Pain guide · Back pain

Upper back pain when breathing: the heart and lungs first, then the rib joints, muscles and a cough

Pain between or around the shoulder blades that catches when you breathe in, cough or sneeze can come from a strained muscle between the ribs, a stiff rib joint beside the spine, or a bruised or cracked rib after a fall or a long cough. But a clot in the lung, pneumonia, pleurisy, a collapsed lung and the heart can cause it too. No study has counted how often each is to blame, and in emergency departments a clot was found in 5% to 21% of people with sharp chest pain on breathing, so the warning signs come first.

Call 999 or go to accident and emergency (A&E) if breathing suddenly becomes difficult, if pain in your chest or upper back comes on suddenly with breathlessness or a very fast heartbeat, or if someone passes out; for chest pain that feels tight or squeezing, or spreads to your arms, neck, jaw or back; and for coughing up more than a few spots of blood. Get an urgent general practitioner (GP) appointment or help from the National Health Service's 111 line (NHS 111) for sharp pain that only comes when you breathe in or cough, or a cough with a fever. Once those are ruled out, this guide covers what helps (deep breaths every hour, supported coughing, keeping moving and not strapping your ribs), how long it usually takes, and a three-stage plan with 3D demos.

3-stage exercise plan When to get help 39 sourcesUpdated 25 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Call 999 or go to A&E if breathing suddenly becomes difficult, if pain in your chest or upper back comes on suddenly with breathlessness or a very fast heartbeat, or if someone passes out. These are the NHS's signs of a blood clot in the lungs (a pulmonary embolism) or another serious condition. Don't drive yourself.
Call 999: chest pain that feels tight or like squeezing on your chest; chest pain that's spreading to your arms, neck or jaw; severe difficulty breathing (you're gasping, choking or not able to get words out); lips or skin that are pale, blue or grey (on brown or black skin this may be easier to see on the palms of the hands); or someone who has passed out and is not responding normally. It could be a heart attack. Don't drive yourself to A&E.
Call 999: sudden pain or discomfort in your chest that does not go away (it can feel like squeezing or pressure inside your chest, burning or indigestion); pain that spreads to your left or right arm, or your neck, jaw, stomach or back; or chest pain and you feel sweaty, sick, light-headed or short of breath. You could be having a heart attack.
Call 999: sudden chest or back pain that can feel like something being torn inside, with shortness of breath and problems walking, seeing or speaking.
Call 999 or go to A&E immediately if you're coughing up more than just a few spots or streaks of blood, or you're coughing up blood and finding it hard to breathe, have a very fast heartbeat or have pain in your chest or upper back. It could be a blood clot in the lungs.
Ask for an urgent GP appointment or get help from NHS 111 if you've coughed up a few small spots, flecks or streaks of blood, or noticed blood in your phlegm, without chest pain or breathlessness.
Call 999 or go to A&E if you have severe difficulty breathing (you're gasping, choking or not able to get words out), your chest feels tight or heavy, pain spreads to your arms, back, neck and jaw, or your lips or skin are turning very pale, blue or grey. Contact NHS 111 if you're more short of breath than usual, you're coughing up blood, or you have pain or swelling in one leg.
Call 999: sudden chest pain or discomfort, or chest pain with feeling sweaty, sick, light-headed or breathless. A collapsed lung (pneumothorax) causes a sudden, sharp, stabbing pain in the chest or shoulder that gets worse when you breathe in, with breathlessness; it is more common in people aged 15 to 34, people who smoke, and tall, thin people.
Ask for an urgent GP appointment or get help from NHS 111: you've had a cough for up to 3 weeks, you're coughing up yellow or green mucus, you have chest pain that comes and goes or happens when breathing or coughing, or you're feeling short of breath. Call 999 or go to A&E if you're struggling to breathe, your skin, lips or tongue are pale, blue or blotchy, you're coughing up blood, or you suddenly feel confused. Don't drive yourself.
Ask for an urgent GP appointment or get help from NHS 111: sharp chest pain that comes and goes, or only happens when you breathe or cough (it can spread to your shoulders and back), sharp chest pain that hasn't got better after a few days, or being short of breath regularly.
Same day (urgent GP appointment or NHS 111): sharp or stabbing chest pain that gets worse when you take a deep breath in, swallow, cough or lie down, or sharp chest pain that only happens when you breathe or cough, or hasn't got better after a few days. These can be pericarditis or pleurisy.
Call 999 or go to A&E: a rib injury caused by a serious accident, such as a car accident. Don't drive yourself: ask someone to drive you or call 999.
Call 999 or go to A&E: with a broken or bruised rib, shortness of breath or chest pain that is getting worse, or coughing up blood. A broken rib may have damaged your lung.
Call 999 or go to A&E: with a broken or bruised rib, pain in your tummy or shoulder. A broken rib can damage the liver or spleen.
Same day (urgent GP appointment or NHS 111): with a broken or bruised rib, you're coughing up yellow or green mucus, or you have a very high temperature or feel hot, cold or shivery. You may have a chest infection that needs antibiotics.
Call 999: calf or leg pain or swelling with breathlessness or chest pain. It could be a clot that has reached the lungs.
Same day: you have or have had cancer, and new back pain that is severe and doesn't let up, is getting steadily worse, is worse at night and disturbs your sleep, is worse when you cough, sneeze or strain, or comes with tenderness over the spine. Contact your cancer team or GP urgently. With cancer, new weakness, difficulty walking, numbness or bladder or bowel problems are an emergency.
Call 999: with bone pain, you suddenly lose feeling in your arms or legs or can't walk or stand, suddenly feel confused, or suddenly can't control when you poo or pee. These could be signs of spinal cord compression, which needs treating immediately. Don't drive yourself to A&E.
Call 999 or go to A&E: you have sudden, severe pain in your tummy; pain that spreads from your tummy to your back, and you're being sick; your temperature is very high, or you feel hot, cold or shivery; or your skin or the white part of your eyes looks yellow. These can be signs of a problem with gallstones.
Same day (urgent GP appointment or NHS 111): pain in your tummy, often in the middle or just under the ribs on the right, that lasts longer than 30 minutes; it may spread from there to your side or shoulder blade. It can be gallstones.
Get urgent medical help: you're pregnant or have given birth in the last few weeks and have symptoms of pre-eclampsia, such as pain below the ribs, a severe headache that does not go away with simple painkillers, vision problems such as blurred vision or seeing flashing lights, or sudden swelling of the face, hands or feet. If you're pregnant, call your maternity unit if you have the number; if you've recently given birth or cannot call your maternity unit, call 111.
Contact your GP or midwife urgently: back pain in the second or third trimester of pregnancy, or back pain in pregnancy with a fever, vaginal bleeding, pain when you pee, or pain in one or more of your sides (under your ribs). It could be early labour or an infection.

