Dear Alice,

I've recently been experiencing chest pains in the sternum area. Although I don't believe it is related to heart trouble, I think the pain is originating from the bones or muscles attached to the sternum. I have seen doctors but most are clueless as to where the pain may be specifically originating. An interesting side is that during times of stress, the pain is more severe and concentrated at specific points along the sternum. One hypothesis is that the pain may be related to an injured sterno-manubrial joint. If indeed this is the case, what therapy is available to a poor, uninsured student? My mental health is being affected since my once pumped-up, rock hard body is slowly atrophying since I can't lift weights without extreme pain. I'm depressed because the size of my chest is now smaller. What do I do? What's wrong with me?

Bird-chest in pain

Dear Bird-chest in pain,

Sounds like a real pain in the chest. A number of possibilities may account for the pain, whether they're cardiac- or non-cardiac-related. A few possibilities are below, but consider seeing another health care provider for a true diagnosis.

One possible cause of chest pain is costochondritis (aka chest wall pain, costosternal syndrome, or costosternal chondrodynia). This harmless condition occurs when the sternum (the cartilage connecting the rib to the breastbone) is inflamed, and this may last a week or two. The sharp pain and tenderness from costochondritis may increase with movement and deep breathing. More common in females, costochondritis may occur from causes of viral, bacterial, or fungal infections, exercise, upper respiratory infections, or minor injury to the area. Treatment for costochondritis may include painkillers or muscle relaxants as well as resting, doing gentle exercise (i.e., walking or swimming), and using a heating pad to relieve pain in the area. As usual, please try to see a health care provider before trying treatment options.

Tietze syndrome, another possible condition, is characterized by swelling at the rib-cartilage junction, and this may last for a period of many weeks to many months. Infection after surgery may contribute to this condition. Sneezing, coughing, or breathing deeply may exacerbate the pain. With any chest pain, it's recommended that you see a health care provider who can diagnose what may be going on, especially since chest pains may be similar to those associated with diseases of the heart, lung, or gastrointestinal tract. Although a number of heart conditions — chronic and acute — may cause chest pain, a number of causes of chest pain that aren't cardiac-related include:

List adapted from Chest pain from the Mayo Clinic

Noting when the pain worsens (i.e., when you're stressed) could hold a clue for health care providers as to what may be causing the pain. In the meantime, check out Exercising while injured and Exercise for people with physical disabilities. You may also want to consider some stress-reducing activities, such as meditation or yoga. As for the depression you've been experiencing, consider asking yourself why you may be feeling this way and how body image may play a role in how you feel about yourself. Speaking about this with a health care provider or counseling professional may also be helpful.

If you're a student at Columbia you can make an appointment to see a health care provider from Primary Care Medical Services for free by calling x4-2284 or by logging in to Open Communicator. A primary health care provider can make the appropriate referrals, if needed, for a physical therapist or another specialist. You can also make a counseling appointment by calling x4-2878 or by Counseling and Psychological Services. If you are not a student at Columbia, you can visit the American Physical Therapy Association and the American Psychological Association websites to find providers in your area.

Here's hoping that your chest pain goes away and that you'll be back to doing exercise you enjoy in no time!


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