Once I became more familiar with how to diagnose trigger points in my patients, I was surprised at the number of times that patients with chronic chest pain or shoulder pain turned out to be long-time sufferers of chest wall trigger points.
If you’re experiencing persistent chest pain, it’s important to seek medical attention immediately, as it could be a sign of a life-threatening condition like a heart attack or pulmonary embolism.
Important medical disclaimer aside, if your chest pain is musculoskeletal in nature, it could be caused by trigger points in your chest wall muscles.
Trigger points are taut bands of muscle fibers that can cause pain and discomfort when they are compressed or stimulated. When trigger points develop in the muscles of the chest wall, they can cause sharp, stabbing pain that may be mistaken for a heart attack or other cardiovascular problems. Common muscles with trigger points causing chest wall pain include the trapezius, scalene, pectoralis minor, and serratus anterior.
Symptoms of chest wall trigger points may include pain that is localized to a specific area of the chest, pain that is worsened by deep breathing or coughing, and pain that is relieved by pressure on the affected area. If you suspect that your chest pain may be caused by trigger points, your doctor or therapist can perform a physical exam to diagnose the problem. Treatment may include myofascial release or Active Release Technique of the trigger points, trigger point injections, physical therapy, and stretching exercises to prevent the development of new trigger points.
Key Takeaways
- Chest wall pain caused by trigger points can be mistaken for a life-threatening condition, so it’s important to seek medical attention if you’re experiencing persistent chest pain.
- Common muscles with trigger points causing chest wall pain include the trapezius, scalene, pectoralis minor, and serratus anterior.
- Treatment for chest wall pain caused by trigger points may include myofascial release of the chest wall trigger points as well as trigger point injections, physical therapy, and stretching exercises to prevent the development of new trigger points.
Common Muscles with Trigger Points Causing Chest Wall Pain
If you are experiencing chest wall pain, there are several muscles that may be the culprit. Trigger points in these muscles can cause pain that is often mistaken for heart-related issues, making it important to understand their role in chest pain.
Pectoralis Major and Minor Muscles
The pectoralis major and minor muscles are located in the chest and are responsible for movements like pushing and pulling. Trigger points in these muscles can cause pain that is felt in the chest, shoulder, and arm. In fact, a study published in ScienceDirect found that a trigger point in the pectoralis minor muscle caused chest pain in a patient who was cross-country skiing.
Serratus Anterior Muscle
The serratus anterior muscle is located on the side of the chest and is responsible for movements like raising the arm. Trigger points in this muscle can cause pain that is felt in the chest and upper arm.
Intercostal Muscles
The intercostal muscles are located between the ribs and are responsible for breathing. Trigger points in these muscles can cause pain that is felt in the chest and can make it difficult to take deep breaths.
Levator Scapulae Muscle
The levator scapulae muscle is located in the neck and is responsible for movements like shrugging the shoulders. Trigger points in this muscle can cause pain that is felt in the upper back and chest.
Trapezius Muscle
The trapezius muscle is located in the upper back and is responsible for movements like shrugging the shoulders and tilting the head. Trigger points in this muscle can cause pain that is felt in the upper back, neck, and chest.
It is important to note that trigger points in these muscles can cause pain that is often mistaken for heart-related issues. If you are experiencing chest pain, it is important to seek medical attention to rule out any serious conditions.
Symptoms of Chest Wall Pain Caused by Trigger Points
If you have chest wall pain caused by trigger points, you may experience various symptoms. Here are some of the most common symptoms associated with this condition:
Location and Quality of Pain
Trigger points in the chest wall can cause pain that is felt in different areas, depending on the location of the trigger point. The pain may be described as aching, sharp, or discomfort. It may also be felt as referred pain, which means that the pain is felt in a different area of the body than where the trigger point is located.
Some common locations of trigger points in the chest wall include the midpoint of the upper fold of the trapezius, the origin of the pectoralis from the sternum, and the lower edge of the scapula. The pain may also be felt in the ribs or arms.
Associated Symptoms Such as Difficulty Breathing or Coughing
In addition to pain, chest wall trigger points may also cause other symptoms. For example, you may experience difficulty breathing or coughing. This may be due to the fact that the trigger point is located in a muscle that is involved in breathing, such as the diaphragm or intercostal muscles.
