How to Tell if Chest Pain is Muscular

Table of Contents
View All
Table of Contents

Musculoskeletal chest pain can be alarming since any type of chest pain can raise concerns about heart disease. And because chest pain may indeed be a sign of angina or of some other cardiac (heart) problem, it is always a good idea to have it checked out.

Heart disease, however, is only one of the many types of conditions that can produce chest pain. One of the more frequent causes of non-cardiac chest pain is a strained chest muscle.

The article will explore some causes of musculoskeletal chest pain and how strained chest muscles are diagnosed and treated.

common causes of chest wall pain

Verywell / Emily Roberts

Musculoskeletal Chest Pain Symptoms

Musculoskeletal chest pain can range from dull and achy to sharp and intense. It may be felt across the chest or on just one side.

Other signs and symptoms may include:

  • Pain that occurs or worsens with certain movements
  • Pain that occurs or worsens with deep breaths, coughing, or sneezing
  • Swelling, tenderness, or bruising

How to Tell If Chest Pain is Muscular

In general, musculoskeletal pain tends to feel worse with deep breathing or when massaging or pressing on the area. However, it can be hard to tell the difference between chest pain due to a strained muscle and more serious conditions, such as a heart issue, so it's important to see a healthcare provider if you have chest pain.

What Causes Musculoskeletal Chest Pain?

Chest wall pain can be caused by problems affecting the muscles, bones, and/or nerves of the chest wall. Healthcare providers find "chest wall pain" in at least 25% of patients who come to the emergency room for chest pain.

There are several causes of musculoskeletal chest wall pain. Sometimes, it indicates a serious problem that may require specific treatment. In many instances, however, musculoskeletal chest pain is caused by a chest muscle strain that will resolve on its own.

Strained Chest Muscles

Trauma or overuse can cause painful muscle sprains, strains, or bruises. The trauma may be a sudden event, such as being struck by a baseball, or it may be more subtle, such as lifting a heavy object. Overuse can include repetitive movements such as swinging a tennis racket. In some instances, you might not remember when a chest muscle strain happened.

Research also suggests that tension and anxiety may also play a role in chest muscle strain and pain with a gradual onset. 

Chest muscles that are commonly involved in muscle strain are:

Rib Fractures

Chest trauma or overuse can also cause rib fractures. This can happen with forceful impact, such as a car accident or sports injury due to a collision, or it can happen as a result of repeated trauma to a bone.

Stress fractures of the ribs can affect athletes who engage in strenuous, repetitive motions involving the upper body, such as rowers or baseball pitchers. Osteoporosis or vitamin D deficiency may increase the risk of fractures.


Costochondritis, sometimes called costosternal syndrome or anterior chest wall syndrome, indicates pain and tenderness in the costochondral junction, which is the area along the sides of the breastbone where the ribs attach.

The pain of costochondritis usually can be reproduced by pressing on the affected area.

The causes of costochondritis are not well understood.

  • In children and young adults, this syndrome can occur with strain or weakening of the intercostal muscles (muscles between the ribs), following repetitive activities that place extra stress on those muscles, such as carrying a heavy book bag.
  • In some cases, costochondritis is associated with subtle dislocation of a rib. The dislocation may actually originate in the back, where the rib and the spine join. The rib may "pop" in and out of its proper orientation, in which case the pain along the breast bone will come and go.

Costochondritis usually resolves without treatment. Sometimes it is treated with localized heat or stretching exercises, but it is unclear whether such measures help. If the pain of costochondritis persists for more than a week or so, your healthcare provider may consider an evaluation looking for other chest wall conditions. Consulting with a chiropractor may also be useful.

Lower Rib Pain Syndrome

Lower rib pain syndrome (also called slipping rib syndrome) affects the lower ribs. People who have this condition usually complain of pain in the lower part of the chest or in the abdomen.

In this syndrome, one of the lower ribs (eighth, ninth, or tenth rib) becomes loosened from its fibrous connection to the breastbone, usually following some type of trauma. The "moving" rib impinges on nearby nerves, producing the pain.

This condition is usually treated conservatively, with advice to avoid activities that reproduce the pain in an attempt to allow the ribs to heal. Surgery may be required to stabilize the slipping rib.

