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When To Worry About Shortness of Breath … and When Not To

Three minor causes of a scary symptom that might be treatable

updated (first published 2007)
by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about PainScience.com
Picture of a man with a respirator, representing difficulty breathing.

Ever feel like you
need one of these?

SUMMARY

Difficulty breathing is a common complaint and a tough diagnostic challenge, and there are some serious causes to be aware of. However, the great majority of mild and moderate cases, and even a few more serious ones, are probably caused by minor muscle knots (trigger points), respiratory dysfunction, and/or anxiety: all of which are relatively simple and cheap problems to try to self-treat. Relief may even be surprisingly easy for some patients. It’s safe and cheap to experiment with self-massage for muscular trigger points. Although changing bad habit is always tricky, respiratory strength training is an effective and worthwhile fitness activity in itself. And learning better anxiety management is something almost anyone can benefit from, even if it doesn’t help the breathing.

full article 4000 words

Difficulty breathing (dyspnea) is a common complaint, affecting about 1 in 10 adults1 .… and a tough diagnostic challenge. Like abdominal pain, dizziness, or fatigue, minor breathing difficulties can have many possible causes.2

Obviously you should discuss stubborn breathing troubles with a doctor — especially if you have other worrisome symptoms, like pain or trouble staying upright. In older patients who mostly feel short of breath during exercise, it’s much more likely to be a symptom of disease of the heart and/or lungs. For everyone else, there are three causes of shortness of breath that are common, minor, and often partially treatable:

There’s definitely hope for some breathing troubles

If you’re short of breath for any (or all) of those reasons, easy relief is possible. It’s safe, cheap, and almost fun to experiment with self-massage for trigger points. Results are hardly guaranteed, but it’s a sensible thing to try.

Changing bad habits is always tricky, but it’s a more likely path to relief, and increasing your respiratory strength is possible with a little oomph345 — and it’s a worthwhile fitness goal in any case.

Anxiety is the toughest problem to beat, but anyone can benefit from trying.

These three issues may all get tangled up, each one complicating the others, but progress with one is also likely to help the others. Some simple and interesting ideas for self-treatment are suggested in this short article, plus links to much more information for those who want to delve.

I write about most topics from professional and/or direct personal experience. Long ago, I suffered from episodes of shortness of breath for many years caused by spasming respiratory muscles. I went to the hospital once because I couldn’t breathe. And much later I had another struggle with shortness of breath related to Ativan withdrawal. But that’s all history for me now: I’ve successfully reduced these incidents to rare annoyances, easily managed. ~ Paul Ingraham

Safety first! A checklist of warning signs of more serious breathing problems

It’s nice that some people may be able to find an easy solution to their shortness of breath, or at least be reassured that it’s mostly harmless. Unfortunately, more ominous causes of dyspnea are also common, so please always alert your doctor about any difficult breathing. If your doctor cannot find any explanation, and you have none of these “red flags,” then you can pursue the possibility of muscle knots and weak breathing muscles. Safety first! And second.

Picture of red flags, symbolizing red flags for shortness of breath with serious causes.

Any of these factors could be associated with a slow, sneaky onset of a serious condition.

The quality of the sensation and what it might mean

Many things contribute to a sensation of shortness of breath,6 and the symptom breaks down into three messily overlapping qualities, which are interesting but don’t tell us much about what’s going on, just a couple rough clues:

Part I: Trigger points
The effects of muscle “knots” on breathing

Drawing of a thumb pressing down on a trigger point.

Trigger points — better known as muscle knots — can cause shortness of breath. They are small patches of sensitive muscle tissue, maybe caused by a “micro cramp,” or possibly neurological hypersensitivity. Trigger points are a big, tricky topic.

Trigger points may form in the muscles we use to breathe, making it difficult or even painful to move the ribs and expand the chest. Even the diaphragm itself might develop trigger points that make it feel weak and tired, and limit its range of contraction.7

Trigger points in the muscles of the throat, neck, chest, and back may also interfere with the nervous system’s control of respiration.8

Trigger points may afflict the respiratory musculature for reasons unrelated to breathing, such as postural strain. Or they can arise in response to bad breathing habits: a chicken and egg problem. Do you get breathing trouble because you have trigger points? Or do you get trigger points as a symptom of breathing trouble? The answer is surely both. If there is an obvious problem in the area, such as an old shoulder injury, then it’s a good bet that the shoulder was the “chicken” that started it all, and it may remain the primary source of discomfort and muscular dysfunction in the area.9 In such a straightforward case, treating the trigger points caused by the old shoulder injury might just solve the problem.

On the other hand, if there is no obvious cause of discomfort in the area, but you are out of shape and sit slumped in a chair all day long, a better guess is that respiratory dysfunction was the “egg” that started it all, and the real challenge is to learn to breathe and sit better.

What can you do about trigger points that might be interfering with respiration?

Muscle trigger points are unpredictable and mysterious: exactly what they are and how to treat them is controversial. Sometimes they seem to melt as easily as ice cream in the sun, and so the first thing to try is just a little simple self-massage, or a warm bath, or both. The problem could be solved by a self-treatment as simple as digging with your thumbs into some aching muscles between your ribs. Voila — no more shortness of breath! I’ve seen it go like that many times, and even experienced it myself…

My story: I am generally prone to muscle pain, and one of the most persistent specific challenges I’ve had is with breathing pain — not “shortness of breath” in my case, but “breathing limited by pain.” For about twenty years, I had routine episodes of strong pain that choked off my breath. Once every few days, I would be nearly paralyzed by it for several minutes, and sometimes nightmarish episodes of an hour or more. The pain would ease when I relaxed for long enough … but it’s hard to relax when you can’t breathe.

I recovered! During my first year of massage college in 1997, I experimented with self-massage of my intercostals, discovered that I could easily stop any “attack” of this pain within a minute just by rubbing between the ribs near the pain.10 It was a revelation. I’ve probably never been so happy to learn anything! Over a year or two, I massaged my intercostals regularly until I stopped having these episodes at all.

Unfortunately, it’s not always that easy. Trigger points can be so stubborn they become a major source of grief. Self-massage is definitely no miracle cure, and trying to treat tougher trigger points can become an epic journey of rehabilitation. You might have a complex array of trigger points, both causing and caused by many factors, including really tricky ones like seriously dysfunctional breathing behaviour and intractable emotional factors.

Again, if you want to learn a lot more about trigger points and how to manage them, please see my advanced tutorial.

Where exactly to massage (muscles of respiration)

The main muscles of respiration are: