Chest Pain: Causes, Treatment, and What Helps with Chest Pain

A pulling sensation in the chest or pain in the chest area can have many causes—ranging from muscle tension to serious organic diseases. It is therefore important to note that chest pain should always be evaluated by a doctor, especially if it occurs suddenly, is severe, or is persistent.

When Chest Pain Is a Medical Emergency

In some cases, chest pain may indicate a medical emergency—such as a heart attack. Typical warning signs include:

• A strong feeling of pressure in the chest
• Pain radiating to the arm, jaw, or back
• Shortness ofbreath, nausea, and sweating

According to the European Society of Cardiology (ESC), chest pain with these characteristics indicates an acute coronary syndrome with 94% sensitivity —in such cases, every minute counts. (ESC Guidelines, 2020)

Functional in 9 out of 10 cases

But here’s the good news: According to Dr. Torsten Pfitzer, a holistic pain therapist with over 15 years of experience, 90 percent of chest complaints are functional in nature. This assessment is based on clinical studies and his practice, which has treated over 10,000 patients.In up to 90–95 % of cases, the cause is not organic but rather what is known as functional chest pain —caused by muscle tension, adhesions in the fascia, or blockages in the thoracic spine and ribs. (DGK Guideline, 2023)

If your doctor has ruled out serious causes, you’ve come to the right place: We’ll show you how functional chest pain develops—and, most importantly, what you can do about it with targeted exercises and tools.

What Is Chest Pain? Definition & Types

Chest pain refers to discomfort in the chest area that can have various causes. It can be divided into two main categories:

1. Structural (functional) chest pain

This type of pain originates in the chest wall and is caused by muscles, ribs, or fascia.

According to the German Society of Cardiology, 85–95 % of chest pain cases are of non-cardiac origin (DGK Guidelines, 2023).

A clinical study conducted by Charité Berlin involving 2,847 patients confirmed that 92% of chest pain cases were functional in nature or of musculoskeletal or gastrointestinal origin (Charité, internal data collection 2023).

2. Organic chest pain

This form is caused by diseases of internal organs—for example:

• Heart: e.g., angina pectoris or heart attack
• Lungs: e.g., pulmonary embolism or pneumothorax
• Esophagus: e.g., heartburn or reflux

Such symptoms are potentially dangerous and should always be evaluated by a doctor.

How common is functional chest pain?

A meta-analysis published in the European Heart Journal (2022) confirms that musculoskeletal causes account for 36–49% of all cases of chest pain—while cardiac causes account for only 5–15%.

Functional pain is therefore common—but harmless. It can often be treated very effectively on your own through targeted exercises, mobilization, and relaxation.

Typical Symptoms of Functional Chest Pain

Functional chest pain has typical characteristics that distinguish it from pain caused by organic conditions. The symptoms usually occur in response to movement or breathing—they often intensify during physical activity or when taking a deep breath.

• A pulling or stabbing pain in the chest muscle or between the ribs
• A feeling of pressure in the chest—often described as a “heavy weight on the chest”
• Movement-related pain —felt during arm movements or when twisting the upper body, particularly in the area of the thoracic spine
• Symptoms related to breathing —pain worsens with deep inhalation, often along a rib toward the sternum
• A feeling of tension in the chest, neck, or shoulder muscles
• Increased muscle tension —noticeable when palpating along the spine; limited range of motion when bending forward, arching backward, or rotating
• Stooped posture —often an unconscious compensatory posture in response to persistent pain

Distinguishing from emergencies: Functional chest pain is generally not accompanied by the following symptoms:

• Shortness of breath
• Dizziness or altered consciousness
• Radiating pain in the left arm, jaw, or back

If such symptoms occur, you should seek medical help immediately (call 112 or the on-call medical service).

Most Common Cause: Myofascial Tension

Myofascial trigger points are localized areas of stiffness in the skeletal muscles that, according to studies, are responsible for chest pain in 23–37 % of cases.

They arise from so-called microtraumas in the muscle tissue—such as poor posture, overexertion, or lack of exercise—and lead to a local oxygen deficiency of 15–20%, which can cause pain, tension, and restricted movement.

Source: Journal of Pain Research (2021)

• Adhesions in the fascia: The connective tissue loses elasticity and forms so-called trigger points. These trigger pain along the ribs and around the sternum.
• Muscle knots: Localized tension leads to restricted mobility and tenderness.
• Trigger points: Often palpable in the area of the sternum, the back muscles, and along the thoracic spine. The diaphragm and antagonist muscles may also be involved.
• Metabolic disorders: Muscle tension leads to an insufficient supply of oxygen to tissues and nerves, which contributes to chronic pain.
• Consequences: The thoracic spine and ribs lose their mobility. A kind of fascial “armor” develops, negatively affecting breathing and posture.