See a doctor or physiotherapist if

Pain at the top of the back, between the shoulders, rather than in the lower back.
Pain that doesn't improve with rest or is worse at night, or pain that is worse when you sneeze, cough or poo.
Back pain that hasn't improved after a few weeks of looking after it at home, stops you doing day-to-day activities, or worries you.
Back or chest pain with a cough that has lasted 3 weeks or more, breathlessness, weight loss or loss of appetite, especially if you smoke or used to: see a GP.
A rib broke from a cough, a sneeze or a minor bump: ask your GP about your bone health.
You're 65 or over, or have heart or lung disease, and have hurt your ribs: get it checked rather than managing alone. In hospital studies, older people with broken ribs were more likely to get pneumonia.
Rib pain with no injury that builds up with rowing, golf or other training: see a GP. It may be a rib stress fracture.
Unexplained back pain with muscle spasms, loss of height, or a curved spine or change in posture: a possible osteoporotic spinal fracture, more likely with older age or long-term steroid tablets.
Upper back stiffness that is worse in the morning and at night and eases with exercise, with pain where the ribs join the spine or breastbone, or a deep breath that is hard to take, especially if it started before 45: see a GP. It can be ankylosing spondylitis.
A burning, tingling or painful patch of skin on one side of your back or chest, with or without a rash: get advice from a pharmacist or NHS 111 as soon as possible. Shingles can cause pain a few days before the rash appears, and rarely without one. Try to see a pharmacist within 3 days of the rash appearing.
Bone pain in your ribs, back, hips or shoulders with no clear cause, especially with feeling very tired for no reason, being very thirsty and needing to pee more often, or losing weight without trying: see a GP. Rarely, it's myeloma; the NHS says these symptoms are common and can have other causes, but they need checking.
See a GP if you have chest pain that comes and goes, or that goes away quickly but still worries you.

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

Breathing that suddenly becomes difficult, or chest or upper back pain that comes on suddenly with breathlessness or a very fast heartbeat

Possibly a clot in the lungs: call 999, as the warning signs say.

Chest pain that feels tight, heavy or squeezing, spreading to the back, arms, neck or jaw

Possibly a heart attack: call 999.

Sudden chest or back pain that feels like something tearing inside

Call 999.

A sudden, sharp, stabbing pain on one side, worse breathing in, with breathlessness

Possibly a collapsed lung: call 999.

Sharp pain on breathing in, with a cough, a fever or yellow or green phlegm

Possibly pneumonia or pleurisy: an urgent GP appointment or NHS 111.

