Chest muscles hurt

Pain in the back and chest is defined in medicine by the general concept of dorsalgia. Dorsalgia is considered one of the most common syndromes, with which doctors of various specializations work – from a surgeon, neurologist to a gastroenterologist, vertebrologist and other areas. A painful symptom in the chest area, including pain in the chest muscles, is called thoracalgia and is noted in 85-90% of people, regardless of age or social status. This syndrome has different causes and is not an independent nosological entity. In order to classify pain in the chest muscles, a complex, comprehensive diagnosis is required, including specific anatomical and topographical designations of pain localization. Thoracalgia, in turn, is as common as abdominalgia – abdominal pain; in contrast to 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, therefore, with myalgia.

Causes of pain in the chest muscles

The causes of thoracalgia, as well as the causes of pain in the chest muscles, can be associated with vertebrogenic pathologies, caused specifically by muscle lesions, and neurogenic factors, as well as diseases of the heart and gastrointestinal tract. Thoracalgic syndromes themselves are pinching, 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 pain in the chest muscles.

There are several well-studied clinical forms of vertebrogenic thoracalgia, which are diagnosed in 65-70% of cases:

1. Functional thoracalgia caused by degenerative changes in the spine in the lower cervical region. 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 intensify 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 chest space, between the shoulder blades, depending on the depth of breathing, but does not change at all with movements due to inactivity.
3. Pain in the chest and back 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 towards the direction of the intercostal nerve endings.
4. Thoracalgia caused by damage, compression of the anterior part of the chest. The pain is aching, long-lasting, localized in the middle or lower part of the chest, depends on physical activity

It should be noted that the causes of pain in the chest muscles can be either vertebrogenic or non-vertebrogenic:

• Osteochondrosis.
• Kyphoscoliosis.
• Xyphoidalgia.
• Spinal (thoracic) injuries.
• Titze syndrome.
• Infectious diseases (herpes).
• Hernias, strangulations, disc protrusions.
• Vertebromuscular coronary syndrome.
• Myalgia associated with overexertion, lifting or moving heavy objects.
• Myofascial pain syndrome – musculoskeletal thoracalgia.

Why do my chest muscles hurt?

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

Any of the etiological 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 – tearing the nerve, and compression and compression of the nerve ending can occur. The damaged nerve no longer performs its function; it can only transmit a pain signal to nearby soft tissues, most often to muscles.

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

In any case, no matter what provokes the pain symptom in the chest muscles, there is one pathogenetic cause – nerve damage, which can lead to swelling, tearing 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 chest hurt?

If the muscle under the chest hurts, this can mean many problems not related to purely muscle syndrome.

• Tietze syndrome or perichondritis, costochondritis, anterior chest wall syndrome and other variant 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 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 metabolic disorders and degeneration of the cartilage structure. There are also theories that explain chondritis by constant trauma, infectious and allergic diseases. Tietze syndrome is characterized by acute, shooting pain in the area of ​​attachment of the sternum to the costal cartilages, most often in the area of ​​the II-IV rib. Inflamed cartilage provokes a pain symptom similar to an angina attack, that is, left-sided pain. However, there are often complaints that the muscle under the chest on the right hurts, and symptoms reminiscent of cholecystitis, gastritis, and pancreatitis are also common.
• The chronic form of Tietze syndrome is called xyphoiditis or xyphoid 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, and intensifies with movement, especially when bending forward. A characteristic symptom of xyphoiditis is increased pain when overeating or a full stomach. Unlike gastrointestinal pain, xyphoiditis manifests itself clinically in a sitting, half-sitting position.
• A hiatal hernia often causes pain similar to muscle spasms in the lower chest. The pain feels like colic, is localized in the chest area, but can move to the area under the chest or to the side, sometimes reminiscent of an angina attack. The symptom depends on the position of the body, intensifies in a horizontal position and subsides in a vertical position, 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 breasts, accompanied by a feeling of nausea and bloating. The clinical picture of this syndrome is very similar to the signs of intestinal obstruction, which significantly complicates both diagnosis and timely provision of assistance.

