Why can breathing, coughing, or sneezing increase rib pain?

Since the ribs enclose so many organs, rib pain that gets worse when breathing, coughing, sneezing or laughing can have a variety of causes. These causes can be most easily grouped into the following categories.

Pulmonary

The lungs are in closest proximity to the ribs/chest wall and are often the most common cause of rib pain associated with exhalation or inhalation. The medical term for such pain is pleurisy or pleuritic chest pain. Pleuritic pain relates to large tissues, called pleura, that separate the lungs from the chest wall. One layer of pleura wraps around the lungs and the other layer of pleura lines the chest wall. Under normal conditions, the layers slide or glide against each other smoothly during inhalation or exhalation. However, certain conditions can cause inflammation or irritation of the pleura causing friction. As a result, the two pleural layers rub against each other like sandpaper, causing pain during any activities or movements that cause expansion of the lungs such as coughing, sneezing, laughing and basic breathing. Many types of conditions can cause such irritation, including:

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• Inflammation: Inflammatory pathogens such as viruses, bacteria, and fungi can infect the pleura and cause pleuritic pain in addition to symptoms such as a cough, fever, and congestion. A primary infection of the lung itself such as in pneumonia can also spread to the pleura and cause pleuritic pain.
• Obstruction: Chronic or acute obstruction to the vessels of the lungs, especially in the form of a blood clot (embolism) can result in sudden shortness of breath and pain worsened with inhalation or exhalation.

Musculoskeletal

The muscles, bones, skin and soft tissues of the chest wall can also become inflamed or injured, resulting in rib pain that worsens with specific activities.

• Overuse: Physical activity that is strenuous and puts stress on the muscles of the chest, such as pushups or weightlifting, can result in soreness that can worsen with taking deep breaths or laughing or sneezing.
• Inflammation: Inflammation to the cartilage that attaches the ribs to the sternum can result in a condition called costochondritis. Costochondritis results in pain and tenderness around the ribs that can be exacerbated with taking deep breaths or coughing.
• Traumatic: Direct injury to the chest wall can result in damage such as a fractured rib or torn muscles that may present as rib pain that worsens with inhalation or exhalation.

Cardiac

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Similarly to the lungs, damage or inflammation to the heart can also result in distinctive pleuritic pain that comes on suddenly and is felt primarily over the front of the chest. A sac called the pericardium surrounds the heart; see an image of the pericardium here. Inflammation of the pericardium is known as pericarditis and similar etiologies such as infection, trauma, systemic inflammatory conditions, etc. can cause it [8].

This list does not constitute medical advice and may not accurately represent what you have.

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