Sharp chest pain that is worse lying down and better leaning forward, often after a cold or flu

Possibly pericarditis: an urgent GP appointment or NHS 111.

Between the shoulder blades or the back of the ribs, worse breathing in, twisting or reaching, after an effort, a twist or a coughing fit

Often a strained muscle or a stiff rib joint, once the warning signs are ruled out. This guide covers it, and our rib pain guide maps the ribs.

Read: Rib pain →One spot on a rib that is very sore to press, after a fall, a blow or weeks of coughing

Possibly a bruised or broken rib.

Read: Rib injury →Beside the breastbone at the front, worse breathing deeply, lying down or pressing

Often costochondritis, once the heart and lungs have been considered.

Read: Costochondritis →

The side of the chest, building over weeks of rowing or other training

Possibly a rib stress injury: see a GP.

Just under the right ribs or in the middle of the tummy, sometimes spreading to the back, lasting more than 30 minutes

Possibly gallstones: an urgent GP appointment or NHS 111. With being sick or a high temperature, call 999.

A burning or tingling band on one side of the back or chest, then a rash

Possibly shingles: see a pharmacist.

Sudden mid back pain after a cough or sneeze, especially over 50 or on steroid tablets

A possible spinal compression fracture.

Read: Spinal compression fracture →

Upper back stiffness that is worse in the morning and at night and eases with exercise, starting before 45

Possibly ankylosing spondylitis: see a GP.

A stiff, achy upper back after long spells of sitting

Our upper back pain from sitting guide covers it.

Read: Upper back pain from sitting →Between the shoulder blades, without pain on breathing

Our upper back pain guide covers it.

Read: Upper back pain →Under or around one shoulder blade

Our pain under the shoulder blade guide maps it.

Read: Pain under the shoulder blade →The middle of the back

Our middle back pain guide maps it.

Read: Middle back pain →The chest muscles at the front

Our chest muscle pain guide covers them.

Read: Chest muscle pain →The breastbone

Our sternum pain guide covers it.

Read: Sternum pain →

Understand it

No study has counted the causesEmerging evidence

No study we found has counted the causes of upper back pain that hurts when you breathe, so the order on this page comes from guidelines and reviews of chest pain. In emergency departments, a clot in the lung was found in 5% to 21% of people with sharp chest pain on breathing, a review says, and in 21% of 173 people in one study. In general practice, the chest wall causes a quarter to a half of chest pain (24.5% to 49.8% across 6 lower-risk studies of about 3,900 people), and in 1,212 German patients aged 35 or over, GPs judged 46.6% to come from the chest wall.

Upper and mid back pain is common on its own: across 33 studies of the general population, 3.5% to 34.8% of people had it in a year. Those studies weren't about pain on breathing, so they don't tell you what your pain is; the warning signs do.

Sources 1, 2, 3, 4, 5

The lungs and the lining of the chestStrong evidence

Pleurisy, inflammation of the lining of the lungs, causes sharp chest pain when you breathe in that is worse when you cough, sneeze or move, and it may spread to your shoulders and back, the NHS says. Pneumonia causes a cough, often with yellow or green phlegm, a high temperature, breathlessness, and chest pain when breathing or coughing.

A clot in the lungs (pulmonary embolism) causes sudden breathlessness, chest or upper back pain that can be worse when you breathe in, a fast heartbeat and sometimes coughing up blood, and in a large study its symptoms could be mild or even absent with a big clot. A collapsed lung (pneumothorax) causes a sudden, sharp, stabbing pain in the chest or shoulder that is worse when you breathe in, with breathlessness; it is commonest at 15 to 34, in people who smoke and in tall, thin people.

Sources 6, 7, 8, 9, 10

The heart, and a tearing painStrong evidence

Heart attack pain can feel tight, heavy or squeezing and spread to the arms, neck, jaw or back; the NHS chest pain page names the back, and the British Heart Foundation says women may feel it spreading to the upper back. Pericarditis, inflammation of the lining round the heart, causes sharp or stabbing chest pain that is worse breathing in, swallowing, coughing or lying down and better sitting up or leaning forward, often after a viral infection. Sudden chest or back pain that feels like something being torn inside, with breathlessness and problems walking, seeing or speaking, is a 999 call, the NHS says.

Sources 11, 12, 13, 14, 15

The muscles, the rib joints and the ribsEmerging evidence

A sprain or strain of the chest wall starts after an injury or exercise, may get worse when you breathe in, and feels better when you rest the muscle, the NHS says. When the small joints where the ribs meet the spine were injected in 8 healthy volunteers, they gave a deep, dull ache and pressure over the joint itself, without chest wall pain. No study we found has measured how often these joints or muscles cause pain on breathing.

