Why Does My Back Hurt When I Cough or Sneeze?
Coughing & sneezing causing back pain?
It’s normal to be a little sore after an intense coughing or sneezing fit. Forcing enough air out of your lungs to clear your airways of mucus and other irritants can put serious strain on the muscles in your chest and ribcage. But is it normal to feel pain in your back when you cough or sneeze?
The answer is no, it’s not normal. But if your back pain flares up when you cough or sneeze – or, for that matter, when you laugh or go #2 – there’s usually a good explanation for their connection.
So let’s explore first what might be causing back pain when you cough, and then how to take care of it.
Not All Back Pain Is The Same
In the US, back pain affects 75 to 85 percent of all adults. And like many of the patients who eventually make their way into Ascent Chiropractic know, getting the correct treatment to alleviate back pain can be a frustrating and challenging task, for both patients and healthcare providers.
Back pain is way too often treated as a single diagnosis. In fact, the term ‘back pain’ really isn’t a diagnosis at all, but rather a description of a symptom. Treating all patients that present with back pain the same is like prescribing antibiotics to every patient with abdominal pain. Just as there are many conditions that lead to abdominal pain, there are many distinct causes of back pain.
If you can identify what’s specifically at the root of the problem, you can customize a treatment plan to address the cause instead of simply managing the symptoms. Matching the diagnosis to the treatment plan is crucial to correcting what’s causing your back pain.
Unfortunately, accurately diagnosing the root of a musculoskeletal problem is a surprisingly rare skill.
Studies have shown that in 85-90% of cases primary care physicians are unable to identify an exact cause of back pain. More often than not, this results in prescribing painkillers, anti-inflammatories or muscle relaxers to manage the pain, or scheduling a cortisone injection and sending the patient on their way – instead of trying to fix the cause of the problem.
3 Types of Back Pain
Biomechanical spine problems can be broken down into 3 general categories: flexion dominant back pain (pain that gets worse when you flex forward), extension dominant back pain (pain that gets worse when you extend backward), and compression dominant back pain (pain caused by the compression effect of gravity on the structures in your spine).
When it comes to coughing or sneezing we’ll be focusing on flexion sources of back pain. After all, when we cough, we naturally engage our abdominal musculature and flex our spines.
Of course, there are plenty of other pathologies that can cause back pain – including inflammatory, degenerative, and chronic pain conditions – but these three basic categories encompass the most common acute causes.
The primary structure involved with flexion dominant back pain is the intervertebral disc (though this isn’t always the case). Discs act as cushions between the vertebral bodies of your spine. They’re pretty darn tough, but due to vertebral misalignment and/or the natural processes of aging, a disc can become inflamed (a ‘hot’ disc) and its outside layer can weaken.
In some cases, the jelly-like nucleus of a disc can bulge outward, hitting nearby nerves and causing radiating arm or leg pain. This is called a bulged, slipped, ruptured, or herniated disc, depending on the severity.
Bending forward puts direct compression on your intervertebral discs, especially those in your lower back. Add to that the extra intra-abdominal pressure created by coughing or sneezing, and it’s no surprise an already-inflamed disc will make you acutely aware that it’s not happy.
In fact, there’s an orthopedic test called the cough test that’s often used if a disc problem is suspected. If a patient experiences sharp, acute back pain when they bend forward and cough, it’s a good bet an inflamed disc is responsible.
Disc problems usually have other distinguishing symptoms, as well:
- Sudden back pain that’s worse with sitting, bending, or lifting
- Symptoms that improve after standing and walking for short durations
- Possible tingling, numbness, or weakness in the legs
- Loss of range of motion (difficulty straightening up from sitting)
Fortunately, disc problems respond extremely well to conservative chiropractic care and physical therapy. Observational studies have shown that over 90% of patients with disc herniations report feeling improved or much improved within the first two weeks of beginning chiropractic treatment. Even better, over 55% of patients report significant improvement after just one visit.