Precordial Catch

Precordial catch is a completely benign and very common condition, generally seen in children or young adults. With this condition, sudden, sharp chest pain occurs, usually on the left side of the chest, lasting for a few seconds to a few minutes.

The pain from precordial catch typically occurs at rest. During the episode, the pain increases with breathing. After a few seconds or a few minutes, the pain resolves completely. The cause of this condition is unknown, and it usually isn't harmful.


Fibromyalgia is a relatively common syndrome that causes musculoskeletal pains. Pain over the chest is common with this condition.

Fibromyalgia often has many other symptoms in addition to pain, such as fatigue, sleep problems, and gastrointestinal symptoms.

Rheumatic Diseases

Chest wall pain associated with inflammation of the spine or rib joints can occur with several rheumatic conditions, in particular, rheumatoid arthritisankylosing spondylitis, and psoriatic arthritis.

How Are Strained Chest Muscles Diagnosed?

If you have chest wall pain, it's important to be evaluated by a healthcare provider. They will ask about your medical history, your symptoms, and if there are any activities that you think may have caused the chest pain. They will also do a physical exam to check for swelling or tenderness and to evaluate your range of motion.

A diagnosis may be based on your symptoms and a physical exam. Your healthcare provider may also recommend imaging tests, such as a chest X-ray, magnetic resonance imaging (MRI) or CT scan to get a more detailed look at the area.

When to Seek Emergency Medical Care

Call 9-1-1 if you experience chest pain that feels like pressure or squeezing and it keeps returning or is getting worse or if you have other warning signs of a heart attack, such as:

  • Shortness of breath or difficulty breathing
  • Lightheadedness
  • Nausea or vomiting
  • Cold sweat
  • Back or jaw pain
  • Discomfort or pain in the arm or shoulder

Treating Musculoskeletal Chest Pain

Treatments for musculoskeletal chest pain often just involve pain management and rest while the muscle or bone heals.

Your healthcare provider may recommend:

For muscle strains, sprains, and other soft tissue injuries, the RICE method is often recommended.

  • Rest for at least two days
  • Ice the area for 30 minutes three times a day
  • Compress the muscle with an elastic bandage
  • Elevate the chest by sitting or lying upright

If there is a serious chest trauma or the injury is impacting your ability to breathe, surgery may be recommended.

Recovering from a Strained Chest Muscle

If you have a strained chest muscle, you may need to modify your activities for a while to give yourself a chance to heal.

Avoid strenuous exercise, heavy lifting, or repetitive motions for a few weeks or as recommended by your healthcare provider. If an activity causes pain, ease off and rest whenever possible.

If your symptoms don't start to improve within a few weeks or get worse, see your healthcare provider. Additional tests may be needed.


Muscle strains are a common cause of chest wall pain and are not usually a serious medical problem. However, your healthcare provider will need to diagnose the cause of your chest wall pain and rule out more serious conditions. In most cases, the treatment will be related to pain management and rest as the area heals.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Ayloo A, Cvengros T, Marella S. Evaluation and treatment of musculoskeletal chest pain. Prim Care. 2013;40(4):863-viii. doi:10.1016/j.pop.2013.08.007

  2. Gräni C, Senn O, Bischof M, et al. Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain: a prospective diagnostic studyBMJ Open. 2015;5(1):e007442. doi:10.1136/bmjopen-2014-007442

  3. Vinther A. Rib stress fractures in rowers. BMC Sports Sci Med Rehabil. 2015;7(Suppl 1):O18. doi:10.1186/2052-1847-7-S1-O18

  4. Foley CM, Sugimoto D, Mooney DP, Meehan W, Stracciolini A. Diagnosis and treatment of slipping rib syndrome. Clin J Sport Med. 2019;29:18. doi:10.1097/JSM.0000000000000506

  5. Barrell A. What is precordial catch syndrome? Medical News Today.

  6. Keskindag B, Karaaziz M. The association between pain and sleep in fibromyalgia. Saudi Med J. 2017;38(5):465-475.  doi:10.15537/smj.2017.5.17864

  7. Sturm C, Witte T. [Musculoskeletal-related chest pain]. Internist (Berl). 2017;58(1):39-46. doi:10.1007/s00108-016-0166-z

  8. American Heart Association. Warning signs of a heart attack.

  9. American Academy of Orthopaedic Surgeons. Sprains, strains and other soft-tissue injuries.

By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.