What’s That Weird Chest Pain?

Patients sometimes come in to my office with pressure and/or pain in their chests. Of course, the first concern is to rule out any cardiac issues, but in many of these cases, they’ve already been checked out medically and have been given a clean bill of health, perhaps with a vague “diagnosis” of “stress”, or something like that.

Assuming the heart can be excluded, typically, the cause of the pain in such cases is one (or both) of two things:

1. Misalignment of one or more ribs where they attach to the breastbone.

2. Trigger points in the scalenes or other muscles.

Rib misalignment can be remarkably painful, especially along the breastbone. Usually, rib symtoms will be fairly localized and if you poke around next to the breastbone, you’ll likely find a point of sharp tenderness over the displaced rib. Such problems are often associated with coughing, sneezing, or impacts or pressure on the ribs (such as when leading over the back of a seat reaching for something). Once a rig is misaligned, it doesn’t move properly with breathing, and the expansion and contraction of the rib cage with respiration tends to continually irritate the dysfunctional rib.

Chiropractic adjustments are usually the most direct and efficient way to correct these problems, but they sometimes do self-correct, or may be re-aligned with stretching and movement, as well as applying cold packs and using other anti-inflammatory measures such as NSAIDS.

Trigger points in the scalene muscles in the front of the neck, and sometimes the chest muscles themselves will often create symptoms in the chest that may include pain, tightness, numbness, and/or tingling.

The scalenes tend to tighten up during activities that require prolonged periods having your head forward (computer use, knitting, etc.) and/or having your arms elevated (driving, overhead work like painting a ceiling, etc.).

The scalene muscles in particular may produce symptoms that mimic those of a heart attack – pain and pressure in the chest, shoulder blade area, and/or arm and hand. Generally the symptoms from the scalenes are limited to abnormal sensations, whereas a heart attack will usually produce additional signs and symptoms such as altered pulse and blood pressure, nausea and vomiting, and profuse sweating. Scalene symptoms also tend to be associated with certain positions and movements whereas cardiac symptoms are not.

Pressing in with your fingers in the front of the neck just above the middle of the collarbone may allow you to locate the trigger point(s). Pressing on the points may elicit direct tenderness, but often causes increased referred symptoms into the chest, shoulder and/or arm without any direct tenderness. In some cases, pressing on the trigger point will immediately decrease the symptoms.

Treatment of trigger points includes gentle self-massage, stretching, and applying moist heat.

To stretch the scalenes, sit or stand comfortably, bend your head backwards and then bend sideways away from the side of the symptoms. It may help to drop your shoulder downward to accentuate the stretch.

When in doubt though, always err on the side of caution and seek immediate medical attention if you have any concern that your symptoms may be due to a cardiac issue.

Until next time,

George Best, D.C.