If you have chest wall pain caused by trigger points, you may also experience numbness or tingling in the affected area. This may be due to the fact that the trigger point is compressing a nerve.
It is important to note that chest wall pain caused by trigger points is usually musculoskeletal in nature and not related to cardiovascular or pulmonary issues. However, if you experience chest pain that is accompanied by shortness of breath, nausea, or other symptoms, it is important to seek medical attention immediately.
In summary, chest wall pain caused by trigger points can cause a variety of symptoms, including pain, difficulty breathing, and numbness. If you experience these symptoms, it is important to seek medical attention to rule out any serious underlying conditions.
Diagnosis of Trigger Points in Chest Wall Pain
If you are experiencing chest pain, it is important to seek medical attention to determine the cause. Chest wall pain can be caused by many factors, including musculoskeletal trigger points. The diagnosis of trigger points in chest wall pain involves a thorough examination by a doctor, which may include palpation of trigger points.
Palpation of Trigger Points
Palpation is a technique used by doctors to feel for abnormalities in the body, such as trigger points. During a physical examination, your doctor may use palpation to locate tender spots in your chest wall. These tender spots may be indicative of trigger points.
The most common sites of tender points in the chest wall include the midpoint of the upper fold of the chest, the upper outer quadrant of the breast, and the lateral border of the pectoralis major muscle. Palpation of these tender points can help your doctor diagnose trigger points in the chest wall.
It is important to note that the diagnosis of trigger points in chest wall pain requires a differential diagnosis to rule out other potential causes of chest pain. This may involve a series of tests, such as an electrocardiogram (ECG) or chest X-ray, to determine if there is an underlying medical condition causing your chest pain.
If you are experiencing new-onest chest pain, it is important to seek medical attention immediately. If you are unsure whether your chest pain is an emergency, it is always best to err on the side of caution and seek medical attention. Primary care doctors and emergency room physicians are trained to diagnose and treat chest wall pain, including trigger points.
Treatment of Chest Wall Pain Caused by Trigger Points
If you are experiencing chest wall pain caused by trigger points, there are several treatment options available to you. These treatments range from manual therapies such as massage or trigger point release to medications that can manage pain and inflammation. Here are some of the most common treatments for chest wall pain caused by trigger points:
Manual Therapies Such as Massage or Trigger Point Release
Manual therapies such as massage or trigger point release can help to relieve pain and inflammation caused by trigger points in the chest wall. These therapies work by applying pressure to the affected area, which can help to release tension and reduce pain. Trigger point release involves applying pressure to specific points in the chest wall to help release tension and reduce pain.
Self-Release Techniques for Chest Wall Trigger Points
Self-release techniques can also be effective in managing chest wall pain caused by trigger points. These techniques involve using your own hands or a tool such as a foam roller to apply pressure to the affected area. This can help to release tension and reduce pain and swelling.
Niel Asher has some very informative and well-done YouTube videos that demonstrate some techniques for the myofascial release of trigger points of the chest wall.
Stretching and Strengthening Exercises
Stretching and strengthening exercises can also be effective in managing chest wall pain caused by trigger points. These exercises can help to improve flexibility and strength in the affected area, which can help to reduce pain and inflammation. A physical therapist can help you develop a stretching and strengthening program that is tailored to your specific needs.
Medications to Manage Pain and Inflammation
I am not a fan of long-term, chronic pain medications except when all other options have been exhausted. I feel that if a patient is still in pain, then the most important next step in the patient’s treatment is to actually take a step back and ask “why are they still in pain?”
Do we have the correct diagnosis and if so, are we applying the correct treatment for that diagnosis?
I’ve been a physician long enough to know that my initial thoughts and diagnosis on a patient are not always correct and part of the true scientific method is always, always, ALWAYS re-evaluate if symptoms are not improving.
That said, medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections can be used to manage short-term acute pain and inflammation caused by trigger points in the chest wall. These medications work by reducing inflammation and swelling in the affected area, which can help to relieve pain. However, the medications don’t necessarily treat the underlying cause of the trigger points, so often times, the pain from the chest wall trigger points will return.
Overall, there are several effective treatments available for chest wall pain caused by trigger points. If you are experiencing chest wall pain, it is important to talk to your healthcare provider to determine the best course of treatment for your specific needs.
