Chest pain is a complex symptom requiring immediate attention to rule out life-threatening causes. While many people associate chest discomfort with cardiac events, the underlying cause often relates to other body systems. Chiropractic care focuses on the neuromusculoskeletal system, including the bones, muscles, nerves, and connective tissues of the spine and rib cage. A chiropractor addresses conditions originating from these structures only after serious medical issues have been excluded.
Understanding the Urgent Need for Medical Triage
Any new, sudden, or unexplained chest pain must first be evaluated by a medical professional to eliminate life-threatening conditions involving the heart or lungs. A chiropractor is not the appropriate first stop for acute chest pain because they cannot triage for cardiac, vascular, or pulmonary emergencies. Seeking emergency medical care is the necessary initial step.
Specific signs, often called “red flags,” demand immediate emergency attention, such as calling 911. These signs include a crushing or squeezing sensation in the chest, or pain that radiates to the jaw, neck, back, or arms. Other concerning symptoms are shortness of breath, sudden weakness, dizziness, cold sweats, or accompanying nausea and vomiting.
Pain that increases with physical exertion and is relieved by rest can indicate a significant cardiac issue like angina. Severe, ripping pain that may extend to the back, especially if associated with a difference in pulse strength between the arms, could signal an aortic dissection. These symptoms require immediate intervention, and paramedics can begin preliminary testing and care during transport.
Identifying Musculoskeletal Sources of Chest Discomfort
Once serious visceral causes have been medically ruled out, remaining chest discomfort often originates from the chest wall, known as musculoskeletal chest pain. This discomfort arises from the bones, cartilage, muscles, and nerves surrounding the heart and lungs. Musculoskeletal chest pain is a common reason for emergency department visits, sometimes accounting for over 25% of chest pain cases.
A frequent diagnosis is costochondritis, which involves inflammation of the cartilage connecting the ribs to the breastbone. This condition is often mistaken for a heart attack because the pain is localized and sharp, but it typically worsens with pressure or movement. Pain can also be caused by a rib subluxation, where the head of a rib becomes misaligned at its articulation with the thoracic spine.
Issues originating from the thoracic spine, such as a stress injury to a costovertebral joint or a herniated disc, can cause referred pain into the chest. Intercostal muscle strain, affecting the small muscles between the ribs, is another cause. Pain from these musculoskeletal sources is often sharp, localized, and reproducible when the patient moves, coughs, or breathes deeply, helping differentiate it from internal organ pain.
Chiropractic Evaluation and Management Protocols
A chiropractor begins evaluation by taking a comprehensive patient history, focusing on the pain’s characteristics, onset, duration, and aggravating or relieving factors. The physical examination includes orthopedic and neurological testing, along with detailed palpation of the thoracic spine, rib cage, and sternum. The goal is to isolate the pain source and confirm it is musculoskeletal.
If a rib subluxation or joint restriction is identified, the primary treatment involves specific spinal manipulation, focusing on the thoracic spine and the joints where the ribs attach. These adjustments restore normal motion to the restricted vertebrae and improve the articulation of the rib heads. Restoring proper movement alleviates pressure on the nerves and reduces the inflammatory response contributing to the pain.
For conditions like costochondritis or intercostal muscle strain, the chiropractor may integrate soft tissue therapy, such as myofascial release or Instrument Assisted Soft Tissue Mobilization (IASTM). These techniques target muscle tension and scar tissue in the chest and back that may be pulling on the rib cage and exacerbating inflammation. Posture correction and therapeutic exercises are also recommended to strengthen surrounding muscles and prevent recurrence of mechanical stress.
The management protocol emphasizes conservative, non-invasive methods to reduce pain and restore function to the chest wall. Co-management with a primary care physician or other specialists may be necessary if the condition does not respond to conservative care or if underlying inflammatory conditions are suspected. The chiropractor’s role is to address the biomechanical component of the chest wall pain.