Mar. 17, 2025

Upper Back Pain While Coughing: Causes & When It’s Serious

Karen Shackelford, MD

Physician

General Medicine / Resources /

Upper Back Pain While Coughing: Causes & When It’s Serious

Back Pain

An older man on the couch using the computer

Upper back pain while coughing is usually a sign of muscle strain, a viral infection, or a lung condition.
Most cases of upper back pain with coughing resolve within two weeks with conservative management at home.
See a medical professional if your symptoms don’t respond to home remedies, worsen, or limit activities of daily living.

Experiencing upper back pain when coughing can cause discomfort ranging from mild to severe. A muscle strain in the rhomboid and trapezius muscles, which support the shoulder and upper back, is usually the cause of upper back pain that you feel primarily when coughing.

If you have a previous back problem, coughing may be especially painful or cause further injury to the muscles and ligaments. You could also have pain from respiratory or cardiovascular disorders, some of which may be serious. Understanding the underlying cause of your pain can help you determine if you should see your doctor for further evaluation.

Is it normal to experience upper back pain when coughing?

Upper back pain during coughing is common, particularly when you’re sick. But experiencing pain while coughing isn’t necessarily considered “normal.” It may be a sign of an infection or chronic health condition.

Coughing with force can strain the muscles between your shoulder blades and along your upper spine, causing pain. Fortunately, this sort of pain is typically temporary and resolves as the underlying cough improves.

You might also experience upper back pain when coughing if you have an injury or illness affecting the lungs, back, or muscles in the surrounding areas.

Causes of upper back pain when coughing

The most common cause of upper back pain and coughing is muscle strain. However, there are many other conditions or circumstances that could lead to both upper back pain and coughing.

Muscle strain

Repeated coughing can overwork the trapezius and rhomboid muscles in your upper back and shoulder region.

The sudden, forceful muscle contractions you may experience while coughing can cause micro-tears in the muscle fibers of the upper back, leading to inflammation and pain.

Muscle or ligament sprain

The muscles and the ligaments that connect your muscles to your bones can become irritated or inflamed from repetitive coughing motions.

This condition typically causes localized pain that gets worse with deep breathing or rotational movements.

Costovertebral joint inflammation

When the cartilage in the joints between the ribs and the vertebrae becomes inflamed, you can experience sharp upper back pain with breathing and coughing.

Pleurisy

The pleura is the thin membrane surrounding your lungs and the inside of your chest cavity.

When the pleura is inflamed, it can cause sharp pain in your upper back when you cough. Pleurisy often develops as a complication of respiratory infections and may be accompanied by difficulty breathing.

Herniated disc

The discs in the spinal column are rubbery cushions that separate your vertebrae. Coughing can cause a disc to herniate (slip or bulge), which also causes an increase in the symptoms associated with a known disc herniation.

A bulging disc presses on the nerves exiting the spinal cord, causing pain that usually radiates. This may cause neurological symptoms like numbness, tingling, or weakness in your arms.

Poor posture

Many people who work all day at their desks or on a computer without changing their posture may develop upper back pain. The strain on your muscles may worsen if you’re also coughing frequently.

Vertebral fracture

A vertebral fracture can develop after a strong cough. This primarily occurs in people who have bone fragility or osteoporosis.

Vertebral compression fractures usually occur gradually, so people are not aware that they have one. Coughing can aggravate the vertebra and cause the fracture to become symptomatic.

Bronchitis

Acute or chronic bronchitis can cause persistent coughing that strains the upper back muscles.

The inflammation of bronchial tubes leads to increased coughing frequency and intensity, potentially causing musculoskeletal pain.

Pneumonia

Lung inflammation from pneumonia can cause upper back pain through several mechanisms. The infection can irritate the pleural lining, leading to pain that worsens with coughing.

Additionally, the increased work of breathing and frequent coughing can strain the chest wall and upper back muscles. Up to 30% of pneumonia patients experience upper back pain.

Upper respiratory infections

Common colds and other upper respiratory infections can lead to post-nasal drip and persistent coughing.

While typically less severe than pneumonia or bronchitis, these infections can still cause significant muscle strain in the upper back, particularly if the cough persists for several days or weeks.

Heart attack

While most people expect chest pain during a heart attack, many patients experience upper back pain, which often worsens with coughing or deep breathing. Women and people assigned female at birth particularly may present with atypical signs, including back pain, rather than classic chest symptoms.

Warning signs associated with a heart attack include:

Upper back pain accompanied by chest pressure or tightness
Pain radiating to jaw, neck, or arms
Shortness of breath
Nausea or cold sweats
Pain unrelated to movement or position

Cancer

While a severe illness like cancer is unlikely to be the cause of your back pain, certain cancers may contribute to this symptom.

Approximately 25% of lung cancer patients, for example, report back pain as an early symptom. Several types of cancer can cause upper back pain that worsens with coughing, including lung cancer, lymphoma, and metastatic disease.

If you're experiencing pain that's not localized to your upper back, read our general guide on back pain when coughing for more.

How to get at-home relief from upper back pain when coughing

Managing upper back pain at home requires a multi-faceted approach that targets the cough and associated muscle tension. Here are some steps you can take to find relief quickly.

Rest

Give your muscles a chance to recover and rest. As you heal, sleeping on your back can help you reduce upper back pain with coughing by keeping your spine aligned.

