Pain •Sensible advice for aches, pains & injuries

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

Two common, minor, and treatable causes of a scary symptom

updated (first published 2007)
by Paul Ingraham, Vancouver, Canada

Difficulty breathing is a common complaint… and a tough diagnostic challenge. Like abdominal pain, dizziness, or fatigue,1 minor breathing difficulties can have many possible causes.

Obviously you should discuss stubborn breathing troubles with a doctor — especially if you have any other worrisome symptoms, like pain, or trouble staying upright. Happily, there are at least two causes of shortness of breath that are quite minor, common, and fairly treatable:

Picture of a man with a respirator, representing difficulty breathing.

Do you feel like you
need one of these?

There are many causes for shortness of breath. Some are complex & serious, but there are also surprisingly simple & non-scary possibilities.

There’s definitely hope for some breathing troubles

If you’re short of breath for one of those two 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 experiment with. And although changing bad habits is always tricky, it’s a more certain path to relief, and increasing your respiratory strength is possible with a little oomph234 — and it’s a worthwhile fitness goal in any case.

Also, these two issues may be intertwined, each one causing the other. Some simple and interesting ideas for self-treatment are provided in this short article, with plenty of links to other information and resources for those who want to delve. has hundreds of articles on other major pain problems, like low back pain or trouble with your IT band (runner’s knee) and many more, plus reviews of treatment methods like stretching or massage therapy: see the home page for a quick tour. I write about most of these things from professional and/or direct personal experience. I’ve suffered from episodes of shortness of breath my whole life. I had to go to the hospital once because I couldn’t breathe! I’ve also successfully reduced these incidents to minor, infrequent annoyance — I can easily resolve them myself.

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 shortness of breath 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. For more help self-diagnosing, please see this page about breathing difficulties at

A quick success story about sore breathing muscles

Recently I developed a sharp pain in the side of my neck when I coughed or sneezed. It was clearly a muscular pain,5 specifically of the scalenes muscle group that kick in when you breathe hard. If I took a really deep breath, I could feel it a little too — but it was mostly only clear when I coughed or sneezed.

Until I went for a run.

After a few minutes of huffing and puffing, that pain started up. I also felt distinctly short of breath, despite being generally quite fit. The pain was like a stitch in my side, but in my neck, and I was not getting full breaths. I realized I was barely using my diaphragm to breathe, and so my scalenes were working overtime to make up the difference — and hurting and failing. (More about this below.) I started using my diaphragm again … and the pain steadily eased even though I kept running.

Not only was the pain clearly caused by over-using my scalenes while breathing, but I was able to fix a fairly significant pain problem without stopping my workout — just by breathing differently. That’s a good, clear example of the easiest kind of breathing trouble to fix. What was going on?

The effects of trigger points (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 localized spasm, or “just” neurological hypersensitivity. Trigger points are a big 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.6

Trigger points in the muscles of the throat, neck, chest, and back may also interfere with the nervous system’s control of respiration.7

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.8 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 a bit mysterious. Exactly what they are and how to treat them is controversial. Sometimes they melt as easily as ice cream in the sun. The first thing to try is just a little simple self-massage. Or a warm bath. Or a holiday. 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 that happen many times, and even experienced it myself, in a big way.

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. The pain would ease when I relaxed for long enough … but it’s hard to relax when you can’t breathe.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.9 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: