What to do when chest pain feels muscular and how to manage it
Nicola Tik
Chest pain of any kind can feel unsettling, and it is completely understandable to want to know what is going on. Most chest pain that comes on after a specific movement, a period of coughing, or unusual physical activity is muscular in origin and settles well with some simple steps. This article helps you make sense of what you are feeling and walks you through what to do next.
Not all chest pain is the same, and the features of your pain can give useful clues about what is likely causing it.
Pain that is more likely to be muscular tends to have some of the following features. It came on after a specific physical activity, an awkward movement, a period of heavy coughing, or unusual exertion. It feels worse when you press on a specific spot on the chest wall. It changes with movement, such as twisting, reaching, or taking a deep breath. It stays in one localised area rather than spreading.
Pain that is worth getting checked promptly tends to feel different. If your pain feels crushing, tight, or like a heavy pressure in the chest, spreads to the arm, jaw, neck, or back, comes with breathlessness that feels unusual, dizziness, sweating, or a sense that something is seriously wrong, it is important to seek medical attention straight away. The same applies if the pain came on at rest without any obvious physical cause, or if you have any history of heart or lung conditions.
If you are in any doubt about which category your pain falls into, getting it checked is always the right decision.
The chest wall is made up of layers of muscle running between and around the ribs, along the breastbone, and across the front and sides of the chest. These muscles are involved in breathing, movement of the arms and shoulders, twisting, and reaching. When they are placed under unusual demand, whether from a sustained awkward position, a forceful cough, a sudden twist, or an increase in upper body activity, the muscle fibres or the small joints where the ribs meet the breastbone can become irritated and sensitive.
This kind of pain can feel surprisingly sharp, particularly when breathing in deeply, coughing, or moving the upper body in certain directions. That sharpness can feel alarming, but in the context of muscular chest pain it is a common feature rather than a sign of something serious. The chest wall muscles are thin and work constantly with every breath, which is part of why irritation in this area can feel more intense than a similar injury elsewhere in the body.
The pain often has a very specific location that you can point to with a finger, and pressing on that spot tends to reproduce it. This reproducibility on touch is one of the more reassuring features of muscular chest pain.
The most useful thing you can do in the early stage is reduce the activities that are loading the chest wall most heavily, without stopping all movement entirely. Complete rest tends to stiffen the muscles and make breathing feel more uncomfortable rather than less. Gentle, regular movement and normal breathing are more helpful than trying to guard the area or take deliberately shallow breaths.
A few practical steps that tend to make the most difference in the first few days:
Avoid activities that require forceful or sustained upper body effort, such as lifting, pushing, pulling, or any exercise that loads the chest and shoulders heavily. These place significant demand through the chest wall muscles and can keep the area irritated while it is trying to settle.
If coughing is a feature, supporting the chest wall with a folded pillow or your hands when you cough reduces the strain on the irritated muscles and tends to make coughing considerably less painful. The same applies to sneezing.
Sleeping positions can make a meaningful difference. Many people find that lying on the affected side, so the chest wall is gently supported by the mattress, feels more comfortable than lying on the opposite side where the chest wall hangs open. A pillow hugged against the chest can also help during the night.
Warmth applied to the area for 15 to 20 minutes at a time helps the chest wall muscles relax and eases the aching that often builds through the day. A heat pad on a low setting or a warm shower are both useful options.
If over-the-counter pain relief is appropriate for you, taking it as directed and consistently for the first day or two, rather than waiting until pain peaks, can help keep discomfort manageable, particularly overnight. A pharmacist can advise on the most appropriate option.
Because the chest wall muscles are involved in every breath, keeping them gently mobile is important even when things are sore. The instinct to take shallow breaths to avoid discomfort is understandable, but sustained shallow breathing can lead to stiffness in the chest wall and make recovery take longer than it needs to.
A useful exercise to try once or twice a day is a gentle deep breathing exercise. Sitting upright in a chair with both feet flat on the floor, place one hand on your chest. Slowly breathe in through the nose, allowing the chest to expand gently, hold for two to three seconds, then breathe out slowly through the mouth. Repeat five to eight times, keeping the movement slow and within a comfortable range. If a full deep breath feels too uncomfortable in the early days, start with whatever depth feels manageable and build gradually as things ease.
Gentle movement of the upper body also helps prevent the surrounding muscles from stiffening. Sitting upright, slowly roll both shoulders backwards five to eight times, keeping the movement small and comfortable. This keeps the muscles across the upper chest and between the shoulder blades gently mobile without placing significant demand through the chest wall.
If you would like a guided routine to support you through this, VIDA has a short video you can follow at your own pace.
Most muscular chest pain begins to ease noticeably within a week and settles considerably over two to three weeks, though this varies depending on how the pain came on and how the chest wall is being loaded day to day. Pain that came on after a prolonged period of coughing can take a little longer to settle because the muscles continue to be loaded with every cough.
A useful marker is whether pain during everyday breathing and gentle movement is gradually reducing over the first week. If it is, things are heading in the right direction. If pain is not easing at all after a week or two, or is getting worse rather than better, it is worth speaking to your GP.