Chiropractic has even been shown to be equal to or better than nerve root injections for disc pain symptoms.
McKenzie Exercises For Disc Injuries
Of course, the exact treatment plan that’s going to be best for you is best determined by your doctor. At Ascent Chiropractic we’ll often also give patients with disc problems passive, progressive extension stretches called McKenzie exercises.
McKenzie exercises are designed to reposition any displaced intervertebral discs and strengthen the surrounding muscles and structures to prevent re-injury. While they can be done at home, it’s important that you start with a foundation set by your doctor to help ensure you’re performing them correctly (and that you should be performing them at all).
Disclaimer: repeated extension exercises performed the wrong way or on spines that have lost significant disc height can make your back pain even worse. Check with your doctor first.
The basic McKenzie exercise progression begins with prone lying, progressing to prone lying while resting on elbows, and then finally to prone press-ups. Start with prone lying and only progress when the stretch you’re doing doesn’t cause discomfort. Here’s the progression:
1. Prone Lying
- Lie down on your stomach. Place your arms at your sides.
- Turn your head to the side or face down.
- Hold for 2 to 3 minutes. Repeat up to eight times a day.
2. Prone Lying While Resting On Elbows
- Lie down on your stomach. Prop yourself up on your forearms with your shoulders above your elbows.
- Hold for 2 to 3 minutes.
- Lower your upper body. Repeat up to eight times a day.
3. Prone Press-Ups
- Lie down on your stomach. Place your hands under your shoulders.
- Slowly straighten your arms to lift your upper body. Hold for 2 seconds. Return to starting position.
- Complete 10 reps. Repeat up to eight times a day.
The other possible source of pain in flexion dominant back pain is the muscles that provide support for your back, ribcage, and pelvis.
If there’s muscle fiber damage – say, from a few days of intense coughing – the muscle tissue can become inflamed, swollen, and stiff. It’s part of the body’s natural response to muscle strain, in which blood is rushed to injured tissue in order to start the healing process.
Unlike disc pain, which is sharp and localized, muscle strains usually cause diffuse, wide-spread pain and stiffness across your back.
If it’s a muscle strain, you’ll likely also experience:
- Muscles that feel tender to the touch
- Muscles that spasm or cramp and contract tightly
- Worse pain with certain movements, such as bending forward or getting out of bed
- Intense pain the first few days, followed by dull, achy pain and stiffness for 1 to 2 weeks
Even if you think it’s simply a muscle strain, it’s worth being evaluated by your chiropractor to confirm that’s all that’s going on. In most cases, though, their recommendation will include resting and icing (20 minutes at a time) for a few days or until your doctor gives you the okay.
Rib (Costovertebral) Pain
The last source of back pain with coughing and sneezing we’re going to discuss is the costovertebral joint, where a rib connects to the vertebra in the upper back. Overstretching the ligaments supporting this joint – say, from a violent sneeze – can lead to pain, reduced range of movement, swelling, and stiffness.
Costovertebral joints are actually a very common source of back, shoulder, and chest pain, but they’re frequently overlooked.
If the cause of your back pain is a rib/costovertebral joint, you might experience:
- Localized pain between the shoulder blades, 3-4cm to one side of the spine
- Worse pain with deep breathing, coughing, or twisting
- Tightness through the chest
But as painful as rib problems can be, they usually improve rapidly with chiropractic treatment. At Brookfield chiropractor Ascent Chiropractic, that’s often followed by stretching and myofascial release therapy for the paraspinal and intercostal muscles along with targeted exercises for the scapular stabilizing musculature.
Back Pain Caused By Coughing or Sneezing?
The bottom line is that it’s not normal to have back pain from coughing or sneezing, but the good news is that there are zero reasons to suffer from it. What we do at Ascent Chiropractic is safe, proven, and should be your first option for relief. Ready to get started? Schedule an appointment by calling us at 262-345-4166 or using our online scheduling app.