Back Pain When Sneezing: 5 Effective Relief Tips

A 69-year-old male presented to the emergency department complaining of pain in his left flank and abdominal bruising after experiencing recent bouts of sneezing that provoked them.

No history of trauma had occurred and no anticoagulants or bleeding disorders were identified as causes for his symptoms.

Back pain when sneezing is usually due to muscle strain or an issue with one of the spinal bones (vertebrae).

Coughing, sneezing and straining often aggravate this discomfort further.

Muscle Strain

Muscle strains involve damage to either muscles or tendons – the fibrous tissues connecting muscles to bones – through overstretching, overextending, or even tearing them.

A minor strain may simply overstretch while severe strains may tear the tissue completely.

Muscle strains commonly result from lifting heavy objects with poor body mechanics or using improper technique during sporting events or overstressing your muscles, and pain from these injuries is typically localized either in your back or the muscles at the back of your thigh (hamstrings).

Coughing, sneezing, and straining can increase pressure on spinal nerves extending down into legs which causes neuropathic back pain which typically manifests itself locally as dermatomal distribution within legs or even worsen radicular back pain symptoms.

Herniated Disc

Herniated discs occur when the inner portion of a spinal disk pushes through its outer layer.

When this happens, nerves that serve that particular disc can become pinched resulting in back pain as well as numbness or tingling sensations in certain body parts served by it.

Symptoms vary from mild to severe depending on where it lies in the spine.

Herniations is most prevalent in the lower spine (lumbar region), though it can occur anywhere along the spine.

When this problem arises, patients usually feel pain in both their back and legs – sometimes radiating to arms or feet too – with symptoms worsening when coughing or sneezing.

People suffering from herniated discs may also experience muscle spasms that can be very painful and make certain tasks difficult to complete.

To diagnose the condition, X-rays, CT scans, or MRI may be conducted; these can detect infections, tumors or issues with spinal column alignment that could cause this discomfort.

Radiculopathy is caused by herniated discs which compress or irritate spinal nerve roots exiting intervertebral foramina, leading to sensory and motor deficits, numbness, and tingling sensations that exit intervertebral foramina exiting nerve roots exiting foraminas – this accounts for about 40% of mechanical back pain estimates; its incidence can be affected by age, lifestyle factors and occupations that involve repetitive actions.

Vertebral Compression Fractures

Patients suffering vertebral compression fractures typically present with acute back pain at the site of the fracture.

This pain may be described as a sharp electric shock-like sensation felt primarily in the lower back and legs but it may radiate to other areas like ribs, abdomen, or chest as well.

Coughing, straining or sneezing may reproduce or worsen it, and often presents with symptoms similar to neuropathies (pain related to nerves).

These types of spinal fractures are most frequently the result of falls with forward flexed trunks, wherein force is dissipated unevenly through fractured bones rather than more evenly dispersed throughout them.

Once fractured, compression of vertebral bodies occurs leading to height loss at certain areas in the spine resulting in decreased lung capacity, thoracic kyphosis, and protuberant abdominal features as a result.

These patients often suffer from severe, debilitating pain that does not respond to oral pain medication and physical therapy.

As an option for relief, they can be referred to an Interventional Radiologist for minimally-invasive procedures called Kyphoplasty/Vertebroplasty that uses image guidance to place bone cement into compressed spinal bones – helping restore spinal column height while relieving compression fracture pain.

Patients can often return home within hours after this procedure has taken place.

Sneezing is an explosive reflex

Sneezing is an explosive, coordinated, and protective respiratory movement involving both nasal and respiratory passages, designed to wash away mucosal debris, irritants, and infectious agents while clearing away airborne particles such as dust.

The physiology of the sneeze reflex is well-established and can be broken into two distinct phases: a sensory or nasal phase and an efferent or respiratory phase.

Chemical or physical stimulants activate receptors on mucous membranes in the nose which in turn send sensory impulses via the olfactory and ethmoidal nerve to what may be considered the putative sneezing center located within the dorsolateral medulla and trigger this first stage.

Sensory impulses from these nuclei are then transmitted through preganglionic fibers of the pterygopalatine and superior salivatory nucleus to nasal and pharyngeal afferent pathways, where they produce sensations interpreted as ticklish sensations in the nose that stimulate nerves that eventually cause sneezing to occur.

Sneezing is usually an automatic process, but its efficacy may be compromised under certain conditions.

A study published in Neuropsychologia discovered that patients experiencing a lateral medullary stroke or transient ischemic attack (TIA) experienced decreased sneezing on the affected side, suggesting sneezing relies upon both sides of the medulla for proper function.

Sneezing causes an injury

Coughing, sneezing, and straining increase upper body pressure, which may result in barotraumatic injuries such as subcutaneous emphysema, hematoma, or hemoptysis.

The severity of such injuries largely depends upon both the intensity of force exerted and location (1).

A 57-year-old male presented to the emergency department complaining of pain in his left metacarpophalangeal (MCP) joint after experiencing a sudden sneeze.

He denied trauma or rheumatological disease and had no prior history of similar symptoms in the past; the pain worsened with finger flexion/extension; this patient was then observed conservatively until symptoms resolved on its own.

Nerve root pain typically radiates along dermatomal lines; not to be confused with spinal cord-referred pain which spreads along axial lines.

Sneezing is a symptom of an injury

A 69-year-old male presented to the emergency department with left flank pain and bruising (Fig 1).

He reported experiencing severe bouts of sneezing four days before presentation, followed by worsening flank pain and abdominal bruising for seven days – without trauma, anticoagulant use, or bleeding disorder in his past medical history – without significant change since.

His history revealed a herniated L4/L5 intervertebral space disc herniation; an MRI confirmed this.

More pain during coughing, sneezing, or straining proved of limited diagnostic value, as increased pressure on spinal nerves may cause mechanical compression which then causes radiating pain throughout his back or leg.