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?

Sincerely,
Bird-chest in pain

Dear Bird-chest in pain,

There are a lot of different causes of chest pain (musculoskeletal, gastrointestinal, and cardiac) and it can be very frustrating to be in pain and not know why. Not to mention, having seen numerous health care providers without a clear answer surely adds to your frustration. There are multiple causes (keep reading for more on those), but talking with a health care provider will help you determine what you’re dealing with specifically. Once the mystery has been solved, they may be able to prescribe a treatment plan for you, and point you in the direction of affordable therapy options. There are also other strategies for you to consider in terms of physical activity and stress management that could help you manage your health as you continue to look for the cause of your pain. 

Getting down to the bones of it, chest pain most often stems from musculoskeletal and gastrointestinal causes rather than cardiac (heart-related) causes, especially in younger adults. The most common cause of musculoskeletal chest pain is costochondritis (a.k.a., costosternal syndrome or costosternal chondrodynia). Considered an acute and temporary condition, it’s typically caused by inflammation of the cartilage connecting the sternum to one or more of the ribs, and may last a week or two. The sharp pain and tenderness from costochondritis can increase with movement and deep breathing. It may also be accompanied by other symptoms of inflammation, such as warmth, swelling, and redness in the affected area. More common in females, costochondritis may occur from causes of viral, bacterial, or fungal infections, upper respiratory infections, an increase in physical activity, or minor injury to the area. Treatment for the condition can 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.

But, when it comes to musculoskeletal causes of chest pain, costochondritis is just one of many possibilities. As with any bone in the body, the sternum is susceptible to fractures of varying degrees. Some injuries — including bruising, full and partial dislocations, and fractures — are typically due to direct trauma (such as the chest hitting a steering wheel during a car crash), and thus are accompanied by injuries to the surrounding ribs, collarbones, and connecting cartilage. While rare, stress fractures can be caused by repeatedly placing pressure on the bone, such as through rowing, throwing, wrestling, golfing, bench pressing, or even repetitive sit-ups. Generally, stress fractures are diagnosed by conducting CT and MRI scans of the affected area. When this type of injury occurs, health care providers typically recommend rest (for one to two months), non-steroidal anti-inflammatory drugs (NSAIDs), cold/ice therapy, and topical pain ointments to help treat the pain.

Along with the musculoskeletal causes, chest pain is also associated with heart, lung, or gastrointestinal tract diseases, as well as a much less common symptom of rheumatic conditions (which affect the joints and connective tissues) such as fibromyalgia. Other possible causes of chest pain include:

  • Gastrointestinal conditions, such as heartburn, hiatal hernia, and gallbladder or pancreatic conditions 
  • Panic attacks
  • Respiratory ailments including pleurisy or asthma
  • Pinched nerves
  • Sore muscles

List adapted from Mayo Clinic.

Because of the possible culprits for your pain can really run the gamut, treatment for your chest pain will vary depending on the underlying cause, but could include anything from rest, to medication, to surgery. However, finding the specific cause for your pain is essential in order to determine the best treatment so it's recommended that you continue working with a health care provider to determine the source of your pain. Noting where the pain is located and what condition you’re in when it worsens (i.e., when experiencing stress) can provide clues to inform a diagnosis.

Though you may feel frustrated about not being able to lift weights at the moment, adequate rest and nutrition will only help you recover from your ailment. In the meantime, you might consider consulting a medical professional on exercises you can do that are won’t exacerbate your pain. You may also want to consider some stress-reducing activities, such as meditation, yoga, and tai-chi. As for the depression you've been experiencing, consider asking yourself how body image may play a role in how you’re feeling about yourself. Speaking about this with a health care provider or counseling professional may also be helpful. If you need help finding a professional to speak with, check out How to find a therapist in the Go Ask Alice! archives.

Here's hoping that your chest pain goes away and that you'll be back to feeling great while lifting weights in no time!

Alice!

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