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Chest pain can feel different depending on the casue and the structure affected. It can be rapid or sudden onset, sharp, dull, stabbing, constant, pressure, tightness, squeezing, heaviness, burning, a tearing or ripping sensation, or generalised non-specific pain. Mostly, it is felt in the chest region, however, pain coming from the heart can also be felt travelling to the jaw, arms or shoulders (most left side). Pain coming from the oesophagus can be also be felt in the lower back. Depending on the cause, other symptoms that may be experienced include breathlessness, cough, fever, high breathing rate, high heart rate, low blood pressure, nausea, vomiting, dizziness or reflux.

Chest pain can be caused by a variety of problems. Below is a list of structures where chest pain can arise from and some of the common causes for these types of pain.

Lung

• Infection, trauma or cancer of the lining around the lung (pleurisy)
• Blood clot, caused by long-distance travel or immobilisation
• Collapsed or punctured lung, caused by lung disease or trauma
• Tumour

Heart

• Heart attack or angina, caused by heart disease
• Infection, inflammation, trauma or tumour of the sac around the heart (pericarditis)

Big blood vessels

• Aortic aneurysm, caused by trauma, atherosclerosis or genetic disorder of the connective tissue (Marfan syndrome)

Oesophagus

• Reflux, trauma, tumour or vomiting

Musculoskeletal

• Ribs—fracture, joint or spine problem
• Muscles—trauma or unaccustomed exercise
• Nerve pain (neuralgia)—shingles, thoracic spine problem or tumour
• Arthritis or other inflammatory conditions

Chest pain is a pain or discomfort felt in the chest region that is not normal for you. It is important to distinguish the difference between chest pain arising from a heart attack compared to other problems.

The Heart Foundation of Australia recommends that if you experience the warning signs of a heart attack for 10 minutes and, if the symptoms are severe or get worse, you must call 0-0-0 immediately for an ambulance. The warning signs are pain, pressure, heaviness or tightness in the chest, neck, jaw, arms, shoulders, abdomen, or back. If you experience these signs, you should:

1. stop and rest
2. tell someone about our symptoms and, if you take angina medicine, you should take a dose
3. if your symptoms are severe, getting worse or have lasted more than 10 minutes you should call 0-0-0.

Refer to the Heart Foundation website for more information. 

Chest pain from other causes

Depending on the cause of the chest pain, the symptoms can be variable. The pain may be rapid or sudden onset, sharp, dull, stabbing, constant, pressure, tightness, squeezing, heaviness, burning, a tearing or ripping sensation or generalised non-specific pain. Mostly, it is felt in the chest region. A GP will help diagnose the cause of chest pain. They will do a variety of tests, including ECG, blood tests and X-rays, to try to identify the cause of the chest pain, and may send you to a specialist medical doctor (respiratory physician or cardiologist). If you are experiencing chest pain associated with musculoskeletal dysfunction, a physiotherapist can help diagnose the specific cause and identify the appropriate treatment for this.

Physiotherapy can help treat many musculoskeletal causes of chest pain, as well as assist in the overall management of number of chronic diseases that result in chronic chest pain, such as lung disease and cardiac disease.

Musculoskeletal chest pain

Physiotherapy may involve exercise. This could include chest, back and shoulder muscle retraining (strengthening and increasing endurance); stretching of the chest muscles; postural correction; taping of the shoulder blades or spine; manual techniques (mobilisation) of the rib joints; or education.

Chest pain secondary to chronic lung disease or heart disease

Physiotherapy plays a very important role in the management of chronic lung and heart disease. Primarily, the role of physiotherapy in these conditions is pulmonary rehabilitation and/or cardiac rehabilitation that includes exercise training, self-management education and support. There is no cure for most of these chronic diseases, however, rehabilitation can improve your quality of life, help you be more physically active and prevent flare-ups. 

If the chest pain is due to a problem with the musculoskeletal system, your physiotherapist will be able to assess and treat the structures causing the pain. Treatment may include exercise, rest, manual therapy (massage, joint mobilisation or manipulation) and education regarding posture and care.