A fall, a blow or severe coughing can bruise or break a rib, and with thin bones (osteoporosis) a cough or sneeze can be enough. In 54 people with ribs broken by coughing, 78% were women, 85% had coughed for 3 weeks or more, the first chest X-ray showed the break in only 58%, and 65% of the 26 who had a bone scan had low bone density; in another 90 people, 64% had been through the menopause and most breaks were in ribs 4 to 9. Rowers can develop rib stress injuries from repeated loading, and costochondritis causes pain beside the breastbone at the front.

Sources 12, 16, 17, 18, 19, 20, 21, 15

Bone, inflammation and other causesStrong evidence

With osteoporosis, a cough or sneeze can break a rib or partly collapse a bone in the spine. Ankylosing spondylitis can affect the joints where the ribs meet the spine and breastbone, causing chest pain and making it hard to expand the chest when you breathe deeply. Myeloma can cause bone pain in the back or ribs, and in people with cancer, back pain that is worse when coughing or sneezing, or at night, can mean the cancer has spread to the spine, NICE says.

Shingles can start as a tingling or painful band on one side of the back or chest before the rash appears. Gallstones cause pain just under the right ribs or in the middle of the tummy, and pain spreading from the tummy to the back with being sick is a 999 call.

Sources 20, 22, 23, 24, 25, 26, 27

How to tell them apartEmerging evidence

How it started is a clue: most of the dangerous causes (a clot, a heart attack, a tear in the main artery and a collapsed lung) come on over minutes, while infections, cancer and inflammation develop over hours to weeks, a review says. True breathlessness points to a clot, a collapsed lung or pneumonia; holding your breath because breathing hurts is different. A fever with a cough and phlegm points to pneumonia or pleurisy. A painful, swollen leg, a recent operation, a long journey, pregnancy or having had a baby in the last 6 weeks raise the chance of a clot.

Pain that is worse lying back and better leaning forward suggests pericarditis, and a burning band on one side suggests shingles. Pain you can press on is typical of the chest wall but doesn't rule out the heart: in an emergency department, 6% of people with costochondritis were having a heart attack, against 28% of people with other chest pain.

Sources 1, 8, 28, 14, 29, 26, 12

When a test or scan helpsEmerging evidence

The warning signs decide whether you need hospital tests: an electrocardiogram (ECG) and blood tests for the heart, a score, a blood test and a scan for a suspected clot, and a chest X-ray for suspected pneumonia in hospital. For a bruised or broken rib there's often no need for an X-ray, the NHS says, and NHS inform says most rib or chest injuries don't need one; X-rays missed 4 in 10 ribs broken by coughing in one series. Pleurisy may need blood tests, a chest X-ray, an ultrasound or a computerised tomography (CT) scan. The NHS asks you to see a GP for back pain at the top of the back, between the shoulders.

Sources 30, 31, 1, 17, 18, 32, 6, 33

How it usually goesEmerging evidence

Bruised or broken ribs usually get better by themselves within 2 to 6 weeks, the NHS says, and NHS inform says most of the healing after a chest or rib injury happens within 6 to 8 weeks. Pleurisy usually gets better on its own in a few days, the NHS says, though it can sometimes be a sign of something more serious, such as pneumonia. Most people feel better from pneumonia in 2 to 4 weeks, and NICE expects chest pain to have substantially eased by 4 weeks and most symptoms by 3 months. Chest wall pain can linger: 55.4% of people in general practice still had chest pain 6 months later. No one can promise a timescale.

Sources 17, 32, 6, 7, 31, 4

What helps, and how strong the evidence is

Keep breathing deeply and coughing, with supportEmerging evidence

For bruised or broken ribs, the NHS says breathe normally and cough when you need to, holding a pillow against your chest, take slow, deep breaths regularly, and walk around and move your shoulders now and then, to help clear mucus from your lungs and prevent a chest infection. NHS inform's routine is a deep breath in, held for 4 seconds, then a slow breath out, 4 times every hour you're awake, sitting upright, followed by 2 or 3 huffs while hugging a pillow. No trial has tested these steps, but they are the consistent advice of both health services.

Sources 17, 32

Don't strap your ribs, and keep movingStrong evidence

Ribs can't easily be splinted or supported like other bones, so they're usually left to heal naturally, the NHS says. Don't lie down or stay still for a long time; NHS inform advises avoiding long periods of bed rest and keeping activity within a pain level of 0 to 5 out of 10, and says you don't need to be pain-free to start moving.

