Chest muscle pain

Pain in the back and chest area is defined in medicine by the general term dorsalgia. Dorsalgia is considered one of the most common syndromes that doctors of various specializations work with - from a surgeon, neurologist to a gastroenterologist, vertebrologist and other areas. The pain symptom in the chest area, including pain in the chest muscles, is called thoracalgia and is observed in 85-90% of people, regardless of age or social status. This syndrome has different causes and is not an independent nosological unit. In order to classify pain in the chest muscles, a complex, comprehensive diagnosis is required, including specific anatomical, topographic designations of pain localization. Thoracalgia, in turn, is as common as abdominalgia – pain in the abdomen, unlike acute painful abdominal symptoms, chest pain in 25-30% of cases is caused not by pathology of internal organs, but by damage to skeletal muscles, and therefore, by myalgia.

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Causes of Chest Muscle Pain

The causes of thoracalgia, as well as the causes of chest muscle pain, can be associated with both vertebrogenic pathologies, caused specifically by muscle lesions, and neurogenic factors, as well as diseases of the heart and gastrointestinal tract. Thoracalgic syndromes themselves are infringement, irritation or compression of the intercostal nerves, which results in muscle spasm and pain of varying nature, localization and duration. Thus, any cause of thoracalgia to one degree or another can be a factor provoking chest muscle pain.

There are several well-studied clinical forms of thoracic pain of vertebrogenic origin, which are diagnosed in 65-70% of cases: 1.

Functional thoracic pain caused by degenerative changes in the lower cervical spine. Pain in the chest, nerve endings and muscles is localized in the upper zone and radiates to the neck, shoulder, and often to the arm. The symptom is directly related to the condition of the spine and can increase with various movements and physical activity 2.

Thoracalgia caused by degenerative processes in the upper thoracic spine. The syndrome is characterized by diffuse pain in the retrosternal space, between the shoulder blades, depends on the depth of breathing, but does not change at all with movement due to low mobility 3.

Chest pain, back pain associated with damage to the scapular area. The pain is characterized by stabbing, sharp, cutting sensations, depends on the depth of breathing, partly on movements and radiates in the direction of the intercostal nerve endings 4.

Thoracalgia caused by damage, compression of the anterior chest. The pain is aching, long-lasting, localized in the middle or lower part of the chest, depends on motor activity

It should be noted that the causes of chest muscle pain can be of both vertebrogenic and non-vertebrogenic nature:

• Osteochondrosis.
• Kyphoscoliosis.
• Xiphoidalgia.
• Spinal cord injuries (thoracic spine).
• Tietze syndrome.
• Infectious diseases (herpes).
• Hernias, infringements, disc protrusions.
• Vertebromuscular coronary syndrome.
• Myalgia associated with overexertion, lifting or moving heavy objects.
• Myofascial pain syndrome – musculoskeletal thoracic pain.

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Why do chest muscles hurt?

What is the pathogenetic mechanism of the syndrome, why do the chest muscles hurt?

Any of the etiologic factors that provoke thoracalgia leads to irritation, pinching, compression of nerve endings that are surrounded by ligaments, fascia and muscles. Irritation can cause inflammation and swelling of the nerve, it can damage it - a nerve rupture, and compression, compression of the nerve ending can also occur. The damaged nerve no longer performs its function, it can only transmit a pain signal to the nearest soft tissues, most often to the muscles.

The reasons explaining why the chest muscles hurt can be myofascial manifestations - musculoskeletal thoracalgia. Myofascial pain syndrome in the chest is directly related to prolonged physical tension of a certain group of muscles, the symptom intensifies and is activated by awkward turns, movements. But the pain is most fully manifested by palpation of the so-called trigger zones, which are diagnostically important and determine the MFPS itself. Muscle irritation in the trigger zones is accompanied by either clearly localized or reflected pain, which can spread beyond the trigger point. Among the causes of MFPS there can be not only purely physical factors, myofascial pain in the chest is often caused by hidden rheumatic diseases, osteochondritis, radiculopathy, neurogenic pathologies, metabolic disorders.

In any case, no matter what provokes the pain symptom in the chest muscles, there is one pathogenetic reason - this is a nerve lesion, which can lead to its swelling, rupture or compression. The nature, localization and duration of pain, that is, the symptoms themselves, depend on the type of damage to the nerve ending.

Why does the muscle under the breast hurt?