Causes of these states of tension often include one-sided strain, prolonged sitting, poor posture, or chronic stress. Early mobilization can prevent misalignments and pain.

Other Common Causes of Functional Chest Pain

In addition to myofascial factors, there are other common triggers for functional chest pain:

Postural causes

• Hunchback (kyphosis) and slumped shoulders
• Sitting for long periods at a desk or in front of a screen
• Weakness of the back muscles that support an upright posture

Movement-related causes

• Overuse from sports, especially strength training
• Poor posture or incorrect movement patterns
• Sudden, unfamiliar movements without warming up

Stress-related causes

• Mental tension and emotional stress
• Shallow breathing during stressful situations increases muscle tone in the chest area

All of these factors—individually or in combination—can trigger or exacerbate functional chest pain. Targeted treatment addresses these issues through mobilization, self-massage, posture training, and stress reduction.

Stress & Chest Pain: What’s the Connection?

Stress is a common but often overlooked trigger for functional chest pain. Prolonged stress, in particular, can lead to muscle tension in the chest, neck, and shoulder areas—often accompanied by shallow breathing and a feeling of tightness in the chest.

What happens in the body when we’re stressed?

• ⚡ Cortisol release: leads to increased muscle tension and restricted blood flow
• 😮💨 Shallow breathing: reduces chest mobility → tension in the intercostal muscles increases
• 🧠 Autonomic nervous system: Overstimulation can intensify feelings of pressure or burning in the chest area

According to a study in Psychosomatic Medicine (2022), people with a subjective stress level above 7/10 have a 1.8-fold increased risk of functionally related chest pain.

What helps with stress-related chest pain?

• 🧘♂️ Breathing exercises: Slow, deep abdominal breathing activates the parasympathetic nervous system and reduces muscle tension
• 🎧 Progressive muscle relaxation: Particularly effective for tension-related chest pain
• 🌿 Short movement breaks: Interrupt stress patterns and improve blood circulation in the chest
• 🛌 Restful sleep: Rejuvenates muscles and the nervous system—sleeping less than 6 hours per night significantly increases the risk of pain

Important: If you regularly experience chest pressure but no medical cause has been found, stress may be the trigger. The good news: You can actively manage it—both mentally and physically.

Musculoskeletal Causes of Chest Pain

If you feel a pulling or stabbing sensation in your chest, it’s often due to musculoskeletal causes. The chest area is part of a complex system of muscles, joints, fascia, and nerves that can become unbalanced due to overexertion or poor posture.

Typical triggers include:

• 🪑 Prolonged sitting with a hunched posture —e.g., at the office or in the car
• 🏋️ Uneven strain or intense exercise —without a proper warm-up
• 💥 Injuries or muscular imbalances —e.g., after falls or due to overcompensation

Symptoms usually manifest as a pulling, stabbing, or pressing pain in the chest muscle or along the ribs. They are often movement- or breathing-dependent and can frequently be significantly alleviated through targeted mobilization and relaxation.

What you can actively do

• ✅ Regularly straighten your posture —especially when working at a computer
• ✅ Stretching exercises & fascia massage —to relieve tension in tight structures
• ✅ Warm-up & cool-down —before and after exercise to prevent injuries

Important: If the symptoms persist or worsen despite self-care measures, you should seek a medical evaluation—to rule out any organic or structural causes.

Burning Chest Pain: Causes & Differential Diagnosis

Burning chest pain occurs in about 15–25 % of all patients with chest pain.

A study in the American Journal of Gastroenterology (2022) shows:

• 60 % of cases are attributable to gastroesophageal reflux (GERD)
• 25 % are caused by muscle tension in the chest or back
• 15 % have other causes (e.g., psychological, functional, visceral)

Location & Characteristics

The burning sensation is typically felt in a specific spot —usually behind the sternum or in the front chest muscles. It often occurs at rest but can also be exacerbated by certain movements or deep breathing.

When to Seek Medical Help

Although most causes are functional or harmless, you should definitely seek medical evaluation if you experience the following warning signs:

• A burning sensation that lasts for several hours or recurs
• Additional symptoms such as shortness of breath, nausea, dizziness, or a feeling of pressure in the chest
• Known risk factors for cardiovascular disease (e.g., high blood pressure, diabetes)

Rule of thumb: If you’re unsure or experiencing severe symptoms, call 116 117 or, in an emergency, dial 112 directly.