Sources 17, 32

Painkillers and other first stepsEmerging evidence

Painkillers such as paracetamol or ibuprofen gel (or tablets if needed) help you breathe and cough, and an ice pack wrapped in a tea towel can help in the first few days after a rib injury, the NHS says. For pleurisy, it advises paracetamol or ibuprofen and not smoking or vaping; for pneumonia, it advises against cough medicine, as coughing helps clear the infection. With pericarditis, sitting up or leaning forward eases the pain.

Sources 17, 6, 7, 14

Exercise: borrowed from the rib and upper back guidesEmerging evidence

No trial has tested exercise for upper back pain on breathing. The plan here borrows from our rib pain and upper back pain guides: breathing exercises and walking first, then movement of the upper back and rib cage, then strength for the upper back and trunk. The breathing steps come from NHS inform's chest injury advice and the NHS breathing exercise for stress; neither has been tested as a treatment for pain. In trials of long-lasting muscle and joint pain, exercise that allowed some pain did no worse than pain-free exercise.

Sources 32, 34, 35

A rib broken by coughing: check your bonesEmerging evidence

In two series of ribs broken by coughing (54 and 90 people), most were women, many had coughed for weeks, and many had low bone density or had been through the menopause. The NHS says that with osteoporosis a cough or sneeze can break a rib. So a rib that breaks from a cough, a sneeze or a minor bump is a reason to ask your GP about your bone health.

Sources 18, 19, 20

Pressing on the pain doesn't rule out the heartEmerging evidence

In 122 people with chest pain in an emergency department, 6% of those with costochondritis (pain you could reproduce by pressing on the rib joints) were having a heart attack, against 28% of the rest. A clot is the commonest serious cause of sharp pain on breathing, a review says. So a sore spot you can press on is never a reason to ignore the warning signs.

Sources 29, 1

How much pain is OK while you exercise?

Breathe and cough first; move within comfort, then up to about 5 out of 10; new breathlessness is never a pain-rule questionEmerging evidence

Breathing and coughing come first: breathe normally, cough when you need to with a pillow held against your chest, and take slow, deep breaths regularly, even though it hurts, the NHS says, taking painkillers so you can. For moving about, NHS inform's chest injury advice uses 0 to 3 out of 10 as minimal, 4 to 5 as acceptable and 6 to 10 as too much, and says you don't need to be pain-free to start moving.

For the strength work later on, this guide uses our rib pain guide's rule: up to about 5 out of 10, settling within an hour and no worse the next morning, with no sharp pain at an injured rib (our suggestion). In trials of long-lasting muscle and joint pain, exercise that allowed some pain did no harm.

Sudden breathlessness, breathlessness that is getting worse, coughing up blood, a fever with a cough, chest discomfort that comes on with effort and eases with rest, or chest pain that is tight, heavy or spreading are never pain-rule questions: see the warning signs.

Sources 17, 32, 35

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

First days: breathe deeply, cough with support, keep moving

Once the warning signs are ruled out, for about the first 4 to 6 days or while breathing is sore: the breathing and coughing steps below every hour, painkillers so you can, sleep more upright for the first few nights, and up and walking every hour. Don't strap your ribs.

Lateral breathing (Pilates breathing) demonstrated on the 3D figure

3D demoLateral breathing (Pilates breathing)Beginner · No equipment

Sitting upright, breathe in deeply into the sides and back of the ribs, hold for 4 s, then breathe out slowly, 4 times every hour you're awake · NHS inform's chest and rib injury breathing exercise; the move page's own dose (5 to 8 breaths at the start of a session) is a suggested starting point. In pregnancy after the first trimester, use the sitting version, as the move page says

Harder: Roll-up (Pilates)

Slow breathing (6 breaths a minute) demonstrated on the 3D figure

3D demoSlow breathing (6 breaths a minute)Beginner · No equipment

At least 5 minutes, once or twice a day and when the pain makes you tense; small, quiet breaths are fine if a deep one catches · The move page's dose: the NHS breathing exercise for stress, with once or twice a day as its editorial starting point. Breathlessness that is getting worse is a 999 call, not a breathing exercise

Easier: Breath reach · Harder: Crocodile breathing (prone diaphragmatic breathing)

Treadmill walking demonstrated on the 3D figure

3D demoTreadmill walkingBeginner · Cardio machine

Up and walking at least once an hour through the day; short walks indoors or out · The NHS's advice to walk around and not stay still for long after a rib injury, as our rib pain guide uses it

Harder: Treadmill jogging

Shoulder rolls demonstrated on the 3D figure

3D demoShoulder rollsBeginner · No equipment

5 to 10 slow rolls, 2 to 3 times a day · As in our rib pain guide, from an NHS trust leaflet's repetitions; the NHS says move your shoulders now and then. The move page's dose (10 to 15 circles each way as a warm-up) is more than the first days need (our suggestion)

