The space between your shoulder blades feels tight, taking a deep breath does not come as easily as it used to, and a morning cough leaves your upper back aching. If you smoke, these things can be more connected than they first appear. Helping your ribs and upper back move more freely can make breathing and your back feel more comfortable.

How breathing and your mid back are linked

Your ribs attach to the bones of your mid back. Every time you breathe in, your ribs lift and widen, and the joints in your upper back move a little with them. Over the course of a day, that is thousands of small movements.

When breathing becomes shallower, those joints move less. The muscles between your ribs and around your shoulder blades can tighten, and your upper back can start to feel stiff.

How smoking can play a part

Smoking can affect your breathing in a few ways. Over time, it can narrow the airways and make breathing feel harder work. Some people find they breathe more from the top of the chest, using the muscles in the neck and shoulders, rather than letting the ribs and belly move freely.

A regular cough adds to this. Each cough is a strong squeeze of the muscles around your trunk, and a frequent cough can leave those muscles tired and sore.

Smoking also reduces the oxygen carried in your blood and may make tissues slower to recover, which can make an achy back feel slower to settle.

Breathing to move your back

Breathing exercises can help your ribs and upper back move more freely. Something to try a few times a day:

• Sit tall, with your hands on the sides of your lower ribs.
• Breathe in slowly through your nose, feeling your ribs widen into your hands.
• Breathe out slowly through pursed lips, as if gently blowing out a candle.
• Repeat five or six times.

You could also try placing your hands on your back ribs, as far round as you can reach, and breathing into them.

Gentle mid back movement

Your upper back is built to turn and gently arch back. Something to try once or twice a day:

• Sit tall, cross your arms over your chest and slowly turn to each side.
• Sitting back in your chair, clasp your hands behind your head and gently lean back over the top of the chair.
• On your hands and knees on the floor, slowly round your back up, then let it gently dip down.

If you would like a guided stretch, VIDA has short videos you can follow at your own pace.

Building strength

Strong upper back muscles help you sit and move more comfortably. Something to try two or three times a week:

• Back lifts. Lie on your front on the floor with your arms by your sides, gently lift your head and chest a little way, then lower.
• Shoulder squeezes. Sit tall, draw your shoulder blades back and down, hold for five seconds, then relax.

If you would like to follow along, VIDA has short videos of back lifts and shoulder squeezes you can use at your own pace.

Staying active

Regular activity, like walking, helps your breathing as well as your back. Starting at a comfortable pace and building gradually tends to work well. If you get breathless, slowing down and using the pursed-lip breathing above can help you recover.

If you are thinking about stopping

Stopping smoking gives your lungs and back the best chance to recover. Many people find their breathing feels easier within a few months of stopping, and coughing often eases too, though it can sometimes increase for a short time at first as the lungs clear. If you are thinking about it, support from stop smoking services, pharmacists or nicotine replacement products makes you more likely to succeed.

Your VIDA pain check-in can help you notice how your back changes as you build these habits.

What to take away

• Your ribs and mid back move together every time you breathe.
• Practise slow breathing into your lower and back ribs.
• Turn and gently arch your upper back once or twice a day.
• Strengthen your upper back with back lifts and shoulder squeezes.
• Stopping smoking gives your breathing and back the best chance to recover.

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