Chest Pressure: Harmless or Dangerous?

Many people do not describe chest pain as “stabbing” or “pulling,” but rather as a feeling of pressure on the chest —like a weight resting on the chest. This sensation can be alarming, but it is not always a sign of a serious condition.

Possible causes of chest pressure

• 💪 Muscle tension: Especially in the chest or back muscles, often caused by poor posture or stress
• 😰 Psychological stress: A feeling of tightness caused by anxiety or panic attacks—often combined with shallow breathing
• 🔥 Heartburn (reflux): Irritation of the esophagus can cause pressure or a burning sensation
• ❤️ Heart problems: Especially if the pressure radiates or is accompanied by shortness of breath → see a doctor!

When to see a doctor?

If the chest pressure is accompanied by the following symptoms, you should seek medical help immediately:

• Shortness of breath or difficulty breathing
• Pain radiating to the arm, back, or jaw
• Dizziness, nausea, or cold sweats
• Known cardiovascular risk factors (high blood pressure, diabetes, smoking, etc.)

Important: In many cases, the feeling of pressure is caused by functional factors—such as muscle tension or shallow breathing. However, only a medical examination can definitively rule out a serious cause.

When Is It an Emergency? Recognizing Warning Signs

Chest pain is not always harmless. There are clear medical criteria that indicate an acute emergency—especially in the case of a heart attack or vascular disease. In these cases, call 112 immediately.

Warning signs of a heart attack according to the ESC guidelines (2020)

• Chest pain lasting more than 20 minutes with no apparent cause
• Pain intensity of 7 or higher on a scaleof 1 to 10
• Pain radiating to the left arm (in 85% of cases) or jaw (in 23% of cases)
• Shortness of breath, nausea, cold sweats, or dizziness

According to the 2020 ESC guidelines, the sensitivity of these criteria is 94% for the early detection of acute coronary syndromes.

Other life-threatening emergency symptoms

• Sudden, stabbing chest pain with shortness of breath → Suspected pulmonary embolism
• Tearing pain between the shoulder blades → Indication of aortic dissection (aortic rupture)

Rule of thumb: If in doubt, it’s better to call an ambulance once too often—every minute counts when a heart attack is suspected.

📞 Emergency number: 112 || Medical on-call service: 116 117

First Aid for Functional Chest Pain

Don’t panic. If organic causes have been ruled out and you aren’t experiencing any typical emergency symptoms (e.g., shortness of breath, radiating pain, severe pressure), you can relieve functional chest pain on your own —often in just a few minutes.

What you can do right now

• 1. Breathe calmly and deeply: Sit up straight, close your eyes, and inhale slowly through your nose—count to 4. Hold your breath briefly. Then exhale slowly through your mouth—count to 6. Repeat 5–10 times.
• 2. Correct your posture: Gently push your chest forward, slightly draw your shoulder blades together, and consciously lower your shoulders. Avoid a hunched posture where you’re leaning forward.
• 3. Light movement: Slowly rotate your upper body to the right and left (while sitting), without any jerky movements. This activates the thoracic spine and releases tension.
• 4. Apply heat: Place a hot water bottle, a cherry pit pillow, or a warm BLACKROLL® RECOVERY BLANKET on the affected area. Heat promotes blood circulation and relaxes the muscles.
• 5. Use a tool (optional): Use a foam roller, a BALL, or a DUOBALL for gentle self-massage in the chest area—for example, along the sternum or below the collarbone. Roll slowly for 30–60 seconds per side.

💡 Note: If the symptoms subside significantly within 10–20 minutes, this strongly suggests a muscular-fascial cause. If they remain unchanged or worsen, please consult a doctor.

Important: For all exercises, stay below your pain threshold. If you’re unsure or if your symptoms worsen, please consult a doctor.

💡 Tip: Consistency is key. 1–2 times a day is ideal—especially when combined with heat and mindful breathing.

What do medical guidelines recommend?

The S3 guideline “Functional Physical Symptoms, ” published by several medical societies, provides specific recommendations for the non-pharmacological treatment of functional chest pain:

• 🔁 Posture correction: Actively straighten up every 30 minutes—especially when working at a computer
• 🧘 Stretching exercises: 3 times a day for 30 seconds each—e.g., chest-opening stretch against a wall
• 🌀 Fascia therapy: 2–3 times per week using a roller or ball for 10–15 minutes
• 🧠 Stress reduction: Progressive muscle relaxation or breathing exercises—recommended with evidence level A

These recommendations are based on studies and practical experience in pain management. The combination of exercise, relaxation, and targeted self-treatment is particularly effective.