In general, if the muscle under the chest, in the lower part of the chest, hurts, the patient should immediately consult a doctor, since most often such signs indicate serious, sometimes life-threatening conditions. It is extremely rare that the localization of muscle pain under the breasts concerns myofascial syndrome.

Symptoms of pain in the chest muscles

The main signs of thoracalgia, including symptoms of pain in the chest muscles:

• Pain localized on the right or left in the chest. The pain is constant and feels like girdling, shooting, paroxysmal pain. The pain can spread in the direction of the intercostal nerve endings and depends on many types of movement – turning, bending, coughing, sneezing, breathing.
• The pain is of a burning nature, accompanied by numbness, radiating to the scapula, to the heart, and less often to the lower back. The burning sensation may spread along the nerve branches. Often this symptom is 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 squeezing or compression of the nerve; rather, it is caused by hypertonicity of the muscle tissue, provoked by overstrain, both dynamic and static. The pain is felt as increasing, aching, and intensifies with load on the muscle damaged by the sprain (turning, bending, lifting weights).
• True thoracalgia must be differentiated from intercostal neuralgia, which is a common diagnostic problem. In addition, the symptoms of chest pain are very similar to the pain symptoms of other syndromes – cervicalgia (pain in the neck) and thoracobrachialgia (pain in the shoulder, arm).
• Intercostal neuralgia is characterized by acute, piercing pain, most often localized in the anterior chest area.
• Thoracobrachialgia is characterized by pain radiating to the arm.
• Cervicalgia is specific because the pain symptom begins directly in the neck; if the pain spreads to the chest area, it is characterized as cervicothoracalgia.

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

Definition of the syndrome

The localization zone of trigger points is determined by palpation

Feeling and nature of pain

Sternal syndrome

Chest area, synchondrosis

The pain is felt deep in the chest area

Ribo-sternal syndrome

Intercostal muscles (zone II of the III rib), as well as costosternal joints, most often on the left

The pain is constant, aching, the symptom depends on many movements – turning, bending, coughing, sneezing

Xyphoidalgia

Xiphoid process area

Pain that depends on body position. Increases in flexion and extension of the body, squatting, half-sitting body position, depends on rich food (large volume)

Anterior rib syndrome

Zone of the VIII-Xth rib, the area of ​​the edge of the cartilage

Severe, acute pain in the lower chest, in the precordial area, intensifies with movement, when turning

Titze syndrome

Zone of the II-III costal articulation, hypertrophied cartilage is palpated

The pain is prolonged, aching, does not subside with 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 have a chronic course, can be localized in various areas, but rarely migrate beyond certain diagnostic trigger points. It is these points that are the pathognomonic criteria that define MFPS – myofascial pain syndrome. Upon palpation in the trigger zones, a painful compaction is revealed, a muscle cord measuring from 2 to 5-6 millimeters in size. If mechanical pressure is applied to the painful point, either externally or due to body movements, the pain intensifies and can be reflected into nearby soft tissue. Characteristic signs of MFPS, defining the symptom – chest muscles hurt:

• The symptom of reflection is a “jump,” when when pressure is applied to a tight muscle, the pain intensifies and grows.
• The pain may increase spontaneously with stress on the affected muscle (active trigger point) with exertion or pressure.
• A feeling of stiffness and aching pain is characteristic of latent trigger points. The pain symptom limits the range of motion of the chest muscle.
• Pain during MFPS often inhibits muscle function and provokes its weakness.
• Myofascial pain may be accompanied by neurovascular symptoms characteristic of compression syndromes if a nerve or neurovascular bundle is located between the trigger points.

The reasons why MFPS develops and chest muscles hurt can be:

• Acute muscle overload, sprain due to physical activity.
• Static posture, long-term preservation of anti-physiological body position.
• Subcooling.
• Congenital anatomical skeletal anomaly (asymmetry of the pelvis, different lengths of the legs, asymmetry of the structure of the ribs, and so on).
• Metabolic disorders.
• Viral, infectious diseases in which MFPS is a secondary syndrome.
• Rarely – psychogenic factors (depression, phobias).