If the muscle under the breast hurts, it can mean a variety of problems not related to purely muscular syndrome.

• Tietze's syndrome or perichondritis, costal chondritis, anterior chest wall syndrome and other variants of names. Judging by the variety of definitions of the syndrome, its etiology is still unclear, but the clinical manifestations have been studied quite well. According to the version of the author, who first described the syndrome in detail at the beginning of the last century, the disease is associated with an alimentary-dystrophic, nutritional factor, that is, with a metabolic disorder and degeneration of the cartilaginous structure. There are also theories explaining chondritis by constant trauma, infectious and allergic diseases. Tietze's syndrome is characterized by acute, shooting pain in the area of attachment of the sternum to the costal cartilages, more often in the zone of the II-IV rib. Inflamed cartilages provoke a pain symptom similar to an attack of angina, that is, the pain is left-sided. However, complaints about pain in the muscle under the breast on the right are also often noted; symptoms resembling signs of cholecystitis, gastritis, and pancreatitis are also often encountered.
• The chronic form of Tietze's syndrome is called xiphoiditis or xiphoid syndrome, when the pain is localized in the area of the xiphoid process, less often in the lower part of the chest (under the breast). The pain radiates to the epigastrium, to the area between the shoulder blades, intensifies with movement, especially when bending forward. A characteristic symptom of xiphoiditis is an increase in pain when overeating, overfilling the stomach. Unlike gastrointestinal pain, xiphoiditis manifests itself clinically in a sitting or semi-sitting position.
• A hernia of the esophagus (diaphragm) often provokes pain similar to muscle spasms in the lower chest. The pain is felt as colic, localized in the retrosternal space, but can move to the area under the chest or to the side, sometimes resembling an attack of angina. The symptom depends on the position of the body, intensifies in a horizontal position and subsides in a vertical one, which helps to distinguish it from angina symptoms.
• The abdominal form of musculoskeletal pain in the chest area may indicate an atypical development of myocardial infarction. The pain is localized in the upper abdomen, under the chest, accompanied by a feeling of nausea, bloating. The clinical picture of this syndrome is very similar to the signs of intestinal obstruction, which significantly complicates both diagnosis and timely assistance.

In general, if the muscle under the breast, at the bottom of the chest, hurts, the patient must immediately consult a doctor, since most often such signs indicate serious, sometimes life-threatening conditions. Very rarely, the localization of muscle pain under the breast concerns myofascial syndrome.

Symptoms of Chest Muscle Pain

The main signs of thoracic pain, including symptoms of chest muscle pain:

• A painful sensation localized to the right or left in the chest. The pain is constant, felt as encircling, shooting, paroxysmal. The pain can spread in the direction of the intercostal nerve endings, depends on many types of movement - turns, bends, coughing, sneezing, breathing.
• Burning pain, accompanied by numbness, radiating to the shoulder blade, heart, and less often to the lower back. The burning sensation can spread along the nerve branches. This symptom is often characteristic of intercostal neuralgia.
• Pain associated with the muscles of the shoulder girdle, back extensor muscles, and scapula muscles. This symptom is not associated with compression of the nerve, but rather is caused by hypertonicity of muscle tissue caused by overexertion, both dynamic and static. The pain is felt as increasing, aching, and intensifies with load on the muscle damaged by stretching (turning, bending, lifting weights).
• True thoracalgia must be differentiated from intercostal neuralgia, which is a frequent diagnostic problem. In addition, the symptoms of chest pain are very similar to the pain signs of other syndromes - cervicalgia (neck pain) and thoracobrachialgia (shoulder, arm pain).
• Intercostal neuralgia is characterized by sharp, piercing pain, most often localized in the anterior chest area.
• Thoracobrachialgia is characterized by pain radiating to the arm.
• Cervicalgia is specific in that the onset of pain symptoms occurs directly in the neck; if the pain spreads to the chest area, it is characterized as cervicothoracic pain.

