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  • Writer's pictureCrucial Rehab Team

Are all chest discomforts red signs?

Chest discomforts, whether it is pain or tightness causes panic among people of all ages. We tend to think of the worst case scenario of having a heart attack or lung fibrosis. However, apart from the heart and lung, there is a multitude of musculoskeletal cases that can contribute to the above symptoms:

  • Costochondritis

  • Muscle tightness or strain

  • Intercostal neuralgia

  • Thoracic nerve impingement

  • Fractures

*If you’d like to skip the description of each condition, you may go straight to ‘Red Flags for Chest Pain’.*


(Image taken from google)

The costochondral and costosternal joints are found at the junction connecting the ribs and cartilage bone as well as the chest bone (sternum). The part ‘itis' indicates an inflammatory condition and in this case is the inflammation of the costochondral joints. This can happen in athletes or people who tend to move their upper body excessively or aggressively, resulting in repetitive trauma in the joints. Poor posture such as slouching can also result in pain.

Despite this being a condition less heard of, it is commonly diagnosed amongst chest pain cases in the emergency department. In a group of 122 patients presenting to the emergency department with chest pain not due to malignancy, fever, or trauma, costochondritis was the diagnosis in 36 of the patients (30%). Another study of chest pain in an outpatient adolescent clinic found that 31 percent of adolescents had musculoskeletal causes, with costochondritis accounting for 14 percent of adolescent patients with chest pain. Costochondritis is usually confirmed after clearing cardiac and pulmonary conditions via diagnostic tests. Pain can be aggravated by pressing on the chest muscles or moving the affected joints. These pains can radiate across the chest in the form of dull or sharp sensations.

Muscle tightness or strain

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Covering the chest wall are muscles such as the pectoralis (also known as chest muscles) and intercostal muscles that are found between rib bones. A traumatic injury to the chest or microtear in these muscles due to excessive loading (eg. carrying something too heavy) can lead to pain even during gentle movements such as breathing. Similar to other chest issues, symptoms can radiate across the chest. In someone who is hunched in the upper back, pectoralis muscle tightness can occur and cause pain overtime.

Intercostal neuralgia

(Image taken from google)

Intercostal muscles are intertwined with nerves known as intercostal nerves. When these nerves get irritated or aggravated by an infection, common in the case of shingles, or a trauma to the chest, they result in neuropathic pain. This can also be mistaken for a chest issue as the pain can be quite irritable.

Thoracic nerve impingement

(Image taken from google)

Most people are familiar with pinched nerves or slipped discs in the lumbar spine which can also happen similarly in the thoracic spine. Certain nerve branches from the thoracic spine serve as sensory nerves for the chest. Poor posture or injury to the spine can pinch or irritate the nerves travelling out from the spinal bones resulting in numbness or pain in the chest.


(Image taken from google)

Like any other fractures in the body, even a hairline fracture can cause extreme pain. Hence, fractures of bones on the chest can cause severe pain throughout the chest where movements are greatly limited. Often times, swelling and bruising can also be noted in the injured area.

Red flags for Chest Pain

Red flags are known as warnings of danger. If 2-3 of these red flags are met, please consult a doctor IMMEDIATELY.

1. Cold sweat – clammy skin

2. Feeling unwell

3. Exertional chest pain – heavy, tight, pressure type pain that INCREASES OVER 5-10MINS

4. Nausea/vomiting

What can be done?

If there are no red flags, there are a few conservative ways to go about chest discomforts:

• Rest and avoid aggravating movements

• Avoid inflammatory foods – refined sugar such as table sugar and high fructose corn syrup

• Postural correction for upper cross syndrome (check our previous post on Upper Cross Syndrome!)

• Stretching exercises – pectoralis muscle stretch

• Mobility exercises - Gentle, oscillatory trunk rotation & extension, side bending

(Image taken from google)

• Breathing exercises

- diaphragmatic breathing

(Image taken from google)

- thoracic expansion exercise

(Image taken from google)

- pursed lip breathing supported forward lean

(Image taken from google)


  1. Schumann JA, Parente JJ. Costochondritis. Available from:

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