Pain when breathing: causes and treatment

If you feel pain with every breath, have difficulty breathing, or feel tightness in your chest, then it's understandable that you're worried. It is well known that heart attack, lung cancer or other serious illnesses can trigger such symptoms. But what you may not know is that your chest muscles and diaphragm can also cause breathing pain.

In this post, we explain possible causes of breathing pain and diseases that have painful breathing as a symptom. Finally, we'll show you a few exercises that you might use to relieve this pain.

the essentials in brief

• Pain when breathing can have a variety of causes. Depending on the affected area, the symptoms are very different.
• There are a wide variety of diseases that have painful breathing as a symptom, such as asthma, pleurisy or pneumonia.
• Depending on where your discomfort comes from, you can choose the best exercise for you to relieve this pain while breathing.

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Background: What you should know about your chest

Since pain when breathing usually originates in the chest area, let's take a closer look at the anatomy of this area.

Structure of the chest

Humans have twelve pairs of ribs. These attach to just as many vertebral bodies, which together form the thoracic spine. At the other end, each rib merges into the costal cartilage, which is fused to the sternum. Due to this special construction, your ribs form a kind of cage that protects the vital organs heart and lungs.

The ribs and processes of the vertebral bodies are each connected by two small joints, in which the rib moves with every breath. Thanks to the joints and the rib muscles, which are arranged like fishbones between the ribs, the chest can rise and fall with every breath. Special respiratory muscles shaped like a saw also help with breathing.

In addition to the auxiliary muscles on and between the ribs, there is also a very special muscle that is significantly involved in every single breathing process: the diaphragm. It separates the thoracic cavity from the abdomen and can be described as a tendon plate covered by a layer of muscular domes. Their beginnings are in the area of ​​the lumbar spine, the sternum and the ribs(1).

The inspiration (inhalation)

When you breathe in, the dome-shaped sheet of muscle contracts. The diaphragm sinks, which increases the volume in the chest cavity. At the same time, the abdominal organs are pushed down and the abdomen bulges out. A negative pressure is created, which allows air to flow into the lungs and allows inhalation(2).

Expiration (breathing out)

Conversely, when you breathe out, the diaphragm relaxes, is lifted high into the chest cavity and, by squeezing the lungs, triggers the outflow of air. The stomach flattens out again(2).

Causes of respiratory pain

Pain while breathing can have a variety of causes, from life-threatening to banal. Depending on the affected area, the symptoms are of course very different. For this reason, you should know what you have to pay particular attention to in order to get the best possible treatment for you.

Pain when breathing can have a variety of causes. (Image Source: Eli DeFaria / Unsplash)

For this reason, we are giving you an overview of the clinical pictures that are often associated with breathing pain. This list cannot replace a medical diagnosis. Therefore, please understand them as a first orientation aid and as an extension of conventional views.

Muscular-fascial causes of pain during breathing

If the diaphragm is not moved enough, it can become unyielding in certain fiber areas and thus build up an unnaturally high tension. This hinders inhalation and, above all, exhalation, because the diaphragm has to give way flexibly.

Respiratory pain is often only pain when moving the muscle that exerts the respiratory movement.

If it doesn't, pain can develop and the breathing volume of both of your lungs decreases. The reason why the diaphragm is not moved enough is that we do not breathe deeply enough or move our trunk too little. This in turn goes back to one-sided movement patterns in everyday life(3).

The entire muscular-fascial network from the shoulder to the diaphragm becomes unyielding and, from a certain point, no longer smoothly follows the gentle gliding up and down of the chest when breathing. When this happens, the body reacts with shooting pains that run from the shoulder to the breastbone, are usually bilateral and can worsen with breathing(3).

Pain in breathing due to diseases of the lungs, bronchi or pleura

In addition to coughing and shortness of breath, breathing-dependent pain in the chest is considered a key symptom of a disease of the respiratory tract or lung disease from a conventional medical point of view. Usually there is an infection behind it and the pleura is involved(4).

However, generalizing statements should be treated with caution, because it is often not possible for those affected to clearly state whether chest pain actually affects breathing. In addition, the transition from breathing dependence to persistent pain is considered fluid, so that it is not possible to reliably classify individual clinical pictures according to breathing dependence of the pain(4).

Painful breathing from heart disease

Chest pain is instinctively associated with heart problems. In fact, narrowed coronary arteries can be responsible for the symptoms. The heart muscle is supplied with blood via the coronary arteries. If, due to the narrowing, there is not enough oxygen to the heart, angina pectoris attacks occur:

Chest pain, anxiety and tightness can last for several minutes and scare the victim to death. The pain often radiates to the left shoulder-arm-hand region and is then described by those affected as pain when breathing(5).

Pain when breathing due to diseases in the abdomen

If breathing pain occurs together with abdominal pain, nausea and vomiting, the gastrointestinal tract must be examined carefully. If the left side hurts when breathing, for example, the organs on the left are possible triggers.

If these are damaged, they can be so irritated when inhaled that you feel sharp pains. Heartburn, an inflamed stomach or an ulcer must then be considered, as well as an enlarged spleen. The liver and gallbladder are on the right side below the costal arch. Due to the spatial proximity to the lungs and diaphragm, underlying diseases of these organs can be associated with painful breathing(6).

Diseases with respiratory pain as a symptom

It is important to note that you should not take the following list of individual diseases as a guide to self-diagnosis.