It should be noted that the most common complaint is “chest muscle pain” among those who begin to engage in sports and training, especially for strength sports – bodybuilding, that is, physical overload of the spinal column and surrounding muscles. Unfortunately, other causes of chest pain often remain undiagnosed in a timely manner; the pain becomes chronic and nonspecific, which makes it difficult to identify the true cause and prescribe adequate treatment.

Diagnosis of pain in the chest muscles

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

• Collecting anamnesis, including hereditary, determining 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 antiangial drugs are possible.
• Identification of symptoms of possible vertebral diseases. The deformation of the spine and its biomechanical disorders are visually determined, and muscle tension at trigger points is identified through palpation. In addition, limitation of movements and the presence of areas of hyperesthesia 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 determined in advance, the affected muscle can be determined by the location of the pain and a more precise therapeutic strategy can be drawn up.

Pain symptom area

Muscles

Anterior chest

Major, minor, scalene, sternosubclavian, sternoclavicular (mastoid) muscles

Posterior sternum, upper part

Trapezius and levator scapulae muscles

Mid chest, middle

Rhomboid and latissimus dorsi, serratus posterior superior, and serratus anterior and trapezius muscles

Posterior surface of the chest, lower zone

Iliocostal and serratus posterior inferior muscles

In addition, the diagnosis of pain in the chest muscles takes into account the following conditions and signs:

• The relationship of pain with 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 muscle-tonic manifestations.
• The presence of accompanying symptoms, including feelings of anxiety and fear.
• Absence or presence of osteofibrotic areas in the upper chest.
• The absence or presence of obvious abnormalities on the ECG.
• Reaction to the use of anticoagulants and nitroglycerin.
• Dependence of pain on massage, biomechanical correction.

To summarize, 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.

Treatment of chest muscle pain

If the vertebrogenic nature of pain in the chest muscles is identified, 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, it all depends on the nature of the pain. The remission stage involves acupuncture, traction therapy, massage, and physical therapy.

Tietze syndrome is treated with warming treatments and ointments containing NSAIDs. If the pain is intense, infiltration with local analgesic drugs is prescribed, more often with novocaine, less often with corticosteroids.

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

Treatment of pain in the chest muscles with sternoclavicular syndrome (hyperostosis) involves the use of anti-inflammatory non-steroidal drugs, both in tablet form and in the form of ointments. Warm compresses, physical therapy and exercises to strengthen muscle tissue are also indicated.

Myofascial syndrome is treated in a comprehensive manner, since it is necessary to influence all the numerous parts of the process. Painkillers, NSAIDs, antidepressants, myelorelaxants, 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, and gentle manual therapy are effective.

In general, treatment of pain in the chest muscles 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 pain in the chest muscles

Today, unfortunately, there are no special, generally accepted recommendations for preventing pain in the chest muscles. This is due to polysymptoms and a variety of causes that provoke pain.

Obviously, the rules to avoid injury and illness throughout life relate to adherence to healthy lifestyle standards. However, even those who constantly take care of their health are not immune from certain pain sensations in the muscles of the body, including in the chest area. However, given that most of the factors that provoke myalgia are associated with spinal degeneration and muscle strain, strain, we can offer the following advice:

• It is necessary to lead an active lifestyle, taking into account the total physical inactivity characteristic of our age of high technology. A sedentary, sedentary lifestyle is a sure path to the development of all types of osteochondrosis, and, accordingly, to muscle pain.
• If pain in the chest muscles is diagnosed, the cause is established and treatment is completed, it is necessary to follow all medical recommendations in the future to exclude the possibility of relapses.
• Considering the close connection between myalgia and the state of the respiratory and digestive systems, you should adhere to the rules of a healthy diet and give up bad habits – alcohol abuse, smoking.
• When playing sports, you should follow the rule of reasonable load distribution and correlation of your own capabilities with the assigned sports task.
• Considering the close relationship of all types of myalgia with 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 to regularly engage in autogenic training, know and perform anti-stress and relaxation exercises.
• At the first alarming sensations of pain, you should consult a doctor and get examined, since sometimes it is timely diagnosis and treatment that helps to avoid not only the development of a painful symptom, but also serious, life-threatening conditions.

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