To determine the exact syndrome for musculoskeletal chest pain, use the following scheme:

Definition of the syndrome	The area of localization of trigger points is determined by palpation	Feeling and nature of pain
Chest syndrome	Chest area, synchondrosis	The pain is felt deep in the chest area
Costosternal syndrome	Intercostal muscles (zone II-III rib), as well as costosternal joints, more often on the left	The pain is constant and aching, the symptom depends on many movements – turns, bends, coughing, sneezing
Xiphoidalgia	Xiphoid process zone	Pain that depends on the position of the body. It increases with bending and unbending the body, squatting, half-sitting position of the body, depends on abundant food (large volume)
Anterior costal syndrome	Zone of the VIII-X rib, area of the edge of the cartilage	Severe, sharp pain in the lower chest, in the precordial area, intensifies with movement, when turning
Tietze's syndrome	Zone of the II-III costal articulation, hypertrophied cartilage is palpated	The pain is long-lasting, aching, does not subside at rest, in the area of compacted cartilage

Myofascial syndrome is the most common cause of pain in the chest area that is not associated with vertebrogenic pathology.

Myofascial dysfunctions are characterized by a chronic course, can be localized in various zones, but rarely migrate beyond certain diagnostic trigger points. These points are the pathognomonic criteria that determine MFPS - myofascial pain syndrome. When palpating in trigger zones, a painful seal is detected, a muscle cord measuring from 2 to 5-6 millimeters. If mechanical pressure is applied to the pain point both from the outside and due to body movements, the pain intensifies and can be reflected in nearby soft tissues. Characteristic signs of MFPS that determine the symptom - chest muscles hurt:

• Reflection symptom - "jumping", when, when pressing on a compacted muscle, the pain intensifies and increases.
• The pain may increase spontaneously when the affected muscle is loaded (active trigger point) under load or pressure.
• The feeling of stiffness and aching pain is typical for latent trigger points. The pain symptom limits the range of motion of the chest muscle.
• Pain in MFBS often inhibits muscle function and causes its weakness.
• Myofascial pain may be accompanied by neurovascular symptoms characteristic of compression syndromes if a nerve or vascular-nerve bundle is located between the trigger points.

The reasons why MFBS develops and the chest muscles hurt may be as follows:

• Acute muscle strain, strain caused by physical exertion.
• Static posture, prolonged maintenance of an antiphysiological body position.
• Hypothermia.
• Congenital anatomical skeletal anomaly (pelvic asymmetry, different leg lengths, asymmetry of rib structure, etc.).
• Metabolic disorders.
• Viral, infectious diseases in which MFBS is a secondary syndrome.
• Rarely – psychogenic factors (depression, phobias).

It should be noted that the most common complaint is "chest muscles hurt" among those who start doing sports, training, especially strength sports - bodybuilding, that is, physical overload of the spine and surrounding muscles. Unfortunately, other causes of chest pain often remain undiagnosed in a timely manner, the pain becomes chronic, non-specific, which makes it difficult to identify the true cause and prescribe adequate treatment.

Diagnosis of chest muscle pain

Pain in the chest muscle tissue may indicate various diseases, including life-threatening conditions. Therefore, the diagnosis of chest muscle pain should not only be timely, but also maximally differential and accurate, which is quite difficult, given the polysymptoms and variability of sensations of this nature. According to statistics, musculoskeletal chest pain is the result of such pathologies:

• Cardialgia – 18-22%.
• Osteochondrosis and other vertebrogenic pathologies – 20-25%.
• Diseases of the digestive system – 22%.
• True benign muscle diseases, most often MFPS (myofascial pain syndrome) - 28-30%.
• Injuries – 2-3%.
• Psychogenic factors, depression – 3-8%.

In order to quickly differentiate purely muscular pathologies from coronary cardialgia and other serious diseases, the doctor conducts and prescribes the following types of examination:

• Collection of anamnesis, including hereditary, determination of the objective cause of pain, its connection with food intake, neurogenic factors, body position, and so on.
• Exclusion or confirmation of typical signs of angina pectoris.
• Electrocardiogram.
• Tests using antianginal drugs are possible.
• Identification of symptoms of possible vertebral diseases. Visually, the deformation of the spine, its biomechanical disorders are determined, with the help of palpation, muscle clamps in trigger points are detected. In addition, the limitation of movements, the presence of hyperesthesia areas are determined.
• Exclusion or confirmation of degenerative changes in the spine using X-rays.
• Conducting a manual examination of muscle tissue.

If MFPS (myofascial pain syndrome) is preliminarily determined, the affected muscle can be determined by the localization of pain and a more precise therapeutic strategy can be developed.

