Lower Back Pain When Coughing: Why It Happens and How to Treat It

If you’re sick with a cold, the last thing you need is lower back pain when coughing on top of the sneezing and congestion that’s already dragging you down. But coughing fits that trigger your lower back to spasm in pain aren’t uncommon. “When you cough, it increases pressure in your abdomen and lungs, which, in turn, puts more strain on your back muscles,” explains Dorian Logan, PT, DPT, a physical therapist at Hinge Health. And if you cough so hard that you’re forced into a bent-over position as you hack away, you may notice even more back pain.

Thankfully, there’s a lot you can do to feel better if you experience lower back pain when coughing. 

Read on to find out why you may experience lower back pain when coughing and how to relieve it, especially with back exercises recommended by Hinge Health physical therapists.

Causes of Lower Back Pain When Coughing

If coughing triggers lower back pain, you’re most likely to feel it around your intercostal muscles — the muscles between your ribs that help expand and contract your rib cage as you breathe. They’re the ones that get activated the most when you cough. But what’s causing the pain in the first place? There are many possible culprits, including: 

• Muscle strain. If your back muscles are already sore from a tough workout or a day of strenuous housework, it can be normal for them to feel uncomfortable when you cough.

• Spinal stenosis. This condition occurs when your spinal column narrows and puts more pressure on your spinal cord and nerves. If you twist or bend to the side when you cough, like when trying to direct your cough away from others nearby, you may move into an aggravating position and irritate the region, causing an increase in pain.

• Osteoarthritis. This is the most common type of arthritis and is due to changes in the shock-absorbing cartilage between your bones that can naturally occur with age. It sometimes causes symptoms such as pain and stiffness, which can be exacerbated by coughing.

Coughing can cause back pain, but exercise therapy can help treat and prevent it so you feel more stable and supported. The exercises above are recommended by Hinge Health physical therapists to ease lower back pain when coughing.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatment Options for Lower Back Pain When Coughing

If your cough is due to a respiratory virus or allergies, you can most likely treat your lower back pain when coughing at home with the following treatments. But if your cough persists for more than a couple weeks, Dr. Logan recommends that you see your doctor to get it checked out. You should also see a doctor if your cough and lower back pain are accompanied by a high fever, loss of bladder or bowel function, or weakness or numbness in your arms or legs.

The following tips from our Hinge Health physical therapists can provide relief for lower back pain when coughing.

• Work with a physical therapist. A physical therapist (PT) can help you understand the underlying causes of your pain and develop a personalized treatment plan that may include exercises to strengthen your core and other lower back muscles, helping to improve overall spinal support and stability. They can also help you make tweaks to some body mechanics to help improve the mobility and health of your back during daily activities. That way, something like a cough doesn’t hurt quite so much. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Engage in regular activity. Movement is one of the best strategies for lower back pain when coughing because it helps improve mobility and increase blood flow and healing nutrients to the area. Don’t push yourself if your cough is due to illness; instead, try a slow walk, or even an activity such as light gardening, advises Dr. Logan. Another option is gentle yoga or tai chi, both of which have been shown to decrease low back pain. As you recover from your cough, you’ll be able to tolerate more activity.

• Do back strengthening and stretching exercises. When your back muscles are stronger and more flexible, you’ll decrease your risk of straining them when you cough, says Dr. Logan. Core exercises are also important. “When you cough, your core muscles, including your back and abdominal muscles, all automatically tighten at once,” she explains. “When you strengthen them, you stabilize your core which allows for a more productive cough.” The exercises listed above are a great place to start.

• Apply heat or ice. You can apply moist heat, like a hot water bottle, or ice to your lower back for 15 to 20 minutes several times a day to help with pain. Either works, so go with the option that feels most soothing to you, or alternate between the two. 

• Change how you sit. Some tweaks to your sitting style may help you feel better as both your back and your body heal. One study found that lower back pain could be relieved simply by switching positions every 15 minutes. Or can try rolling up a towel and placing it between your low back and the back of your chair for support. It’s also a good idea to take movement breaks, where you get up periodically and walk around, says Dr. Logan. This will help prevent your back from stiffening up, which can make coughing even more painful.

• Try a foam roller. Foam rolling uses a foam tube to help relieve back muscle tightness and soreness. It applies pressure to areas that are tight, helping to release them, explains Dr. Logan. It may help temporarily relieve lower back pain when coughing.

How to Prevent Lower Back Pain When Coughing

While there are many strategies to manage lower back pain when coughing, ideally, you want to prevent it from happening in the first place. Here are some ways to help do that:

• Brace yourself. Got a tickle in your throat? Try something called braced coughing. “It’s a way to allow the strength of your upper body — including your shoulders and arms — to support your trunk while you cough,” explains Dr. Logan. This will take strain off your back. If you’re sitting or standing, simply push your hands against your thighs as you cough. If you’re lying in bed, grab your pillow and hug it across your chest.

• Drink plenty of fluids. If you’re coughing because of allergies or a respiratory virus, you’ll want to make sure you’re well hydrated. “It will help to thin out mucus in your throat and lungs that may trigger a cough,” says Dr. Logan. This can help make coughing less frequent or intense. Research also suggests that it can significantly decrease coughing, especially if the cause is related to asthma.

• Reduce triggers. If you know that certain allergens, like pet dander or dust, can bring on a coughing fit, try to avoid them as much as possible, especially if you’re recovering from a back strain or sprain, suggests Dr. Logan. This way, you reduce the chances that you’ll cough.

• Stay active. The best way to prevent back pain when coughing is to make sure that you have strong back muscles, advises Dr. Logan. Research shows that a combination of strengthening, along with stretching and aerobic exercise several days a week, reduces your risk of developing back pain by about a third. The exercises listed above are a great way to start.

PT Tip: Try Diaphragmatic Breathing

“The whole reason you cough is to get something out of your respiratory system,” says Dr. Logan. “Diaphragmatic breathing helps to expand your lungs and makes this process easier.” A 2019 study published in the journal Respiratory Care found that this breathing technique helps to increase chest capacity and decrease symptoms such as breathlessness. Here’s how to do it: Inhale through your nose for four seconds, filling your belly with air. Hold your breath for two seconds, then exhale through your mouth for about six seconds, pushing all the air out. Repeat several times.

How Hinge Health Can Help You 

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

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2. Chou, R. (2021, September 20). Patient education: Low back pain in adults (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/low-back-pain-in-adults-beyond-the-basics

3. Mendes, L. P., Moraes, K. S., Hoffman, M., Vieira, D. S., Ribeiro-Samora, G. A., Lage, S. M., Britto, R. R., & Parreira, V. F. (2018). Effects of Diaphragmatic Breathing With and Without Pursed-Lips Breathing in Subjects With COPD. Respiratory Care, 64(2), 136–144. doi:10.4187/respcare.06319

4. Qin, J., Zhang, Y., Wu, L., He, Z., Huang, J., Tao, J., & Chen, L. (2019). Effect of Tai Chi alone or as additional therapy on low back pain: Systematic review and meta-analysis of randomized controlled trials. Medicine, 98(37), e17099. doi:10.1097/MD.0000000000017099

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6. Zanasi, A., & Dal Negro, R. W. (2022). Coughing Can Be Modulated by the Hydration Status in Adolescents with Asthma. Children, 9(4), 577. doi:10.3390/children9040577