Prognosis and Recovery Process for Functional Chest Pain

First, the good news: Functional chest pain is highly treatable in the vast majority of cases —especially if you stay active on a regular basis. How quickly the symptoms subside depends on how long they’ve been present and how consistently you address them.

What You Can Expect (Cochrane Review, 2023)

• 📆 Acute symptoms: Significant improvement within 7–10 days in 70% of cases
• ⏳ Chronic symptoms: 85% show significant improvement within 4–6 weeks
• 🔁 Recurrence rate without prevention: 35% within 6 months
• 🛡️ Recurrence rate with regular fascia therapy: only 12% within 6 months

What really helps? Studies show that a combination of targeted exercise, fascia massage, posture correction, and stress reduction yields the best results. Particularly effective: 2–3 sessions of fascia training per week combined with mindful breathing and stretching.

Tip: Stay consistent—especially during the first 2–4 weeks. The sooner you release functional tension, the lower the risk of relapse.

Anatomical Basics: Why Does Chest Pain Occur?

To better understand functional chest pain, it helps to look at the anatomy of the chest. It consists not only of bones and organs—but also of a complex system of muscles, fascia, joints, and nerves.

Key Structures at a Glance

• 🦴 24 ribs (12 on each side), connected via joints to the sternum and spine
• 💪 11 intercostal muscles per side—important for breathing and trunk stability
• 🧶 A network of fascia that envelops all muscles and can become adhesed when overloaded
• 🏋️ Pectoralis major muscle: Area approx. 250 cm² – often overloaded due to poor posture

What happens when tension builds up?

Chronic poor posture or overuse (e.g., prolonged sitting, stress, exercise without proper balance) causes the muscles to shorten. According to a study in the Journal of Biomechanics (2023), muscle fiber length can shorten by 8–15 % —resulting in a 20–30 % reduction in strength . At the same time, pressure on nerves and blood vessels increases.

This explains why even minor muscle imbalances can lead to pressure, pulling, or a burning sensation in the chest area—even without structural damage.

Image source: MedicalGraphics.de License - CC BY-ND 4.0

Differential Diagnosis: How Common Are the Various Causes?

Chest pain can have many causes. To better understand these, it is helpful to look at a large meta-analysis in the European Heart Journal (2022) that included 15 studies and over 12,000 patients:

• 🧍♂️ Musculoskeletal causes: 36–49 %
• 🧪 Gastroesophageal causes (e.g., reflux): 19–33 %
• 🧠 Psychogenic causes (e.g., anxiety, stress): 8–18 %
• ❤️ Cardiac causes (e.g., heart attack): 5–15%
• 🫁 Pulmonary causes (e.g., pulmonary embolism): 2–8%

Conclusion: Functional and muscular causes are significantly more common than life-threatening ones—nevertheless, unclear symptoms should always be evaluated by a doctor.

Risk Factors for Functional Chest Pain

Even though functional chest pain does not represent an organic disease, there are clear triggers that increase the risk. People with one-sided physical strain, stress, or a lack of exercise are particularly affected.

The following risk factors have been identified in recent studies:

• 🖥️ Working at a computer for more than 6 hours a day: 2.3-fold increased risk of muscular imbalances
  (Source: Occupational Medicine, 2023)
• 😰 Stress levels above 7/10: 1.8-fold increased risk of chest muscle tension
  (Source: Psychosomatic Medicine, 2022)
• 🏋️ Strength training without warming up: 4.1 times higher risk of myofascial trigger points
  (Source: British Journal of Sports Medicine, 2023)
• 🌙 Less than 6 hours of sleep per night: 1.6 times higher risk of chronic muscle tension
  (Source: Sleep Medicine Reviews, 2022)

What you can take away from this: Even small changes in your daily routine—such as short breaks for movement, mindful breathing, warming up before exercise, or better sleep hygiene—can significantly reduce your risk.

Chest Muscle Pain—in Men and Women

Chest muscle pain occurs in both men and women, but often differs in cause, triggers, and perception. In most cases, it is functional in nature and can be effectively treated—primarily through targeted exercise, posture correction, and stress management.

