Chest and Back Pain — Causes, TReatment Methods & Exercises

An elderly woman clutches her back and chest area in discomfort.

© ShotPrime Studio | shutterstock.com

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Breathing difficulties, perhaps shortness of breath, pain in the upper back, and an uncomfortable feeling in your chest: Could this be a heart attack? We understand chest pain can be a sensitive issue, and many become concerned about this possibility when they feel a stinging pain in the chest area. But try not to panic; it doesn’t always have to mean the worst! The reason for your chest pain could be a vertebral blockage on the thoracic spine which can be felt throughout the chest region. We’ll explain everything you need to know in this article. You’ll learn:

Would you prefer to start right away? Then jump straight to our three best exercises for chest and back pain.

📌 To begin at the beginning: What do we mean by chest and back pain, and how does it develop?

Several symptoms involving the thoracic spine and chest and back pain indicate a very broad clinical picture. This variety of possible symptoms and complaints occurs because the thoracic spine is connected to the chest and the rest of the spine via many small joints and even more muscles. That’s why a thoracic spine blockage affects different parts of your body. In almost every instance, the pain does not arise from displaced or locked joint components but from strained muscles and fasciae.

Roland Liebscher-Bracht

Roland Liebscher-Bracht

Germany's most trusted pain specialist and author of several bestselling self-help books on the treatment of pain conditions.

 
Read more

Roland Liebscher-Bracht is Germany's most trusted pain specialist and author of several bestselling books on pain treatment. Together with his wife, Dr. med. Petra Bracht, he has developed a revolutionary method to treat pain conditions. With the help of the so-called "osteopressure", where you press specific points on your body, and special stretching exercises, pain can be stopped entirely without medication or surgical intervention. This pain treatment allows you to alleviate pain by yourself. Find out how exactly this works in this article or our numerous YouTube videos.

Roland Liebscher-Bracht

Germany's best-known pain specialist and author of several bestselling books on self-help against pain.

 
Read more

Roland Liebscher-Bracht is Germany's best-known pain specialist and author of several bestselling books on pain treatment. Together with his wife, the physician Dr. Petra Bracht, he has developed a revolutionary new form of pain treatment: With the so-called "Osteopressur", in which certain points on your body are pressed, and special stretching exercises, pain can be stopped completely without medication or surgical intervention. It is particularly important that this pain treatment gives you the opportunity to help yourself against your pain in a self-determined way. You can find out exactly how this works in this article and in the numerous YouTube videos.

1. The Thorax (Chest) — An Anatomical Overview


Our rib cage is like a suit of armour. The picture below clarifies that the sternum in the middle acts as a protective shield at the front. The ribs are anchored to the sternum and then extend left and right like bars to connect with the thoracic spine at the rear. Why is all this protection necessary? Our rib cage encloses the chest cavity, which contains our vital organs – lungs, heart, trachea, and oesophagus – as well as major blood vessels (veins and arteries).

Illustration of the human chest, showcasing the skeleton.

© Dimitry Shanchuk | shutterstock.com (edited)

However, the rib cage does more than accommodate these internal organs. It also protects them.

The rib cage is a complex construction made up of bones, muscles, tendons, and ligaments. But just because it acts as a protective chamber doesn’t mean it only functions as an impenetrable, rigid structure. The rib cage also has to be flexible enough to support the expansion of our lungs and diaphragm when breathing.

Being such a complex structure does make it more susceptible to damage, which can lead to many problems in the chest area. For better understanding what happens in the case of a thoracic spine blockage and why there can be more symptoms than just chest pain, we now take a closer look at the anatomy of our chest region.

1.1 The Bones — The Scaffold

Sternum

The sternum, or breastbone, sits right in the middle of the front of the chest and consists of three flat bones:
• the manubrium, a short, thick handle shape,
• a longer breastbone body, and
• an elongated, often tapering sword-like xiphoid process.