Prevention of Trigger Points in Chest Wall Muscles
If you want to prevent trigger points in your chest wall muscles, there are several things you can do. Proper posture and body mechanics, regular exercise and stretching, and stress management techniques can all help.
Proper Posture and Body Mechanics
Maintaining proper posture and body mechanics is essential to prevent trigger points in your chest wall muscles. When you sit or stand, make sure your shoulders are relaxed and your chest is open. Avoid slouching or hunching forward, as this can put extra strain on your chest muscles.
If you work at a desk or computer, make sure your workstation is set up ergonomically. This means that your monitor should be at eye level, your keyboard and mouse should be at a comfortable height, and your chair should provide good lumbar support.
One common syndrome I see in patients that spend a lot of time either at a desk/computer or scrolling thru their smartphone is “Upper Crossed Syndrome” which, in part, is due to tight pectoralis muscles.
Regular Exercise and Stretching
Regular exercise and stretching can help prevent trigger points in your chest wall muscles. Exercise can improve circulation and strengthen your muscles, while stretching can help improve flexibility and reduce tension.
Incorporate exercises that target your chest muscles, such as push-ups, chest presses, and flyes, into your workout routine. Be sure to stretch your chest muscles after your workout to help prevent tension and soreness.
Stress Management Techniques
Stress and anxiety can contribute to the development of trigger points in your chest wall muscles. To prevent this, try incorporating stress management techniques into your daily routine.
Deep breathing exercises, meditation, and yoga are all effective ways to reduce stress and promote relaxation. You can also try progressive muscle relaxation, which involves tensing and then relaxing your muscles to help release tension.
By following these tips, you can help prevent trigger points in your chest wall muscles. Remember to listen to your body and take breaks as needed, especially if you engage in repetitive motions or activities that put extra strain on your chest muscles.
Conclusion
In conclusion, chest wall trigger points can be a source of pain and discomfort for many people. It is important to seek medical attention if you are experiencing chest pain, as it could be a sign of a more serious condition.
Summary of Key Points
- Chest wall trigger points can cause pain and discomfort in the chest area.
- Manual-type therapies and some physiologic therapeutic modalities can be effective in managing myofascial pain syndrome and myofascial trigger points.
If you are experiencing new-onset chest pain, it is important to see a doctor or go to the emergency room immediately. Chest pain can be a sign of a heart attack or other serious condition that requires immediate medical attention.
In addition, if you have been diagnosed with myofascial pain syndrome or myofascial trigger points, there are a variety of treatment options available. Your doctor can help you determine which treatment option is best for you based on your individual needs and medical history.
Overall, it is important to take chest pain seriously and seek medical attention if you are experiencing any discomfort in the chest area. With the right treatment and management, chest wall trigger points can be effectively managed and controlled.
Importance of Seeking Medical Attention for Persistent Chest Pain
Persistent chest pain can be a symptom of several medical conditions that require prompt medical attention. If you experience chest pain that lasts for more than a few minutes or that comes and goes, it is important to seek medical attention immediately.
Chest pain can be caused by various conditions, such as heart disease, lung problems, gastrointestinal issues, or musculoskeletal problems. Chest wall trigger points can also cause chest pain, which may be mistaken for more severe conditions like heart attacks. Therefore, it is crucial to have a medical evaluation to determine the cause of the chest pain and receive appropriate treatment.
A doctor can perform a physical examination and order diagnostic tests, such as an electrocardiogram (ECG), chest X-ray, or blood tests, to determine the underlying cause of your chest pain. In some cases, you may need to be referred to a specialist, such as a cardiologist or pulmonologist, for further evaluation and treatment.
If you are experiencing chest pain that is severe, or accompanied by other symptoms such as shortness of breath, dizziness, nausea, or sweating, it is important to seek emergency medical attention immediately. These symptoms may indicate a serious condition, such as a heart attack, and require immediate treatment.
In summary, persistent chest pain can be a sign of a serious medical condition, and it is important to seek medical attention promptly. A doctor can evaluate your symptoms and determine the underlying cause of your chest pain, and provide appropriate treatment. If you experience severe chest pain or other symptoms, seek emergency medical attention immediately.