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Massage Today
February, 2008, Vol. 08, Issue 02

Chest Pain

By Ben Benjamin, PhD

Question: If taking a deep breath causes pain in the chest area, what are the three most likely musculoskeletal problems?

Answer: Intercostal muscle strain, a fractured rib or thoracic ligament sprain.

Whenever there is pain in the thoracic region, it's important to have the client see a physician quickly. Damage or disease of the organs in the thorax region - including the heart, lungs, spleen and gall- bladder - can produce pain in the chest that mimics a musculoskeletal problem. The pain often also extends into the middle or upper back.

When a musculoskeletal problem is to blame, pain on inhalation most likely is caused by a tear of the internal or external intercostal muscles. These muscles are used in breathing; more tension is placed on them as the chest expands. Intercostal muscle tears can cause sharp, debilitating pain, but they heal fairly quickly when treated by friction therapy followed by massage. Locating the injury generally is quick and easy; gently run your index finger over the muscles in the grooves between the ribs in the painful area.

Common referred pain patterns for ligament injuries in the thorax. - Copyright – Stock Photo / Register Mark Common referred pain patterns for ligament injuries in the thorax. The second possible cause is a fractured rib. This usually is quite painful and likely will be picked up by a doctor's examination or by an X-ray. Any time a client reports pain resulting from a physical blow to the chest, think rib fracture and get the person to a doctor. When a rib is fractured, the pain is felt right at the location of the break. There is no significant referred pain. With this injury, even gentle touch will be quite painful and the pain caused by a deep breath, cough or sneeze will be sharp and intense. It often feels as though the person is being stabbed in the chest. Breathing will be very shallow and there may even be some discoloration in the injured area. The physician may tape the area to diminish movement and often will prescribe pain-reducing medication if the pain is very severe. Fractured ribs generally take six to eight weeks to heal.

A third common cause of chest pain is ligament sprains in the thorax, usually between T2 and T10 (see illustration). On a deep inhalation, these refer pain into one side of the chest or from the mid-back through the body to the chest. The pain may range from mild to severe, and also will occur during rotation of the torso. Remember that this is referred pain, not local pain, so treating the painful area will not be effective. Only identifying and treating the damaged ligament or ligaments will provide relief.


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