Anxiety, upper back pain and shortness of breath: what’s going on?

An ache between your shoulder blades, a tight upper back, and a feeling you can’t take a full breath. Anxiety can cause all of these together. But this combination of symptoms can also be a sign of something serious, so it’s important to know when to get help straight away.

Call 911 straight away if you have pain in your chest or upper back with sudden difficulty breathing, a very fast heartbeat, chest pain that’s worse when you breathe in, pain spreading to your arm, jaw or neck, sweating, feeling sick, or someone has passed out. Don’t drive yourself.

When it could be serious

Upper back pain with shortness of breath can be a sign of:

• A heart attack. Heart attacks don’t always cause crushing chest pain. They can cause pain in the back, jaw, neck or arm, with breathlessness, sweating or nausea. The American Heart Association notes this is more common in women.
• A pulmonary embolism, a blood clot in the lungs. The NHS lists sudden difficulty breathing and pain in the chest or upper back among the signs that need emergency help. Clots are more likely after surgery, long flights or drives, during pregnancy, or if you’ve had one before.
• Other conditions, like a chest infection or a problem with the large blood vessels.

If your symptoms are new, sudden, severe, or feel different from your usual anxiety, get checked straight away. It’s always better to check.

How anxiety causes upper back pain and breathlessness

When a doctor has ruled out other causes, anxiety is a common explanation for this combination:

Tense muscles

When you’re anxious, you tense your shoulders, neck and upper back, often for hours without noticing. The muscles between and around your shoulder blades can become tight, achy and sore.

Shallow breathing

Anxiety makes you breathe fast and high in your chest, using your neck, shoulder and upper back muscles more than usual. That extra work adds to the ache, and can leave you feeling you can’t get a full breath.

Posture

Hunching over a desk or phone, especially when stressed, strains your upper back and squashes your chest, making breathing feel more restricted.

Paying close attention

Once you notice a sore back or a tight breath, anxiety makes you watch it closely, and worry about what it means, which makes you tense up more.

What helps when it’s anxiety

• Drop your shoulders. Roll them up, back and down a few times, then let them hang loose.
• Breathe low and slow, into your belly, with a longer out-breath. Our post on anxiety and shallow breathing shows how.
• Stretch gently, like shoulder rolls, neck stretches and opening your chest in a doorway.
• Use warmth, like a warm shower or a heat pack on your upper back.
• Move. A walk loosens tight muscles and helps you breathe more freely.
• Check your posture at your desk, and take regular breaks from screens.

How Breatheasy can help

Once a doctor has confirmed it’s anxiety, Breatheasy can help you loosen up and breathe more freely. Its guided breathing exercises pulse your phone as you breathe in, so you can close your eyes and focus on breathing low and slow, which eases the strain on your upper back. If symptoms tip into panic, tap “I’m feeling anxious” and Luma walks you through it. Breatheasy is coming soon to iPhone and Android.

When to see a doctor

See a doctor if upper back pain and breathlessness keep coming back, are getting worse, or you’re not sure what’s causing them. And call 911 for any of the warning signs at the top of this post. How to tell if shortness of breath is from anxiety has more on the signs to look out for.

Sources

• Pulmonary embolism, NHS
• Heart attack symptoms, NHS
• Heart attack symptoms in women, American Heart Association
• Shortness of breath, NHS