Back pain when sneezing

A herniated disk

A prolapsed (‘slipped’ or ‘herniated’) disk occurs when the outer part of one of the protective pads of cartilage that sit between the backbones ruptures. This causes the gel inside the disk to bulge outwards and press on the adjacent nerves. It occurs most frequently in the lower back, is more common in men aged between 30 and 50, and causes 1 in 20 cases of acute back pain. There is often no clear reason - many occur with ageing as the disks become less flexible – but other causes include awkward bending or lifting, being overweight, trauma, and spending lots of time sitting or driving. Sneezing is a potentially powerful cause of a herniated disk as this can occur during the peak force of a sneeze.

Very small slipped disks may cause few symptoms but larger ones typically cause pain in the lower back which may be severe. There may also be tingling, numbness or pain in one or both legs and this can be worse when coughing or sneezing. Large slipped disks can cause muscle paralysis and loss of bladder control. Many people will recover from a mild slipped disk within 6 weeks using a combination of painkillers and physiotherapy or gentle exercise. One in ten cases will require surgery, where the protruding disk is excised. This usually occurs if symptoms are not resolving or if there is difficulty in standing or walking.

Muscle strains and sprains

Sprains and strains are an extremely common type of injury – usually self-limiting – that affects the muscles and ligaments. With a sprain, one or more of the ligaments (the tough band of fibrous tissue connecting one bone to another in a joint) is damaged as a result of excessive force being applied to a joint. The most common place for this to occur is the ankle, although the knee, wrist and thumb are also commonly affected joints.

A strain refers to tearing or stretching of a muscle, or a tendon – the fibrous cord of tissue that connects muscle to bone.  This occurs because the muscle has contracted (shortened) too quickly, or it has been over-stretched beyond its limits. This usually occurs in the lower back, as well as the hamstring and quadriceps muscles in the legs, and it is a muscle strain that causes pain on sneezing or when using the affected muscles. A violent sneeze may pull a muscle in your back because of the sudden tensing of your abdominal muscles during it, and every time you sneeze after that it can cause more pain there.

Fortunately, most strains and sprains settle within a few days and can be treated at home with self-care techniques, particularly the R.I.C.E. approach – Rest/Ice/Compress/Elevate.

• Rest: Avoid any activities that cause discomfort or pain to the joint or body area. Most people can resume normal activity within six weeks or less for a sprain and three weeks to three months for muscle strains depending on severity and location.
• Ice: Cold packs help reduce pain and swelling in injured joints and muscles. Apply an ice pack or cold towel to the area immediately for up to 15 minutes and repeat every two to three hours for a few days. Never put these directly onto your skin - if the area turns white, stop the ice pack immediately.
• Compress: Use an elastic bandage to help reduce swelling but take care not to use one that is too tight and loosen or remove it if the pain worsens, if the area becomes numb or if swelling develops below the wrapped area.
• Elevate: Keep the injured area (e.g., ankle) above the level of your heart as this helps to reduce any swelling by draining excess fluid away from the area.

Over the counter pain relievers such as the nonsteroidal anti-inflammatory drug ibuprofen can also help reduce back pain when sneezing if it is due to a muscle pull but check with your doctor first before taking these. Check out our shop to purchase this.

Vertebral compression fracture

A vertebral compression fracture, or VCF, occurs when part of one of your backbones collapses. This is usually due to the condition osteoporosis, especially in women over the age of 50, that causes bones to become thin and weak.

In more severe cases of osteoporosis, sneezing or coughing can cause a compression fracture, but in milder cases this is usually due to a fall or other trauma. Apart from back pain when sneezing, other symptoms of VCF include pain on twisting or bending, back pain that eases when lying down, difficulty lifting heavy objects and loss of height.

Sciatica

The sciatic nerve is the main nerve in the leg and the largest nerve in the body. It runs from the base of the spine, along the back of the thigh to the knee, where it divides into branches. Sciatica is the name given to sciatic pain, usually caused by compression of this nerve at the point where it leaves the spine. Damage to the nerve can also cause pain.

In young and early middle-aged adults, the most common cause of sciatica is a prolapsed disk. In older people, changes in the spine due to conditions such as osteoarthritis may be responsible, and sometimes sitting awkwardly can cause it, too (so avoid sitting in awkward positions for long periods of time).

