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Chest pain worse when leaning forward


Chest muscle pain is probably the most common type of chest pain, more than indigestion or cardiac chest pain.

Where there's a stiff, sore muscle, there's likely to be a stiff, sore spinal joint.

Here this joint may be between your shoulder blades, or with upper chest pain, maybe in your neck.

See the neck and upper back pages for details.

But now back to your muscles.

Characteristics of chest muscle pain

Musculoskeletal chest pain can mimic heart pain quite closely.

Chest wall pain may be felt in exactly the same central position ( and left shoulder and arm,) and it can be related to exertion. Both can have pains lasting minutes at a time, rather than seconds or hours. Both can have back pain with chest pain at the same time.

Chest muscle pain is is less likely to spread to the throat.

It is likely to be felt out at the sides of your chest.

A deep breath in and movement may bring it on, or alter it. In PCS. with an extremely sharp chest muscle pain, you may not want to move or breathe.

Check it out with twists, bends or wriggles.

Straightening yourself up and having a wriggle, or doing a couple of quick shoulder rolls, may immediately stop chest wall pain. This is a pretty certain way of deciding the issue, if it works.

Equally, if you can bring on the chest pain by stretching, that is a very reassuring indication that you are on the right track thinking of chest muscle pain.

Or shoulder rolls.

This exercise is best done sitting, leaving your hands clasped, resting in your lap. Your shoulder is moving in a big circle, while your chest and head remain still.

People often find it difficult initially, to move their shoulders without moving head and chest. If you concentrate on keeping your head still, your chest will be also.

It may be easier to initially move the point of the shoulder in a square pattern. back. then up without coming forwards, then forwards without going down, then down without moving back, then back and around again.

Take each of these movements to its limit, so the points of your shoulders are up near your ears, then forward beside your jaw, then down close to your chest, etc.

Do you have chest pain when breathing?

This is often a clue to the cause of chest pain. Unlike in pleurisy, here the pain is slight and only on a deep breath in.

If holding a really deep breath in hurts, this is the way to stretch the intercostal (between ribs) muscles.

Lie down, put one hand on your chest, and breath in fully. Now breath out by pulling your tummy in, ensuring that your chest stays fully lifted up (feeling with the hand on your chest, that the ribs don't move.) This may take a little practice.

Breath in by pushing your tummy out, each time trying to also lift your ribs up even more. Keep this up until the chest pain eases. This often takes 1 or 2 minutes, which feel like hours. It isn't easy, but it does work.


From injury

Rib pain from injury may be from a broken rib, when the pain is severe and every movement hurts. Pressing over the breast bone hurts badly, out at the side where the rib is broken.

Our ribs are made of bone at the back and gristle at the front, the two joining at the sides of our chest. If you run your finger along a rib, you can often feel a slight bump where they join, the costo-chondral junction.

There is a picture on the musculoskeletal chest pain page

The typical story of CC junction damage is of leaning one's chest against a sharp edge, hearing or feeling a sort of clunk, and knowing instantly one has done considerable damage!

The good news is that costochondral separation takes only about three weeks to heal, instead

of the 6 weeks for cracked ribs (fractured bony rib.)

For either, gently apply the oil out of a vitamin E capsule over the tender spot, then tape a piece of plastic wrapping over that. Leave this on for the first night. The worst it will do is give you a rash, and it can help.

An elastic and Velcro rib support is very comforting after that. This should not be worn at night in bed.

Or from disease

The bony part of the ribs is a common place for metastatic cancer to lodge. This may result in a pathological fracture, so there may be an obvious injury history (a red herring.)

A medical checkup is therefore in order even if you have no history of cancer.

Rib pain from cancer may be the first you know about it.


The lower margin of your chest is composed of the gristle ends on the ribs, each curling up and attaching to the one above.

As with ribs, these can be injured or affected by disease.

Injuries are usually from leaning over an edge, or from very sudden, strong contraction of your 6 pack abdominals during a fall or accident.

If the injury tears the connecting tissue, one can be left with a couple of costal cartilages clicking on each other with movements.

A topical anti-inflammatory such as aloe vera gel, may be useful here. I would also try an elastic rib splint, worn when active during the day.

I haven't done it, but would expect expert prolotherapy to be useful if this persisted. This involves injecting sugar solution to stimulate proliferation of extra fibrous tissue.

Gristle has no blood vessels for cancer cells to lodge in, but these cartilages and their connections can get painful in people with emphysema who are continually struggling to breath enough.

Chest muscle pain is also part of this, as the intercostal muscles are continually overworked.

If you have COAD or COPD. it is really important that you breath efficiently, whether or not your chest hurts.

People often pull their tummy in as they breath in at the top of their chest. This lifts the diaphragm, reducing the amount of air taken in. Put your hand on your tummy and see if you do this.

You can change this habit, so that you breath using the bases of your lungs as well. This is essential for singing, and in COPD it uses more of your limited lung capacity (if the pain allows.)

Learning to use your diaphragm is one of the parts of the very valuable Buteyko breathing training.

And emotional distress can be both a consequence and a cause (in part) of chest muscle pain.

Pleuritic chest pain - pleurisy or pneumonia

For the pleura to be involved in inflammation from the lung, pneumonia must be present to some degree.

The pleura is like the peritoneum in your abdomen - a layer which covers the lung and the inside of your chest cavity.

This pain is severe and with every breath, like a broken rib.

If you have this pain with a chest cold, and are sicker than you can remember with other chest colds, you may have pneumonia.

Pleurodynia - epidemic myalgia or Bornholm disease

This Coxsackie B virus infection also causes severe pleurisy type pain for a week, which is actually chest muscle pain.

Spontaneous pneumothorax

This condition of young men also causes sudden pleuritic chest pain.

One lung has leaked air into the space around it, and collapses from its own elasticity. Each lung is normally stretched up to fill one side of our chest.

Someone needs to put their ear on the chest in question, to compare the sound of breathing on the two sides. It should be absent on the affected side.

Tension pneumothorax is a worse degree of the same condition, when midline structures move across and the other lung starts to collapse as well.

The person will be breathless. This is a desperate emergency.

copyright В© Dr.J.Rose 2008

Category: Forex

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