No doubt, spinal subluxation and associated muscle spasm/trigger points could cause pain on breathing. Chiropractic care would be the best approach to resolving this issue as it will address both the spinal and muscular components. A good massage isn’t bad, but it will likely only produce half-results, and thus a rapid return to upper back pain on deep inspiration.
The next cause of musculoskeletal pain on breathing would be due to a subluxated rib. Ribs attach to the thorax via the sternum (breastbone) in front and thoracic spine in back. This structure together is called the thoracic cage and houses your heart and lungs. The ribs, like most bony structure, attach via joints, and this allows their movement. Rib movement is necessary during breathing – the thoracic cage must expand and contract along with the lungs on respiration. Like all joints, rib joints can subluxate – in other words, they can fixate. Some people refer to this type of situation as “bone out of place,” and while there is some truth here, it is really more accurate to speak in terms of non-movement, or joint fixation. But if bone out of place makes things more visually understandable for you, then by all means, your ribs can be knocked out of place. It is not a dislocation, although these can happen too, but instead more like a displacement (again, not totally accurate, but for help conceptualizing, then okay).
Rib subluxations can and do occur. I personally had a rib “knocked out of place” while playing touch football many years back, and I received a solid block to the thorax which knocked a rib out. It took roughly six weeks of care to resolve the issue. Rib subluxation pain is not fun; I felt it in front on my rib cage by the right nipple, particularly on breathing. One might also feel rib pain in back. The necessary treatment for this situation is chiropractic care, primarily to release the fixated joint, and then myofascial release for any associated spasm of surrounding muscle.
Another common ailment which can cause pain on breathing is spasm or strain of the intercostal muscles. The rib cage itself has muscles between adjacent ribs, which are necessary for rib movement during inspiration and expiration. Like any muscle, intercostals can be injured and spasm. Injuries may occur from blunt trauma, like my football accident. One client of mine banged her rib cage on her baby’s crib reaching in to grab the tyke for a feeding at 3 am when she was half asleep. That woke her up the hard way. And it also kept her somewhat sore, particularly on deep inspirations, for about four month’s time. Unfortunately, in my experience, an injury to the rib cage muscles can cause chronic pain, which means it can stick around for some time, so it’s essential for a person who has injured this area to seek immediate chiropractic care lest four months turns into eight for lack of attention. This is true for any musculoskeletal condition – the sooner you address the issue, the sooner it will go away. Fail to address the issue, and it is possible that the pain sticks around for a long time.
The third musculoskeletal condition which can cause pain on breathing is costochondritis, an inflammation of the costochondral joints which articulate the ribs and costal cartilage in the front of the rib cage. This extremely painful condition warrants an article all its own, thus I will save it for next time. However, if it does hurt you to breathe – literally, pain on respiration – then you will need a doctor. Pain associated with other symptoms like coughing, fever, sharp pain or chest tightness, should have you seeing an ER doctor straight away. When those symptoms are absent but pain with breathing persists, then you’ll need a chiropractor. If you are in Beverly Hills, Los Angeles, or West Hollywood – contact my office. We will get you breathing pain free again in no time.