You cannot technically “pull a muscle” in your sternum, as the sternum (breastbone) is a flat bone, not a muscle. However, the sensation of a strain directly behind your breastbone is a common experience. The pain you feel is almost always related to the muscles, cartilage, and joints tightly connected to the sternum and rib cage. This musculoskeletal pain often mimics the feeling of a pulled muscle because a strain in the surrounding tissues radiates pain toward the center of the chest.
The Muscular Anatomy Surrounding the Sternum
The chest wall is a complex structure made of bone, cartilage, and muscle that protects organs and facilitates breathing. The sternum connects to the ribs through flexible segments called costal cartilage, which allows for the necessary movement of the rib cage during respiration.
The chest muscles that attach directly to or near the sternum are the primary source of muscular pain in this area. The large Pectoralis Major muscle covers the upper chest and originates partly from the sternum and the first six costal cartilages. A strain in this muscle, often from heavy lifting, can pull on its sternal attachment and feel like central chest pain.
Deeper muscles, such as the Intercostal muscles, lie between the ribs and are responsible for moving the rib cage during breathing. These muscles are also susceptible to strains from forceful movements like coughing, sneezing, or twisting. When these muscles are injured, the pain is felt across the rib cage and often registers as a sharp ache near the sternum. The Transversus Thoracis muscles are also found on the inside of the rib cage and sternum.
Common Causes of Pain Near the Sternum
The most frequent source of non-cardiac, centralized chest pain is inflammation of the cartilage connecting the ribs to the sternum, known as Costochondritis. This pain is typically sharp or aching and is localized to the touch; pressing on the affected joint will reproduce the tenderness. The pain tends to worsen with deep breaths, coughing, or any movement that twists the rib cage.
A related, though less common, condition is Tietze Syndrome, which presents with the same pain characteristics as Costochondritis but is accompanied by visible swelling of the affected costal cartilage. Both conditions involve inflammation of the costosternal joints. These forms of inflammation are often mistaken for muscle strains because they are triggered by physical activity or respiratory stress.
A frequent cause of central chest discomfort is a strain in the Intercostal muscles, the thin layers of muscle found between the ribs. These strains commonly occur during intense physical exertion, such as rowing or swinging a golf club, or through repetitive forceful coughing. The pain is sharp and increases dramatically when you twist your torso or take a deep breath.
Pain from a Pectoralis muscle strain, or a “pulled pec,” can radiate toward the sternum, especially if the injury is near the muscle’s attachment points. This type of injury results from overstretching or forcefully contracting the chest muscle, such as during a heavy bench press or an awkward fall. The discomfort is usually felt more broadly across the chest and may be accompanied by bruising or weakness when pushing the arm forward. Differentiating this from cartilage pain involves noting that the most tender spot is typically on the muscle belly or near the shoulder.
Immediate Steps and When to Seek Medical Help
For suspected musculoskeletal pain near the sternum, initial management focuses on reducing inflammation and allowing the tissue to rest. Applying an ice pack to the painful area for 15 to 20 minutes several times a day can help minimize swelling and acute discomfort. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be used to manage pain and inflammation.
It is important to temporarily modify activities that aggravate the pain, often meaning avoiding heavy lifting, pushing, or movements that cause twisting of the torso. Once the acute pain begins to subside, gentle stretching and gradual return to activity can help restore full movement. However, chest pain always warrants caution.
Any chest pain must be treated as a potential emergency until a cardiac cause is ruled out, particularly for those with existing risk factors. Seek immediate emergency medical attention if the pain is accompanied by pressure, tightness, or a crushing sensation in the chest. Other critical symptoms include pain that radiates to your jaw, neck, back, or down one or both arms, or if the discomfort includes sudden shortness of breath, cold sweats, or dizziness. These “red flag” symptoms suggest a possible heart-related issue and require professional medical evaluation.