Suspecting musculoskeletal chest pain, this is my first spot to check. You can check it the same way...

Sit and rest your right forearm on a table, then use your left hand’s index or middle finger to dig firmly under your right collar bone. Move the finger along, feeling for tender areas here, immediately under the bone.

Swap over and compare your two sides . One or both may be quite tender. This is likely to be tenderness of a little muscle named “Subclavius,” which runs under your collar bone.

This is a common cause of musculoskeletal chest pain.

I do treat this muscle by pressing on it, but this is quite painful. It requires a lot of pressure and is likely to give the person temporary pins and needles and numbness in their arm.

I am pressing right on their brachial plexus - the nerves from the neck to the arm. The nerves complain about this rough treatment.


shoulder rolls instead - for a minute or so, daily.

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Serratus anterior

Now reach across your chest to the opposite armpit. About a hand’s breadth below the top of the armpit, as far back as you can reach, find the bony lump which is the bottom of the shoulder blade.

You can tell it is the shoulder blade, by feeling it move when you move the other arm.

Press around on the chest wall (ribs) just in front of the bony lump, feeling for tenderness near here. Swap to the other side and repeat, comparing the tenderness.

The muscle which gets tender here, is called “Serratus anterior.”

finding Subclavius and Serratus anterior muscles

These two muscles commonly cause pain in the breast (Pectoral) region.

It is very likely that they account for the sharp pain in left chest which was part of the soldiers' heart syndrome (Da Costas' syndrome.)

Serratus anterior (named for it's serrated front edge) is a flat thin muscle sitting on the ribs. You can't feel it, so just press where it is tender, until the tenderness eases off.

If this happens quickly, your finger has probably slipped off the tender spot, so just move it around and see if you find it.

If muscles are very sore, the tenderness may not ease until you take the pressure off. If there is no let up after say three minutes, just let go and see if you feel better anyway.

An exercise to stretch Serratus anterior, is done bracing your shoulders back as hard as you can. Then with your hands behind your back, use one hand to clasp as far up the other forearm as you can manage. Now breath in deeply and hold your breath in as long as you can.

Pectoralis minor

This little muscle only occasionally causes chest pain, so I only look for it if nothing else is turning up.

It is hidden under your pecs - Pectoralis major, a very strong muscle which nothing much goes wrong with.

Find the hard round bone like the tip of a finger, pointing forwards at the front of your shoulder. It is just below the outer end of your collar bone. This is your coracoid process, part of your shoulder blade.

Push a finger tip straight inwards quite firmly, right alongside it, immediately under and then on the inner side. Compare the tenderness at these two spots. If the tenderness is more on the inner side, pectoralis minor may be responsible.

I treat it exactly the same way, just continuing the backwards pressure until it relaxes. This is guaranteed to give you pins and needles in the arm, as you are pressing directly on your nerves going down your arm. The nerves stop complaining when you have finished.

Pectoralis major

This big strong muscle and when it is sore the reason is usually perfectly obvious - unaccustomed use +++.

If you're not sure, pinch the front fold of your armpit, between your forefinger and thumb. It will be quite tender if this is the problem.

Vitamin E and selenium supplements can be used prior to unaccustomed exercise, and during it. I had a weekend skiing some years ago, with no prior exercise. By the end of the second day, I could hardly put one foot in front of the other, but I had no muscle pain. I don't remember the number of 500iu vit E capsules I consumed over that weekend, but it was quite a few.

Intercostal muscles - between the ribs

These are overlaid everywhere by other muscles, which may be tender in their own right.

One can get a clue about them, however, by comparing the spaces between the ribs on the two sides. If two ribs are closer together and it is quite tender between them, this muscle is tight.

You can check your own lower ones by digging your thumbs between the ribs near their front ends, where they meet your costal cartilages.

As you feel each intercostal space, note the movement or lack of it, between the pair of ribs on each side, as you breath in and out.

If you can get someone to examine you, my method is described and illustrated in the transcript of a lecture I gave many years ago on referred pain.

As well as treating joints at the back, breathing deeply while bending sideways away from the stiff side, and yoga mudras (hand positions,) are used to open up different parts of the chest.

Maybe muscoloskeletal chest pain from muscles in your neck?