Harder: Shoulder CARs (controlled articular rotations)

Thoracic rotation demonstrated on the 3D figure

3D demoThoracic rotationBeginner · No equipment

Seated, arms crossed: 5 to 10 small turns each side, 2 to 3 times a day, within comfort · As in our rib pain guide, from an NHS trust leaflet's seated turn

Easier: Side-lying open book · Harder: World's greatest stretch

Move on when: A deep breath and a cough hurt less, and getting in and out of bed and a chair is easier (our rib pain guide's check).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Restore: the upper back and rib cage

From about day 4 to 6, daily: move a little further each time, to mild discomfort at most, never sharp pain, and build up your walking. Keep the breathing steps going.

3D demoThoracic rotationBeginner · No equipment

6 rotations each side, moving with the breath, turning a little further each time · The move page's dose

Easier: Side-lying open book · Harder: World's greatest stretch

3D demoCat-cowBeginner · No equipment

8 slow waves, slower than feels natural · The move page's dose, within a comfortable range

Harder: Half lord of the fishes (Ardha Matsyendrasana)

Side-lying open book demonstrated on the 3D figure

3D demoSide-lying open bookBeginner · No equipment

8 to 10 slow openings each side, pausing 2 s at the end, lying on the less sore side first · The move page's dose, an editorial starting point

Harder: Thoracic rotation

Breath reach demonstrated on the 3D figure

3D demoBreath reachBeginner · No equipment

5 breaths, with the out-breath longer than the in-breath, letting the ribs widen · The move page's dose; the page says it isn't a treatment for pain

Harder: Slow breathing (6 breaths a minute)

3D demoTreadmill walkingBeginner · Cardio machine

Build up to 20 to 30 minutes a day · As in our rib pain guide (editorial)

Harder: Treadmill jogging

Move on when: Deep breaths, coughing, turning and reaching are comfortable most of the time (our rib pain guide's check).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Strength, lifting and sport

Usually from about 4 to 6 weeks, 2 or 3 days a week, with your usual lifting, training and sport brought back by the written steps below. After a broken rib, your clinician's limits come first.

3D demoBand rowBeginner · A band + An anchor point

2 to 3 sets of 10 to 15, stopping 2 to 3 reps short of failure · The move page's dose (3 sets, an editorial starting point), starting at 2 sets as in our rib pain guide

Harder: Supported single-arm dumbbell row

Wall push-up demonstrated on the 3D figure

3D demoWall push-upBeginner · A wall

2 to 3 sets of 10, then push-ups on a lower surface · As in our rib pain guide (editorial)

Harder: Push-up

Prone Y-T-W raises demonstrated on the 3D figure

3D demoProne Y-T-W raisesBeginner · No equipment

2 to 3 rounds of 8 · As in our front and back of shoulder guides (editorial); leave it until lying face down on the ribs is comfortable (our suggestion)

Easier: Wall angel · Harder: Bent-over reverse fly

3D demoDead bugBeginner · No equipment

8 slow reps each side · As in our rib pain and costochondritis guides (editorial). In pregnancy after the first trimester, keep time flat on your back to a few minutes, as the move page says

Easier: Dead bug heel taps · Harder: Forearm plank

Foam roller thoracic extension demonstrated on the 3D figure

3D demoFoam roller thoracic extensionBeginner · A foam roller

5 to 8 slow breaths at each of 3 or 4 spots along the upper back · The move page's dose, an editorial starting point. Leave it out after a recent chest or rib injury, and check with your clinician first if you have osteoporosis (our sternum pain guide's advice)

Harder: Fish pose (Matsyasana)

Move on when: Our suggestion: your usual lifting, training and sport stay within the pain rule, with no extra pain the next morning. Any new breathlessness, coughing up blood or chest discomfort with effort is a warning sign, not a flare.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

Breathing, coughing and huffing (written steps)

Our 3D figure can't show these steps. They come from NHS inform's chest and rib injury advice and the NHS.

1. Sit upright. Take a deep breath in, hold it for 4 seconds, then breathe out slowly and relaxed. Do this 4 times every hour you're awake (NHS inform).
2. After the deep breaths, do 2 or 3 huffs: a fast breath out through an open mouth, as if steaming up a pair of glasses or a mirror. Hugging a pillow or cushion to your chest may ease the pain (NHS inform).
3. Cough when you need to, holding a pillow against your chest; coughing helps clear mucus and prevent a chest infection (the NHS).
4. Take your painkillers so you can breathe deeply and cough (the NHS).