Pain symptom zone	Muscles
Anterior chest	Large, small, scalene, sternosubclavian, sternoclavicular (mastoid) muscles
Posterior zone of the sternum, upper part	Trapezius and levator scapulae muscles
Middle chest, middle	Rhomboid and latissimus dorsi, serratus posterior superior, serratus anterior and trapezius muscles
Back of the chest, lower area	Iliocostalis and serratus posterior inferior muscles

In addition, the diagnosis of chest muscle pain takes into account the following conditions and symptoms:

• The relationship between pain and the position and posture of the patient's body, as well as with hand movements.
• The absence or presence of radiological signs of vertebrogenic syndrome, or muscular-tonic manifestations.
• The presence of concomitant symptoms, including feelings of anxiety and fear.
• Absence or presence of osteofibrous areas in the upper chest.
• Absence or presence of obvious abnormalities on the ECG.
• Reaction to the use of anticoagulants and nitroglycerin.
• Dependence of pain on massage, biomechanical correction.

In summary, it can be noted that an experienced doctor always remembers the so-called "red flags" in the process of diagnosing dorsalgia in general and thoracalgia in particular. This allows you to quickly exclude or confirm serious pathologies and begin adequate therapeutic measures.

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Treatment for chest muscle pain

If the vertebrogenic nature of chest muscle pain is detected, treatment is aimed at the main, provoking factor. The pain is relieved either by injection blockades using corticosteroids or by prescribing anti-inflammatory drugs in tablet form, everything depends on the nature of the pain. The remission stage involves acupuncture, traction therapy, massage, and therapeutic exercise.

Tietze's syndrome is treated with warming procedures and ointments containing NSAIDs. If the pain is intense, infiltration with local analgesics is prescribed, most often novocaine, less often corticosteroids.

Costochondral syndrome is treated by blocking the intercostal nerve endings, then, depending on the patient’s condition, massage and exercise therapy.

Treatment of chest muscle pain in sternoclavicular syndrome (hyperostosis) involves the use of non-steroidal anti-inflammatory drugs, both in tablet form and in the form of ointments. Warming compresses, physiotherapy and muscle strengthening exercises are also indicated.

Myofascial syndrome is treated in a complex manner, since it is necessary to influence all the numerous links of the process. Painkillers, NSAIDs, antidepressants, muscle relaxants, massage and stretching of the affected muscles, thermal procedures, electrical stimulation and even botulinum toxin injections are prescribed. Local applications with dimexide and lidocaine, post-isometric relaxation, manual gentle therapy are effective.

In general, treatment of chest muscle pain is a competent combination of drug therapy and non-drug methods, which allows not only to relieve the pain symptom, but also to significantly reduce the risk of relapse of the syndrome.

Prevention of chest muscle pain

Unfortunately, there are currently no special, generally accepted recommendations for preventing chest muscle pain. This is due to the polysymptomatic nature and variety of causes that provoke the pain syndrome.

Obviously, the rules that allow you to avoid injuries and illnesses throughout your life concern the observance of healthy lifestyle standards. However, even those who constantly take care of their health are not immune to certain painful sensations in the muscles of the body, including in the chest area. Nevertheless, given that most of the factors that provoke myalgia are associated with spinal degeneration and overexertion, muscle strain, we can offer the following advice:

• It is necessary to lead an active lifestyle, taking into account the total hypodynamia inherent in our age of high technology. A sedentary, inactive lifestyle is a sure path to the development of all types of osteochondrosis, and, accordingly, to muscle pain.
• If chest muscle pain has been diagnosed, the cause has been established and treatment has been completed, it is necessary to continue to follow all medical recommendations to eliminate the possibility of relapse.
• Considering the close connection between myalgia and the state of the respiratory and digestive systems, one should adhere to the rules of healthy eating and give up bad habits – alcohol abuse, smoking.
• When playing sports, one should follow the rule of reasonable distribution of the load and the relationship between one’s own capabilities and the set sports task.
• Considering the close relationship between all types of myalgia and the state of the nervous system and the fact that about 15% of its causes are due to psychogenic factors, it is necessary not only to protect the nerves, but also to regularly engage in autogenic training, know and perform anti-stress, relaxation exercises.
• At the first alarming pain sensations, you should consult a doctor and get examined, since sometimes it is timely diagnosis and treatment that help to avoid not only the development of pain symptoms, but also serious, life-threatening conditions.

Chest muscle pain is not a specific symptom indicating a specific problem or disease, so self-medication can only transform acute pain into chronic pain. Constant discomfort in the chest area interferes with full-fledged work, reduces the quality of life, while a disease treated in time helps to fully experience all the benefits of recovery, that is, restored health.