In the following table we list various diseases that often have painful breathing as a symptom(7,8):

Illness	Description
asthma	Asthmatic symptoms are partly due to muscular-fascial tension in the chest muscles and the diaphragm. This refers to the physical symptoms associated with asthma: pain when breathing, tightness, tension and pressure in the chest and shortness of breath.
Acute pleurisy	Severe pain at the end of a deep inhalation, which occurs on one side and sometimes radiates to the back, is characteristic here. The character of the pain can be light, cutting or burning, and the intensity can range from mild to extremely severe. Fever is often an accompanying symptom of pleurisy.
Acute tracheitis and bronchitis	Pain in the throat or behind the breastbone when breathing can also develop with a simple cold. The pain is then often caused by an infectious disease, usually an inflammation of the trachea or bronchi.
pneumothorax	Acute, unilateral and breath-dependent chest pain is the most important symptom of the so-called spontaneous pneumothorax. It is often accompanied by severe shortness of breath and a feeling of suffocation. A pneumothorax is a tear in the pleura that allows air to enter the space between the pleura and the lungs.
pulmonary embolism and pulmonary infarction	This can lead to acute and one-sided pain when breathing. These symptoms usually occur together with coughing up blood-containing secretions and shortness of breath. The reason for this is the blockage of a pulmonary artery, which leads to a pulmonary infarction.
lung cancer	If chest pain increases steadily and is accompanied by coughing, shortness of breath, hoarseness and bloody sputum, this may indicate lung cancer. However, chest pain is not a defining symptom of lung cancer - pain with breathing is even more so.
lung infection	Pain when breathing is a common side effect. Fever, a general feeling of illness, coughing or rattling breathing noises are other typical symptoms of the infectious disease.

Exercises to relieve pain when breathing

If your doctor has ruled out possible causes in the heart, lungs or other organs, you can now do something directly about your pain. In this section you will find valuable tips and two exercises that you can try at home. Test without risk which of the two exercises helps you better.

Depending on where your discomfort comes from, you can choose the best exercise for you to relieve this pain while breathing. (Image source: La Pájara Azul / Unsplash)

Depending on whether your complaints come from tension in the chest muscles or from a "shortened" diaphragm, you can choose the exercise that is best for you or simply integrate both into your daily routine.

stretching of the chest muscles

You will need two chairs for this exercise. You set them apart so far that you can still put your hands and wrists on the seat. Now place a soft pad between the two chairs, kneel on it and place your palms on the seats. Make sure that your upper body is still slightly above the outstretched arms. Keep your elbows stretched the entire time.

Now let your upper body sink to the floor as far as you can bear the pain and your hands can remain on the chairs. Work your way further into the stretch through your breathing.

After 40-60 seconds you go into the counter-tensions: First you press your hands - as hard as you can - into the chairs. You release this force after about ten seconds. Then command your hands to lift off for 10 seconds. Once you have completed this exercise step, you go into deep stretching of your chest muscles again for about 30 seconds(9).

stretching of the diaphragm

Stand or sit up straight. Take a deep breath and then blow out whatever air is currently in your lungs. The best way to do this is to lean your upper body slightly forward just before the end. In this way, you pull your diaphragm up as high as possible. This is how you stretch it to the maximum and, over time, create more and more room to breathe in.

You can also increase this exercise effect if you close your mouth and hold your nose after breathing out completely (as in step 1). Stand back up and slowly start sucking in air as if you're about to inhale. This creates a vacuum. With the help of this negative pressure, the diaphragm can reduce existing incorrect tension in its greatest extension and find its way back to its former strength(10).

Conclusion

Pain when breathing is tricky and should always be clarified with a doctor. In this case, one visit too many is always better than one too few or one too late. There are many different causes that can be behind your pain when breathing, such as muscular-fascial causes, diseases of the lungs, bronchi or pleura, heart diseases or diseases in the abdominal cavity.

It goes without saying that no remote diagnosis is possible through this post. Nevertheless, we would like to offer you an initial orientation on how you can best recognize muscle-related breathing pain.

itemizations

1. lungenaerzte-im-netz.de: pleura, thorax & diaphragm Source
2. Mechanics of Breathing in Man, Arthur B. Otis, Wallace O. Fenn, and Hermann Rahn, 01 MAY 1950https://doi.org/10.1152/jappl.1950.2.11.592 Source
3. Breathing pattern disorders, Journal of Osteopathic Medicine Volume 7, Issue 1, April 2004, Pages 33-40 Source
4. Brims FJ, Davies HE, Lee YC. Respiratory chest pain: diagnosis and treatment. Med Clinic North Am. 2010 Mar;94(2):217-32. doi: 10.1016/j.mcna.2010.01.003. PMID: 20380952. Source
5. Grabhorn R, Jordan J. Functional heart pain. Heart. 2004 Sep;29(6):589-94. German. doi: 10.1007/s00059-004-2593-1. PMID: 15912433. Source
6. Norman W.RantanenD.VM, MS, Diseases of the Abdomen, Veterinary Clinics of North America: Equine Practice, Volume 2, Issue 1, April 1986, Pages 67-88 Source
7. healthline.com: Why Does It Hurt to Breathe, Judith Marcin, MD, 09/18/2019 Source
8. medicalnewstoday.com: What could cause chest pain, Gerhard Whitworth, RN, 01/20/2020 Source
9. acefitness.org: 5 Chest Stretch Variations, Stephanie Thielen, 09/17/2015 Source
10. liebscher-bracht.com: PAIN WHILE BREATHING — IT'S NOT ALWAYS LUNG OR HEART, Roland Liebscher-Bracht Source