Sources 32, 17

Sleep, moving and smoking (written steps)

These come from the NHS, NHS inform and Asthma + Lung UK.

1. Sleep more upright, propped up on extra pillows, for the first few nights, then go back to your usual position after a few days (the NHS and NHS inform).
2. Walk around and move your shoulders now and then; don't lie down or stay still for a long time (the NHS).
3. Don't strap your chest: ribs are usually left to heal naturally (the NHS).
4. Don't smoke or vape: it can make pleurisy pain worse, and stopping smoking lowers the chance of another collapsed lung (the NHS and Asthma + Lung UK).
5. With pericarditis, sitting up or leaning forward eases the pain (the NHS).

Sources 17, 32, 6, 9, 14

Lifting, rowing and sport come back (written steps)

No trial has tested how to bring these back. These steps are our suggestion, except where a source is named.

1. While ribs heal, don't strain yourself, lift heavy things or play sport that makes the pain worse (the NHS).
2. After a broken rib, our rib pain guide's NHS trust limits are heavy lifting after at least 4 weeks and contact sport after at least 6 weeks; these are minimums, not targets.
3. Bring back lifting first, then pushing and pulling, then twisting and contact sport, a little more each week.
4. Rowers with a rib that hurts more each session need a GP: rib stress injuries have their own return plan (a UK rowing guideline).
5. Any new breathlessness, coughing up blood or chest discomfort with effort is a warning sign, not a flare.

Sources 17, 21

In pregnancy

Pregnancy and the 6 weeks after a birth raise the risk of a blood clot, the NHS says, so breathing that suddenly becomes difficult, or chest or upper back pain that comes on suddenly with breathlessness or a very fast heartbeat, is a 999 call. Pain below the ribs with a severe headache, problems with your vision or sudden swelling of the face, hands or feet needs urgent help for pre-eclampsia. Otherwise, tell your midwife or GP, and after the first trimester do the breathing exercise sitting up.

Sources 28, 8, 36

Positions to swap, and why

Habit or position	Why it matters	Instead
Breathing shallowly and holding back coughs because it hurts	Deep breaths and coughing help clear mucus and prevent a chest infection, the NHS says.	4 deep breaths every hour you're awake, then huffs and supported coughs.Try: Lateral breathing (Pilates breathing)
Strapping or binding your chest	Ribs can't easily be splinted or supported, the NHS says, and they're usually left to heal naturally.	Painkillers so you can breathe and cough.
Lying still or in bed most of the day	The NHS says don't lie down or stay still for a long time, and NHS inform advises against long periods of bed rest.	Up and walking at least once an hour.Try: Treadmill walking
Lying flat at night in the first few days	Sleeping more upright is more comfortable for the first few nights, the NHS says.	Extra pillows, then your usual position after a few days.
Lifting heavy things, straining, or sport that makes it worse while the ribs heal	The NHS's advice for rib injuries.	Light pulling and pushing once stage 3 allows.Try: Band row
Smoking or vaping	It can make pleurisy pain worse, and stopping smoking lowers the chance of another collapsed lung.	Ask a pharmacist or GP about support to stop smoking.
Cough medicine for a pneumonia cough	The NHS says coughing helps clear the infection.	Supported coughing and huffing.
Foam rolling over a sore or recently broken rib	Our sternum pain guide leaves the foam roller out after a recent chest injury.	Seated turns, then the side-lying open book.Try: Thoracic rotation
Upper back raises lying face down on sore ribs	Lying face down presses on the ribs (our suggestion).	The side-lying open book and band rows until lying face down is comfortable.Try: Side-lying open book
Planks while coughing still hurts	Our suggestion: heavy bracing presses on sore ribs.	Dead bugs in stage 3.Try: Dead bug
Rowing training through rib pain that builds every session	It can be a rib stress injury, which a UK rowing guideline manages with its own return plan.	See a GP, and walk or cycle gently meanwhile (our suggestion).
Putting new breathlessness, a fever or chest pain with effort down to your back	These are the warning signs of a clot, an infection or the heart.	Call 999, or get an urgent GP appointment or NHS 111, as the warning signs say.

Routines to follow

Breathing exercises to relax

A 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.

6 minBeginner5 movesNo equipment

Spine mobility routine: neck to pelvis, every direction

A 15-minute routine that moves your neck, upper back and lower back through bending, arching, side bending and twisting, then holds the spine steady.

15 minBeginner12 movesNo equipment

Upper back mobility routine

A 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.

12 minBeginner8 movesA foam roller, A wall

Easy cardio workout

A steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.