Its function is to protect the heart, which sits on the left behind the breastbone. It stabilises the chest by providing anchor points for the true ribs (incisura costalis I – VII) and the clavicle or collarbone (incisurae claviculares), which opens out above the first rib.

Illustration of the sternum.

© Tefi | shutterstock.com

Illustration of the spine and its vertebrae.

© Peter Hermes Furian | shutterstock.com (edited)

Thoracic Spine

The thoracic spine is a crucial part of the rib cage. And because the ribs are suspended from it, the thoracic spine is very different from its neighbouring spinal regions, the cervical spine and the lumbar spine. But to start with the basics:

Where is the thoracic spine located?
The thoracic spine is the second of a total of five spinal sections. It lies between the cervical spine and lumbar spine and is also above the sacrum and coccyx regions where the spine finishes.

Form and function
Together, each section of the spine protects the spinal cord. Adopting a double S-shape, the spine stabilises the trunk so we can walk upright. The normal thoracic spine curves backwards. This curvature is particularly pronounced and visible on a rounded back. And with its twelve vertebrae, to which the ribs are attached, the thoracic spine is also the longest spinal section.

Thoracic Vertebrae

There are 12 thoracic vertebrae, and their designation comes from ‘thorax,’ the Latin term for the chest. These are conventionally numbered T1-T12. The intervertebral discs are located between them. You can read more about the general structure of our vertebrae in our extensive Pain Encyclopedia article on back pain.

We now take a look at these thoracic vertebrae. In some respects, their characteristic features differ from the vertebrae found in the cervical spine and lumbar spine.

1. The vertebral bodies of the thoracic vertebrae are rather hoof-shaped.

2. Because forces acting on the spine increase from top to bottom, they become broader and higher down towards the lower back.

3. The spinous processes (bony projections) are long, sloping, and overlapping, and they point downwards so that they lie on top of each other like roof tiles.

4. The transverse processes, which are the most noticeable special feature of the thoracic vertebrae, bend sideways rather than at right angles:

5. 👆 On the transverse processes of vertebrae T1 to T10, there are articular surfaces designed especially for the ribs. They form part of the rib vertebral joints. Unlike the thoracic vertebrae, there are no such articular surfaces on the cervical spine and lumbar spine. Here, we must mention these are not the same as facet joints (articular processes), which all have vertebrae connected to them from top to bottom! And it’s because of this difference that we feel symptoms all over the chest when the spine is blocked.

6. Rib articular surfaces are located above and below on the left and right of the respective vertebral body. However, the first, eleventh, and twelfth thoracic vertebrae (T1, T11, and T12) have only one articulated connection.

Anatomical illustration of the spine.

© Ellen Bronstayn | shutterstock.com

Anatomical illustration of the rib cage with annotations.

© Satymova Alena + Sonata_V | shutterstock.com (edited)

Ribs (Costae)

Humans have a total of 24 ribs. They are attached to the thoracic vertebrae: one on the left and one on the right. This produces twelve pairs of ribs, of which the first ten converge and meet at the front of the sternum. Each rib consists of a rib bone with a section of cartilage at the front, which is termed costal cartilage.

True ribs: Ribs one to seven connect directly to the sternum via this cartilage.

False ribs: The three ribs numbered eight to ten are only indirectly connected to the sternum. Their costal cartilages first connect and form a sizeable costal arch. This finally docks with the cartilage of the sixth rib, which is joined to the sternum.

Floating ribs: Ribs eleven and twelve do not connect to the sternum.

Rib bones each have a rib head at the rear end, which looks like a wedge because the articular surface slopes away to the left and right. This is how an individual rib, which is located between the vertebrae, can connect to an upper and lower vertebra (via a rib-vertebral joint). The rib neck connects to the head. This is followed by the rib tubercle, which has another joint surface for connection to the transverse process of the upper vertebra. The long rib body has a slight forward curve. The space between the ribs is called the intercostal space.