Cold therapy

Apply an ice pack to the sore muscles or use a liquid cooling solution like Biofreeze®, which comes in a spray, cream, and roll-on. Keep your cold compress on the affected area for about 15 to 20 minutes, and be sure to wrap it in a thin towel to protect your skin.

Heat

Apply a heating pad or warm compress to the affected area for 15-20 minutes every two to three hours. The heat helps increase muscle blood flow, reduce tension, and promote healing.

Massage

Massaging the affected area can help your muscles relax and promote blood flow to the area. If the pain is between your shoulder blades, you can lay flat and roll on a tennis ball under the sore muscles.

Over-the-counter medications

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are available over-the-counter and can help reduce pain and inflammation. Follow package instructions and avoid exceeding recommended daily doses.

Gentle stretching

Carefully performed stretching exercises can help relieve muscle tension and improve flexibility. Focus on shoulder blade squeezes and gentle thoracic extension movements, performing each stretch for 15-30 seconds.

How to prevent upper back pain when coughing

Prevention strategies focus on maintaining good respiratory health and proper body mechanics during coughing episodes.

Practice a good cough technique

You can limit the strain coughing puts on your muscles by maintaining a specific position. Support your upper back by placing one hand on your chest and the other on your abdomen while coughing. This technique helps distribute the force more evenly across your torso.

It can also be helpful to hold a pillow to your chest to reduce the force of large, painful movements when you cough.

Maintain good posture

The core muscles provide support for the upper back while you are coughing. By maintaining good posture, you can develop your core muscles and reduce the odds of straining your upper back.

Exercise regularly

Strengthening your core and upper back muscles through regular exercise can help them better withstand the stress of coughing. Gentle exercise can help maintain back muscle flexibility and reduce pain.

Avoid irritants

Keep your lungs and airways healthy by avoiding irritants like smoke and maintaining good air quality in your living space. This can reduce the frequency and severity of coughing episodes.

When to see a doctor about upper back pain when coughing

Specific symptoms warrant prompt medical attention to rule out serious conditions of upper back pain when coughing. They may be caused by an underlying condition or disease that needs additional treatment.

You should see a doctor if:

Talk to your doctor if one or more of the following applies to you:

Your upper back pain and coughing persist for more than two weeks despite home treatment.
You have pain that significantly limits your daily activities.
You have unexplained weight loss or night sweats.

You should go to the emergency room if:

You have one or more of the following symptoms:

Chest pain or pressure radiating to the back, jaw, arm, or shoulder.
Difficulty breathing.
A fever above 101.5°F (38.6°C).
Coughing up blood.
Sudden, severe upper back pain or chest pain.
Numbness or tingling, weakness, or incontinence.
Pain that feels like ripping or tearing.

Questions to ask your doctor about upper back pain when coughing

What diagnostic tests might be needed to determine the underlying causes of my pain?
Are there any specific activities or movements I should avoid?
What red flags should prompt me to seek immediate medical attention?
How long should I expect recovery to take?

How a doctor may help treat upper back pain when coughing

Healthcare providers will recommend treating the underlying cause of a cough with upper back pain. Your doctor will ask you to describe your symptoms and take a detailed history to determine which steps to take next. Here are some potential interventions your doctor may suggest:

Physical therapy

A physical therapy program can help strengthen your core and upper back muscles, give you more support, and improve your posture. Treatment typically includes specific exercises and manual therapy techniques.

Prescription medications

Healthcare providers may prescribe muscle relaxants, stronger pain medications, or medications to address the underlying cause of chronic cough.

Radiological imaging

Doctors sometimes order imaging studies like X-rays, CTs, or MRIs to evaluate structural problems or severe conditions.

Read our full guide on back pain treatments for more.

Frequently asked questions: upper back pain when coughing

Understanding common concerns can help you better work with your doctor to manage your symptoms. Below are some questions frequently asked by people who have upper back pain when coughing:

Can upper back pain from coughing be caused by pneumonia?

Yes, pneumonia can cause upper back pain when coughing due to inflammation of lung tissue and surrounding structures. Pneumonia is typically accompanied by fever, fatigue, and difficulty breathing.

What if your upper back pain when coughing is felt between your shoulder blades?

Pain between the shoulder blades often indicates muscle strain but can signal conditions like pleurisy and thoracic disc problems.

If this pain persists or is severe, a medical evaluation is recommended. Severe back pain could also be a sign of a heart attack or a thoracic aortic aneurysm.

What if you feel a stabbing pain in your upper back when coughing?

Stabbing pain could be an indication of pleurisy or costovertebral joint inflammation. If accompanied by difficulty breathing or chest pain, seek immediate medical attention.

What you should remember if you have upper back pain while coughing

While upper back pain during coughing is often mild and usually resolves within a few days to a couple of weeks, it is essential to understand the cause and know when to see the doctor or healthcare provider. With proper treatment and prevention strategies, you can minimize the impact of this common but uncomfortable condition.

Most cases respond well to home care, but you should seek medical attention if you have concerning symptoms. Recognizing alarm symptoms will help you get faster care with potentially better outcomes.

General Medicine follows a strict editorial process, including using real experts to write our articles, vetted primary sources, fact-checking, a secondary medical review, and updates as necessary. This article was medically reviewed and fact checked by Dr. Lane Thaut, DO.