Better Me

Is It a Heart Attack or a Pulled Chest Muscle?

Sharp pain and tightness in your chest. Difficulty breathing. These are just a few of the symptoms of a potential heart attack, but they can also mirror a pulled chest muscle.

A strained or pulled chest muscle is much less serious than a heart attack, but it can be quite painful.   

Read on to learn more about the causes and symptoms of muscle strains in the chest, how they are diagnosed and treated and how the symptoms differ from a heart attack.

The muscles of the chest

Your chest is made up primarily of two muscles, the pectoralis major and the pectoralis minor, as well as your intercostal muscles.

  • The pectoralis major muscles are the fan-shaped muscles that go from your armpits to the center of your breastbone, or sternum. 
  • The pectoralis minor muscles are smaller muscles under the pectoralis major that run along your ribs, just under your collarbone. 
  • The intercostal muscles run between the ribs and form the chest wall.

While it’s possible to strain the pectoralis major or pectoralis minor muscles, nearly half of all chest muscle strains occur in the intercostal muscles.

“Your intercostal muscles are responsible for helping you breathe, so straining them can feel scary, especially if you’re having trouble breathing,” said Sarah Chapman, DPT, an orthopedic clinical specialist at Banner Health in Gilbert, AZ. “Thankfully, usually all these strains are minor.”

What causes a strained chest muscle?

A pulled chest muscle can occur due to overstretching or pressure or strain on the muscles. These can be caused by a number of different situations, but are most commonly seen in athletes. 

“Many people pull their chest muscles in contact sports and other athletics that require forceful or repetitive motion, like tennis, golf, gymnastics and rowing,” Chapman said. “Similarly, if your arm is pulled back and overhead quickly or for prolonged periods of time, such as during weightlifting, it can cause a chest strain.”

The other common causes of chest muscle strains include:

  • Skipping warm-ups before sporting activities
  • Accident or injury, such as a car accident or fall
  • Lifting the wrong weight
  • Lifting while twisting, such as lifting heavy boxes off of shelves or moving furniture 
  • Hard coughing or sneezing during illness, such as bronchitis or a bad cold

What are the symptoms of strained chest muscle?

A strained chest muscle usually causes pain in the chest area that gets worse with movement or coughing. 

“You may notice pain or tenderness along the chest, tenderness when touching the strained muscle, pain with arm movements and difficulty moving the arm,” Chapman said. “There may also be bruising, swelling or muscle twitching or spasms.”

As mentioned earlier, this pain may be confused with a heart attack. However, in the case of a heart attack, there are usually other symptoms that will occur.

“With a heart attack, the pain will radiate down your arm and you may also feel nausea, shortness of breath, dizziness, fainting, sweating, fatigue and an irregular heart rate,” Chapman said. 

Call 911 if you are experiencing symptoms of a heart attack. Do not drive yourself to the emergency room.

How is a muscle strain diagnosed?

Avoid trying to self-diagnose and treat without seeing your health care provider first. Although strains are often minor, it’s important for your provider to evaluate your symptoms and rule out something more serious, such as a broken bone.

If your pain is caused by a pulled muscle, your provider with determine if its acute (due to an injury or trauma) or chronic (due to repetitive use) and will assign a grade based on the severity of the injury.

  • Grade 1 strains describe mild damage to the chest that affects less than 5% of the muscle fibers.
  • Grade 2 strains describe a moderate tear to the chest that affects a higher amount of muscle fibers. This may affect mobility and strength, but the muscle isn’t fully ruptured.
  • Grade 3 strains describe a complete muscle rupture, which may require surgery to reattach the affected tendon to the bone.

What are the best ways to treat a strained chest muscle?

Most of the time, a pulled muscle is a minor injury and with proper care can heal on its own within a few weeks. 

In most mild to moderate chest muscle strains, as with all muscle strains, RICE (rest, ice, compression and elevation) is the best first line of treatment. 

Rest: Stop activity, especially those that cause you to pull your chest muscle. 
Ice: Apply ice or heat to help reduce pain.
Compression: If necessary, wrap a bandage to help reduce swelling. It’s important to not make the bandage too tight, as this can cause additional pain. 
Elevation: Keep your chest elevated, especially at night. You can use pillows or a wedge to help.

You may also want to consider taking over-the-counter pain relievers such as ibuprofen or acetaminophen to help with inflammation and pain.

As your pain lessens, you may slowly return to previous sports and activities.

For chronic muscle strains that don’t improve with rest, your provider may recommend physical therapy or changing your exercise routine to build strength in the surrounding areas. 

How can I prevent a pulled chest muscle from happening again?

It’s important to keep the muscles in your chest stretched and strong in order to avoid injury.  

“Remember to properly warm up before performing any sport or exercise, lift heavy objects with care and avoid lifting heavy weight without proper training or practice,” Chapman said. “As well, stretch after exercise to maintain flexibility in your chest.”

Some exercises to try are a pec stretch and a doorway stretch:

  • To do a pec stretch, stand with your arms at your side and then clasp your hands together behind your back. Slowly push arms up until you feel a stretch in your chest and hold for 10 to 30 seconds.
  • To do a doorway stretch, stand by an open doorway with your arms at a 90-degree angle and palms flat on the doorframe. Slowly step forward with one foot and lean forward until you feel a stretch in the chest. Hold this for 10 to 30 seconds.

Takeaway

A strained chest muscle can be painful but it’s often a minor condition that, with some rest and proper care, can get better. 

Experiencing chest pain?

Call 911 if you have symptoms of a heart attack.

For all other chest pain:

Save your spot for a virtual or in-person urgent care visit.
Schedule an appointment with a primary care provider.

For more healthy exercise tips, check out:

Sports Medicine Physical Therapy Fitness

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