Your upper chest skin receives its' nerves from your neck. These supraclavicular nerves pass over your collarbone as shown...

innervation of upper chest wall from neck

Pain from neck muscles innervated by C3-4 sensory nerves, may be felt as referred upper chest pain.

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Or from your upper thoracic paraspinal muscles (and T joints)

These are the muscles running up alongside the thoracic spine. They have your levator scapulae and rhomboids over them, so it's a bit hard to tell which are the sorest.

You can soon tell if something is sore in this area, by putting your (opposite) hand over your shoulder and digging your fingers in.

These paraspinal muscles are stretched during a forwards neck stretch, by using your tummy muscles to bend yourself down more. If you do this and you feel pain in your upper thoracic region as well as neck, you are stretching the paraspinals.

You may feel pain in the front of your chest when you start this stretch, referred from the neck/upper back or due to spasm in one of the front muscles.

This last phenomenon happens with various stretches, particularly of thigh and pelvic muscles. Stretch one muscle and you relax it's antagonist muscle. If that muscle already has tight sore parts, relaxing it may bring on a cramp.

If the chest pain is too intense, it may be best to let go and stretch the front muscles first, by arching one's back and looking up at the ceiling. Strain to look progressively further back over your head, over a few minutes, until any pain in the front of your neck or chest stops.

Then return to the forward neck stretch.

If these stretches appear to stop chest pain, this supports the idea that it is at least partly musculoskeletal chest pain. It doesn't rule out the possibility of pain from internal organs such as your heart.

It is quite common in our body, for multiple causes to contribute to one symptom.

If it becomes difficult to breath because your chest is cramped up, continue the stretch standing up and leaning your calves against something to help with your balance.

In this position, force your shoulders down as far as you can, and you will also be stretching levator scapulae superioris.

While levator scapulae is not a cause of referred musculoskeletal chest pain, the general rule for everywhere is, if stretching it hurts, continue to stretch until it no longer hurts.

If you are interested in a home study course on examination of the spine, please send me your e-mail address by the contact form.


Thoracic spine joints

Your upper thoracic spine can also be the source of your musculoskeletal chest pain.

Costovertebral joints

The people I've seen with a prior diagnosis of Tietze syndrome or costochondritis, have had osteopathic lesions of their thoracic spine as the cause of their chest pain.

The back end of each rib joins two adjacent vertebral bones.

costo vertebral joint anatomy

When a vertebral joint is hitched, the rib is levered out of place.

This can be seen having the person lay face down and pressing a finger on the back part of each of a pair of ribs, to judge their prominence.

One of the pair of ribs will be higher in this face down position.

After the vertebral joint has been unhitched, the ribs lie at the same height. I only occasionally have to give the rib a sharp thrust on its angle, as is used in "Activator Methods" chiropractic technique.

Costochondral junction

Our ribs are made of bone at the back and gristle at the front. The junctions between the bone and gristle are shown...

costochondral junction anatomy

The rib out of position places a lot of strain on the connection between the front end of the bony rib and the gristle part (costal cartilage.)

This gets sore, and guess what - musculoskeletal chest pain.

If you run your fingers along your ribs now, there will be a distinct tender spot at the junction.


Is every inbreath hurting? Tender chest wall here, behind the line of the costo-chondral junctions? One can feel along the individual ribs for localized tenderness.

Our bony ribs are a common place for cancers to spread to. A history of injury doesn't rule out this possibility.
An x-ray is therefor a good idea here, if one is middle aged or older.

An elastic rib splint about 6 inches wide, is very comfortable if one has a fractured rib. One shouldn't wear this for the whole 24 hours, just in the day when active.

Years ago it was common practice to put adhesive strapping around the chest, but it was found that complicating pneumonia was encouraged.

Dangerous musculoskeletal chest pain treatment!

The ribs are not commonly sore from referred pain, but the breast bone is.

Sternal tenderness can be an indication of leukaemia, but not usually.
Push in under your collar bone, over subclavius. This is often the source of the pain.

Shoulder rolls may be in order - always a good bet when you suspect musculoskeletal chest pain.

To the other page on muscular, rib and pleuritic chest pain

From musculoskeletal chest pain to thoracic spine page.

Do you suspect acid reflux is a problem for you?

From musculoskeletal chest pain to home page

References for musculoskeletal chest pain page on nutrients for MSK sructures.

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If you are interested in a home study course on examination of the spine, please send me your e-mail address by the contact form.