Chest pain can be alarming, particularly when it’s in the area of your sternum. The sternum, or breastbone, is located at the centre of your chest, just below your neck. It connects your ribs and serves as a protective shield for vital organs like your heart, lungs, and major blood vessels. So, when you feel discomfort in this area, it’s natural to be concerned. However, most causes of sternum pain are benign and treatable. That said, it’s important to understand the potential causes and know when to seek medical attention.
This article explores the different causes of sternum pain, addresses common misconceptions, and provides guidance on when it’s important to seek professional help.
Do you know that not all chest pain comes from the heart? In fact, many cases are musculoskeletal in nature, linked to the joints, muscles, or soft tissues around the chest, and can be effectively managed with physiotherapy.
Senior Physiotherapist John explains that sternum pain often stems from tightness, irritation, or strain in the surrounding muscles and joints. “We often see this in individuals with poor posture, overtrained chest muscles, or stiffness in the upper spine,” he says. “Rib misalignment, tight pectoral muscles, and restricted movement in the upper back can all contribute to discomfort in the sternum area. With proper assessment and targeted physiotherapy, these issues can usually be resolved effectively.”
Causes behind sternum discomfort
Muscular strain in the chest or upper body can result in sternum pain. This typically happens due to overuse, heavy lifting, or sudden movements. If you've recently been involved in physical activities like intense exercise or lifting, this could explain the discomfort.
Most muscle-related chest pain improves with rest, ice, and gentle stretching. However, if the pain persists or worsens, it’s a good idea to consult a doctor. Poor posture or improper lifting techniques can contribute to this type of pain, so strengthening the chest muscles through physiotherapy may help prevent recurrence.
One of the most frequent causes of sternum pain is costochondritis. Although this condition is rarely serious, it can cause sharp or stabbing pain, particularly when you move or press on the area.
Costochondritis is the inflammation of the cartilage where the ribs meet the sternum. It often causes sharp, localised pain that can be mistaken for a heart problem. Physiotherapy helps by reducing strain on the affected area and supporting the body’s natural healing process.
Treatment typically includes hands-on techniques to relieve tension, gentle exercises to restore mobility and strength, and postural corrections to minimise stress on the chest. With consistent care, most people see improvement within a few weeks.
In some cases, chest pain isn’t from the heart or ribs—it’s related to digestion. Acid reflux, often experienced as heartburn, occurs when stomach acid backs up into the oesophagus. If this reflux becomes frequent or severe, it may develop into GERD (Gastro-oesophageal Reflux Disease), a chronic problem. This can lead to chest pain that feels similar to sternum pain.
While GERD can often be managed with lifestyle changes and medications, frequent or severe symptoms should be addressed by a healthcare provider to prevent complications like oesophageal ulcers, strictures, or Barrett’s oesophagus.
Sternum pain can sometimes be associated with heart problems like angina, heart attacks, or pericarditis (inflammation of the heart’s protective sac). However, chest pain related to heart problems is commonly felt in areas like the arms, neck, jaw, or back. While pain in the sternum can occur, it is not typically a classic symptom of heart problems.
Angina typically occurs with physical exertion and eases with rest, whereas heart attacks are often accompanied by symptoms, such as shortness of breath, dizziness, nausea, or cold sweats. However, symptoms can vary widely, and some individuals may experience atypical signs, particularly women, older adults, or those with diabetes. If you have risk factors such as hypertension, smoking, or a family history of heart disease, it’s important to seek immediate medical advice to rule out serious conditions.
Sitting for long hours with poor posture can place significant stress on the chest and upper back. Slouching, rounded shoulders, and shallow breathing can lead to tightness in the chest muscles and increased pressure around the sternum. Over time, these postural patterns may cause muscle imbalances and joint stiffness, contributing to discomfort in the chest area.
To counter this, simple daily habits can help:
- Stretch the upper back regularly using a foam roller
- Sit upright and gently draw your shoulder blades back every hour
- Practice deep breathing, focusing on expanding your ribcage
John notes that small adjustments like these, done consistently, can go a long way in preventing or reducing chest-related musculoskeletal pain.
Signs that need immediate attention
If you experience any of the following symptoms, it’s important to seek medical attention promptly:
Severe, sudden chest pain that radiates to the arm, neck, or jaw, accompanied by shortness of breath, sweating, or nausea. These may be classic signs of a heart attack.
Pain that worsens with physical exertion or doesn’t improve with rest, which can also indicate a heart-related issue.
A history of heart disease, hypertension, or other cardiovascular risk factors. If you experience chest pain, even if it seems unrelated to the heart, it’s important to seek medical attention to rule out serious conditions.
Persistent or recurrent pain, especially if it’s accompanied by fatigue, dizziness, or changes in blood pressure.
Stress can contribute to chest pain, particularly when it affects breathing patterns. John explains that during periods of stress, people often shift to shallow breathing from the upper chest rather than using the diaphragm. “This type of breathing increases tension in the chest and neck muscles, which can lead to discomfort over time,” he says.
Physiotherapy helps by retraining breathing techniques, guiding gentle movements, and calming the nervous system. Managing stress and improving breathing habits play an important role in long-term recovery from musculoskeletal chest pain.
Practical steps for managing sternum pain
Understanding the source of your sternum pain is the first step toward managing it. Here are some practical steps you can take:
If you suspect the pain is caused by costochondritis or muscular strain, avoid activities that worsen the pain. Focus on gentle stretching and allow your body time to heal.
If you think GERD might be contributing to your discomfort, steer clear of spicy foods, caffeine, and alcohol. Eating smaller, more frequent meals and avoiding eating right before bedtime can help manage symptoms.
If the pain persists or you're unsure of the cause, it's always best to consult a healthcare provider. They can help identify the source of the pain and recommend an appropriate treatment plan.
When the ribs don’t move well, it can restrict deep breathing and place extra strain on the sternum and surrounding muscles. This lack of mobility often contributes to ongoing discomfort.
Physiotherapy helps by improving rib movement through targeted breathing exercises, rib mobilisations, and stretching techniques. At Rapid Physiocare, every case of chest pain includes a thorough assessment of rib function and breathing mechanics to ensure no contributing factor is overlooked.
Sternum pain may not always indicate a serious condition, but understanding its potential causes can help you decide when it’s important to seek professional medical advice. Early diagnosis, especially in uncertain or more serious cases, can help prevent complications.
By increasing awareness of the causes of sternum pain, we can help more people recognise when it’s important to seek professional care, potentially preventing serious health issues.
If you experience sternum pain, it may not always indicate a serious condition, but if in doubt, consulting a healthcare professional can provide clarity and peace of mind.
Stay informed and, if you experience chest pain, take the appropriate steps to determine whether medical advice is needed.
John Abraham
Founder and Senior Principal Physiotherapist
Rapid Physiocare, Singapore
Instagram: @rapid_physiocare
This article was produced by Healthful For You. The views and opinions expressed throughout are those of the authors and do not necessarily reflect those of the Expert Contributor. The Expert Contributor has provided input solely for the EXPERT INSIGHT and TIP segments, based on their professional expertise. These comments are intended to offer general guidance and may not apply to all individuals. Any interpretations or conclusions beyond that section are those of Healthful For You. This article is not a substitute for personalised medical advice, diagnosis, or treatment. Please consult your doctor or a healthcare professional regarding your specific health needs.
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