1.2 Joints, Ligaments, and Muscles — What Holds the Bones Together

Now we’ll have a good look at your bony rib cage. And because it would be nothing but a “rickety skeleton” without organic components and tissue, we now consider the materials which hold everything together. Our main focus will be on the special rib joints because they can become restricted in the event of a vertebral block; and also on the muscles, because muscle tension can cause a vertebral blockage, and in many cases trigger your pain.

Joints

The nuts and bolts of our rib cage are the rib vertebrae and the joints between the ribs and the sternum. This structure provides the flexibility we need when we breathe. Below in section 1.3 “The diaphragm – an essential part of your respiratory system”, we take a much closer look at the interplay between muscles and joints during breathing.

As already described for the thoracic vertebrae, these have articular surfaces on the vertebral body and the transverse processes, to which the ribs are attached. And this is what those joint connections look like:

Rib vertebrae

Each rib is connected to the vertebrae via two joints:

  • First rib-vertebral joint: A rib sits between two thoracic vertebrae, which engage the head of the rib with their articular surfaces at the top and bottom of the vertebral body. The first, eleventh, and twelfth ribs are an exception because they are connected to just one vertebral body.
  • Second rib-vertebral joint: The rib then connects via the rib tubercle on the rib neck to the joint surface on the transverse process of the corresponding thoracic vertebra at the same height. But floating ribs don’t have this joint.
Illustration of the rib joints.

© eveleen | shutterstock.com (edited)

In medicine, rib-vertebral joints are also known as costovertebral joints.

Joints between the ribs and the sternum

  • Costochondral joints: These are the joints between each rib and its costal cartilage.
  • “Sternum-rib joints” (sternocostal joints): The rib cartilage here creates a flexible connection to the sternum, and this flexibility is a crucial part of breathing.
  • Interchondral joints: These are cartilage joints on the costal arch of ribs six to ten.

The articular surfaces of the rib-vertebral joints and the joints between the ribs and the sternum are held together by cartilage (false joints) or joint capsules (true joints). In each case, ligaments play a supporting role.

Muscles

There are, of course, many different muscles that can be grouped into chest, abdominal, and back muscles. Therefore, we restrict ourselves to an overview of the most important muscles, some of which are part of the respiratory musculature:

Back muscles
The back muscles can trace their origin and attachment to the spinous and transverse processes on the vertebrae. The primary (autochthonous) back muscles are important. They run along the entire spine from the pelvis over the chest and on to the head. They include, among others, all the muscles which lie between the spinous and transverse processes of the vertebrae in order to connect them lengthways. These fragmented muscles function as a lever for the back muscles which lie above and attach to them, for example:

  • latissimus dorsi muscle: upper arm, thoracic spine, lumbar spine, ribs, shoulder blade.
  • trapezius muscle: cervical spine, thoracic spine, shoulder blade, clavicle.

Chest muscles
The chest muscles are the muscles of the upper front, which are often closely linked to the rib cage:

  • major pectoral muscle: sternum, ribs, upper arm, abdominal area.
  • minor pectoral muscle: lying underneath the major pectoral muscle.
  • saw (serratus anterior) muscle: found at the back above the cervical- and thoracic spine, below the lumbar spine, at the front on the side.
  • Intercostal muscles: run between the ribs, both outside and inside.

Abdominal muscles

  • The abdominal muscles are the opponents of the back muscles:
    Straight abdominal muscle: running straight down the midline of the body via ribs, sternum, pelvis.
  • Abdominal (external oblique) muscles on the side: sloping inwards and outwards and attaching to the stomach and chest.

📌 In Summary — The Function of the Rib Cage
You will notice that all the bones of the chest – sternum, ribs, and thoracic spine – are connected to each other via muscles and joints. In addition, these connections also extend beyond the chest to other parts of the body – such as the pelvis, head, cervical spine, and lumbar spine. Together, these bones, joints, and muscles form a unit. This creates a stable and interactive skeleton with both articulated and muscular connections to control bodily forces. This unit primarily serves to:

  • protect your organs,
  • stabilise the trunk, and
  • support your breathing.