40 minBeginner3 movesCardio machine, A wall

3-minute desk movement break

A 3-minute standing break to repeat every 30 to 60 minutes at your desk: sit-to-stands, calf raises, marching, an upper-back turn and chin tucks.

3 minBeginner5 movesA bench or box, A wall

Breathe and move: a home workout for COPD

A 25-minute home session for COPD: marching and light strength work, with pursed-lip and paced breathing and rests in a recovery position when you need them.

25 minBeginner12 movesA bench or box, A wall

More moves for this area

Questions people ask

Why does my upper back hurt when I breathe in?

A strained muscle between the ribs gets worse when you breathe in and better when you rest it, the small rib joints beside the spine can cause a deep, dull ache, and a bruised or broken rib hurts most when you breathe in or cough. Pleurisy, pneumonia, a clot in the lung and a collapsed lung also cause sharp pain on breathing in, sometimes felt in the back. The other symptoms, not the pain alone, tell you which is likely.

How can I tell if it's my lungs or a muscle?

A muscle or rib joint problem usually follows an effort, a twist or a coughing fit, hurts in one spot or with certain movements, and feels better when you rest it. Breathlessness, a fever, coughing up blood, a fast heartbeat or a swollen calf point to the lungs or a clot and need help the same day or a 999 call. Pain you can press on doesn't rule out the heart, so the warning signs come first.

When is upper back pain with breathing an emergency?

Call 999 or go to A&E if breathing suddenly becomes difficult, if pain in your chest or upper back comes on suddenly with breathlessness or a very fast heartbeat, or if someone passes out: these are the NHS's signs of a clot in the lungs. Call 999 for chest pain that feels tight or squeezing or spreads to the arms, neck, jaw or back, for coughing up more than a few spots of blood, and for sudden chest or back pain that feels like something tearing. New, sharp pain that only comes when you breathe in or cough, without those signs, needs an urgent GP appointment or NHS 111, as the NHS pleurisy page says.

Can coughing cause upper back pain, or break a rib?

Yes. Severe coughing is one of the NHS's causes of broken or bruised ribs, and in a series of 54 people with ribs broken by coughing, most were women and most had coughed for 3 weeks or more. A rib that broke from a cough, a sneeze or a minor bump is a reason to ask your GP about your bone health.

I'm pregnant and my upper back hurts when I breathe. What should I do?

Pregnancy and the 6 weeks after a birth raise the risk of a blood clot, so breathing that suddenly becomes difficult, or chest or upper back pain that comes on suddenly with breathlessness or a very fast heartbeat, is a 999 call. Pain below the ribs with a severe headache, problems with your vision or sudden swelling of the face, hands or feet needs urgent help for pre-eclampsia. Otherwise, tell your midwife or GP, and after the first trimester do the breathing exercise sitting up.

How should I sleep?

After a rib injury, sleeping more upright on extra pillows is usually more comfortable for the first few nights, and you can go back to your usual position after a few days. Take painkillers so you can breathe deeply and cough. Chest pain that is worse lying back and better leaning forward can be pericarditis and needs an urgent GP appointment or NHS 111.

Should I strap or bind my ribs?

No. The NHS says ribs can't easily be splinted or supported and are usually left to heal naturally. What matters is breathing deeply, coughing with a pillow held to your chest and keeping moving, which help prevent a chest infection.

Do I need an X-ray?

Often not for a bruised or broken rib: the NHS says there's often no need, and NHS inform says most rib or chest injuries don't need one; X-rays also missed 4 in 10 ribs broken by coughing in one series. Hospital tests are for the warning signs, such as a chest X-ray for suspected pneumonia or a scan for a suspected clot.

How long does it take to get better?

It depends on the cause, and no one can promise a timescale. Bruised or broken ribs usually get better within 2 to 6 weeks, and most of the healing after a chest or rib injury happens within 6 to 8 weeks; pleurisy usually improves in a few days; after pneumonia, chest pain should have substantially eased by 4 weeks. A broken rib that is no better after 6 to 8 weeks needs a GP.

What exercises help?

Breathing first: NHS inform's chest injury routine is a deep breath in, held for 4 seconds, then a slow breath out, 4 times every hour you're awake, followed by 2 or 3 huffs. Then walking and gentle upper back movements such as seated turns, and later rows and push-ups from a wall. None has been tested in a trial for this pain, so let comfort and the pain rule guide you.

Why does it hurt between my shoulder blades when I breathe?

Often the upper back muscles or the rib joints beside the spine. But the NHS asks you to see a GP for back pain at the top of the back, between the shoulders, and heart attack pain can spread to the back, which women may feel in the upper back. Gallstone pain that spreads from the tummy to the back with being sick is a 999 call.

Related exercise guides

Spine guide

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.