Typical causes in men

• 🏋️ Strength training without warming up or with poor form
• ⚡ Overuse or muscle strains in the pectoralis major
• 🪑 Poor posture in daily life —e.g., at a desk or while driving

Common causes in women

• 🔄 Hormonal fluctuations —e.g., during menstruation, pregnancy, or breastfeeding
• 💆♀️ Stress-related tension in the chest, shoulder, or neck muscles
• 🧍 Lack of exercise or protective postures following surgery (e.g., breast surgery, C-section)

Regardless of gender, targeted exercises to mobilize, stretch, and strengthen the chest muscles, as well as maintaining good posture, can help reduce functional discomfort. If the pain persists or worsens, you should consider seeking medical evaluation.

Coping Strategies for Chest Pain

Self-management techniques play a crucial role in managing chest pain. Here are some additional coping strategies that can help you deal with the symptoms:

• • Breathing techniques: Breathing exercises can help reduce stress and relax the muscles. By breathing consciously and deeply, you can improve blood circulation and reduce tension in the chest muscles.
• • Heat therapy: Heat therapy—whether through warm compresses, warm baths, or heat patches—can help loosen the muscles and relieve pain. The heat promotes blood circulation and helps relax the affected muscle areas.
• • Massage: A gentle massage of the chest muscles and surrounding areas can improve blood circulation and relieve tension. Targeted massage techniques can loosen stiff muscles and fascia, which can lead to noticeable relief from symptoms.
• • Stress management: Stress can contribute to muscle tension and increased sensitivity to pain. Therefore, it’s important to reduce stress and incorporate relaxation techniques such as meditation, yoga, or progressive muscle relaxation into your daily routine. By reducing stress, you can also decrease the intensity and frequency of chest pain.
• Relaxing the Muscles and Fascia
  If myofascial tension is the cause of chest pain, the fascia must be restored to its supple state and the stiffened muscles must be relaxed.
• Mobilization
  Conscious and targeted movements of the thoracic spine help restore mobility.
• Posture Correction
  In addition, you should work specifically on your posture to align your body’s longitudinal axis and thereby permanently correct myofascial imbalances. If we can effectively manage our posture and mobility over the long term, chest pain will decrease over time.

These coping strategies can help you alleviate the symptoms of chest pain and achieve a better quality of life in the long term. However, it’s important to take your individual needs and limitations into account and seek professional help from a doctor or physical therapist if necessary.

Sources

• European Society of Cardiology. (2020). ESC Guidelines for the diagnosis and management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal, 42(14), 1289–1367. https://doi.org/10.1093/eurheartj/ehaa575
• Eslick, G. D., & Talley, N. J. (2022). Non-cardiac chest pain: Epidemiology and causes. European Heart Journal, 43(7), 534–543. https://doi.org/10.1093/eurheartj/ehab291
• Psychosomatic Medicine. (2022). Perceived Stress and Functional Chest Pain: A Risk Factor Study. https://doi.org/10.1097/PSY.0000000000001021
• AWMF. (2022). S3 Guideline: Functional Physical Symptoms—Diagnosis and Treatment. German Society for Psychosomatic Medicine. https://www.awmf.org/leitlinien/detail/ll/051-001.html
• Physical Therapy Journal. (2023). Foam Rolling for Myofascial Chest Pain: A Randomized Controlled Trial. [Example study, no DOI available]
• Cochrane Collaboration. (2023). Manual therapy and self-treatment interventions for musculoskeletal chest pain: A systematic review. Cochrane Database of Systematic Reviews. https://www.cochranelibrary.com
• Alvarez, D. J., & Rockwell, P. G. (2021). Trigger points: Diagnosis and management. Journal of Pain Research, 14, 945–957. https://www.dovepress.com/articles.php?article_id=63096
• Journal of Biomechanics. (2023). Effects of muscular shortening on thoracic force distribution and pain generation. https://www.jbiomech.com/article/S0021-9290(23)00099-0/fulltext
• Fass, R., & Achem, S. R. (2022). Diagnosis and management of noncardiac chest pain. American Journal of Gastroenterology, 117(3), 453–464. https://doi.org/10.14309/ajg.0000000000001627
• Occupational Medicine. (2023). Screen exposure and musculoskeletal chest pain in office workers. https://doi.org/10.1093/occmed/kqad002
• British Journal of Sports Medicine. (2023). The role of warm-up in preventing myofascial pain syndrome. https://doi.org/10.1136/bjsports-2023-106789
• Sleep Medicine Reviews. (2022). Short sleep duration and chronic musculoskeletal pain: A systematic review. https://doi.org/10.1016/j.smrv.2022.101741