Yes, a pulled back muscle can cause pain that feels like it originates in the chest, which is a common but often frightening experience. While chest pain immediately suggests a serious cardiac problem, it frequently has a non-cardiac origin, often stemming from the musculoskeletal system. Pain from a muscle strain in the back or rib cage area can mimic heart pain due to the complex network of nerves and muscle attachments in the torso. This type of pain is generally referred to as musculoskeletal chest pain and understanding this connection helps distinguish between a muscle injury and a medical emergency.
Understanding Referred Pain and the Muscles Involved
Referred pain occurs when the brain misinterprets the true source of a pain signal. Nerves from the internal organs, chest wall, and back enter the spinal cord at similar levels, allowing the brain to mistakenly attribute the pain signal from a strained back muscle to the front of the chest. This neurological crossover explains why an injury in one area of the torso can manifest as pain in another location.
The thoracic spine is the origin point for the ribs, which wrap around to the front of the body. Several back muscles are intricately connected to this rib cage structure, making them potential sources of referred pain. The intercostal muscles, small bands of tissue between the ribs, are particularly prone to strain and can cause pain felt along the rib from the back to the chest.
Larger back muscles, such as the rhomboids and the latissimus dorsi, also attach to the thoracic spine and ribs. A spasm or strain in these muscle groups can exert tension on the rib cage, leading to anterior chest wall pain. When one of these muscles is injured, the resulting inflammation or nerve irritation can travel along the nerve path, resulting in pain that feels sharp or deep within the chest. Furthermore, a pinched nerve in the upper spine caused by a disc or bone spur can cause pain to radiate along the nerve path into the chest.
Characteristics of Musculoskeletal Chest Pain
Musculoskeletal chest pain has specific qualities. A defining characteristic of pain from a pulled muscle is that it is often reproducible, meaning you can point to one specific spot on the chest or rib cage that feels tender when pressed. This pain is typically sharp, stabbing, or aching, and it tends to remain localized rather than radiating widely.
The pain from a muscle strain will usually worsen with movement or changes in posture. Twisting the torso, lifting an object, or taking a deep breath, cough, or sneeze can significantly increase the discomfort. This relationship between movement and pain is a strong indicator of a musculoskeletal source. Conversely, the pain may feel better when the person is resting or when a comfortable position is found.
Cardiac chest pain is more often described as a crushing pressure, squeezing, or tightness under the breastbone. This type of pain may spread or radiate to the jaw, neck, shoulder, or down one or both arms. Unlike muscle pain, cardiac pain is generally not relieved by changing position and often feels worse with exertion but does not change when pressing on the chest wall.
Systemic symptoms also help distinguish the cause of the pain. Cardiac pain is frequently accompanied by symptoms such as cold sweats, nausea, dizziness, or shortness of breath. If chest pain is the result of a muscle strain, these other symptoms are typically absent. Any instance of unexplained or severe chest pain should always be evaluated by a medical professional to rule out serious conditions.
Home Care and Recognizing Emergency Symptoms
For mild back muscle strains, initial home care focuses on reducing inflammation and allowing the muscle to heal. Rest is generally recommended for the first 24 to 48 hours to prevent further injury, but prolonged inactivity is often discouraged as it can lead to stiffness. Applying ice or a cold pack to the affected back area for 10 to 20 minutes at a time, several times a day, can help decrease swelling and numb the pain.
After the initial few days, switching to a heating pad can help soothe the muscle and promote blood flow to the injured tissue. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can also be taken to help manage both the pain and the inflammation. Gentle movement is encouraged, and light stretching, performed slowly to the point just before pain begins, can help maintain flexibility as the muscle heals.
Despite the high likelihood of a musculoskeletal cause, chest pain should never be dismissed without considering the possibility of a serious medical event. If the pain is described as a sudden, severe pressure, squeezing, or crushing sensation, call for emergency services right away.
Other emergency indicators include chest pain that radiates to the jaw, arm, or back, or pain that is accompanied by shortness of breath, excessive sweating, or profound dizziness. Pain that lasts longer than a few minutes and does not improve with rest also warrants an immediate call to emergency services.