Sciatica usually only affects one leg, and the pain may be felt in the buttock, down the back of the leg, below the knee and into the foot. Such pain can be mild or severe, may be persistent or come in spasms. Sufferers may also experience numbness, tingling and muscle weakness in the affected leg, and all these symptoms can be worse if you sneeze.

Sciatica can get better on its own without treatment, but if it doesn't there are a variety of treatments available including painkillers, anti-inflammatory medication, physiotherapy, or epidural injections. Surgery may be required if these treatments don't resolve the problem.

How to prevent back pain when sneezing

It is sometimes tempting to bend forwards just before you sneeze to try to protect your back. In fact, this is not a good idea so always try to stay upright when you sneeze in order to take pressure off the disks between your backbones. It can also sometimes help if you are standing up when sneezing to support your hands on something like a table or the back of a chair in order to help keep the pressure off your back.

Make sure you are not overweight. Carrying those excess pounds means more pressure is put on your backbone and muscles of your back, and so can make it more likely that a forceful sneeze could cause back problems.

If you have to lift something heavy, make sure you lift it in a way that does not cause excessive back strain - always keep your knees and elbows slightly bent when lifting and use your legs for power rather than your back. Try not to bend and twist at the same time as this can increase the chance of a slipped disk occurring.

A back brace

A back brace is a simple appliance that is worn to help give your back extra support as well as reducing back pain and stress on your spine. If you have an existing back problem or an old back injury, wearing a back brace can help give you extra protection against more back problems occurring when you sneeze. It’s important not to wear them all the time though, or your back muscles can become weakened through lack of use.

Cold therapy

Using cold therapy is a well known way of reducing inflammation and pain, and so if you have back pain caused by sneezing or want to reduce your chances of this occurring, using an ice pack on back muscles can contract them and so reduce swelling and discomfort. This can be done for 15 minutes at a time, several times a day if needed. Remember to never put ice directly onto your skin as this can damage it - always use a towel or similar to wrap around the ice pack.

Heat therapy

Warming your back muscles can help reduce muscle spasms or cramping by increasing the circulation to the area, and so can help with any muscle problems linked to sneezing. Having a deep soak in a warm bath, or applying a heat pack (or hot water bottle wrapped in a towel) to the back helps to reduce stiffness and discomfort. Do this for 20 minutes at a time, up to three times a day but remember not to use heat treatment in the first 72 hours after any new injury as this may make inflammation worse.

Pain relief medication

Taking simple painkillers for a few days if you are experiencing a painful back due to sneezing is usually recommended by doctors as these can reduce inflammation and ease away muscle-related back pain. Nonsteroidal anti-inflammatory tablets or topical rubs (gels and creams) are often used here as these not only reduce pain but also help to ease muscle spasms. Check with your doctor that these are safe for you to use beforehand, and look at the painkiller options we have available for you here.

TENS therapy

TENS stands for Transcutaneous Electrical Nerve Stimulation and is a type of treatment that uses a very low level electrical current to help to relax the muscles of the back and so reduce back pain. It can be very effective at reducing back muscle spasms caused by sneezing but always discuss this type of treatment with your doctor beforehand to make sure it is safe for you to use. It can be used at home, several times a day if needed.

Rest

Do not forget just how important rest can be in treating back pain. Although bed rest or long periods of immobility is no longer recommended (and in fact may make back pain worse), if you have back pain after sneezing it is sensible to avoid doing any of your normal activities that may make this worse. Apart from when you are asleep at night, try not to lie down for more than an hour or two at a time. If lying on your back, put a pillow under your knees and if on your side, put it between them - this helps to reduce pressure on your back and help keep you comfortable.

If you have back pain that does not improve with self-help treatment after a couple of weeks, or it starts to get worse, then make an appointment to see your doctor. See your doctor urgently if you have back pain with any of the following:

• loss of feeling in your low back, groin, hips or legs
• loss of control of your bladder or bowels
• pain travelling down your legs
• a history of cancer
• a high temperature
• worsening abdominal pain
• unexplained weight loss

Back pain after sneezing is not unusual, and fortunately is usually due to a muscle pull that subsides after a few days with rest, simple painkillers and self-care. If it persists, or you have any concerns about persisting back pain then always seek a medical opinion so an accurate diagnosis can be made.