1.3 The Diaphragm — An Essential Part of Your Respiratory System

The muscles listed above not only form the chest and protect your organs. Some also function as breathing muscles – either direct or auxiliary breathing muscles. These respiratory muscles, therefore, attach directly to the bony rib cage. And the diaphragm is the most important muscle in this group.

Illustration of the rib cage.

© blamb | shutterstock.com (edited)

Diaphragm

Where is the diaphragm located, and what does it look like?
This muscle is attached to the chest like a transverse plate and forms a dome inside, behind the ribs. The diaphragm has its root in two strands of muscle fibre, left and right, on the lumbar vertebrae. These are then connected higher up on the thoracic spine. From the lumbar spine, these muscle fibres ascend on both sides along the ribs and the cartilaginous rib arch to finally “arrive” at the sternum in the xiphoid process area.

Diaphragm function
Lying horizontally in the torso, the diaphragm separates the chest and abdominal cavity and their respective organs. Below the diaphragm, the liver, gall bladder, spleen, stomach, kidneys, and small and large intestine are located in the abdominal cavity. While above, as already mentioned, the chest cavity houses the heart, lungs, and trachea.

The diaphragm is a large respiratory muscle. Its horizontal location also helps stabilise the torso: Inflated by a combination of back, abdominal and pectoral muscles, the diaphragm helps keep the spine and ribs in place. And employing this same action of inflating and deflating, the diaphragm also generates the positive and negative pressures required for breathing.

What Happens When You Breathe?

There are two breathing techniques: Chest and abdominal breathing. We use both subconsciously in our normal breathing. We can also use them consciously, as in our chest and back pain exercises, for example. The intercostal muscles and the diaphragm are the principal respiratory muscles, and some of the other muscles described above also act as auxiliary breathing muscles.

Inhalation

  • Chest breathing: Inspiration is the technical term for inhalation. When we breathe in, the outer intercostal muscles of the chest contract. This causes the chest to rise, which can be easily observed externally. The ribs rotate, and the articulated rib cartilages rise, which causes the volume of the chest to increase. And because the lungs rest against the chest wall, these elastic organs also expand when the chest is raised.
  • Abdominal breathing: Abdominal breathing (diaphragmatic breathing) creates additional space for the lungs to expand downwards. When you breathe in, your diaphragm also contracts as the dome flattens out and sinks. As a result, the organs in the abdominal cavity are also pushed downwards, and the stomach expands. This creates a negative pressure in the chest cavity, allowing the lungs to draw in fresh air.

Exhalation

While the outer intercostal muscles and the diaphragm are tense during inhalation, they now relax. The diaphragm resumes its dome shape and pushes up into the chest cavity. The inner intercostal muscles pull the chest downwards, and the costal cartilage lowers again. This reduces the size of your chest area, and as a result, the air is forced out of your lungs. The medical term for this process is expiration.

You can also take active control of exhalation. Here, the abdominal breathing muscles tighten and exert strong additional pressure from below against the diaphragm.

Illustration of the process of inhalation and exhalation.

© NoPainNoGain | shutterstock.com (edited)

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2.Origin and Cause of Chest and Back Pain


Elasticity – the key to optimal chest function:
Our rib cage must be strong and stable to protect the vital organs inside the chest cavity. Yet this is also the area where our breathing muscles operate – which means our rib cage must also be flexible. That’s why there are so many muscular and articulated connections!

Our rib cage could simply act as a large, secure repository.

But because of the sheer number of small “hinges” on:

  • the thoracic vertebrae,
  • the ribs,
  • the rib cartilage sections, and
  • the intervertebral discs themselves,

the thoracic spine, ribs, and sternum also have considerable flexibility.

Thus they lend support to every inhalation and exhalation.

Our chest rises and falls with every breath because the lungs inflate. To achieve this, our rib joints move up and down about 16 times a minute in adults, about 20 times in adolescents, and about 40 times a minute in newborns. And with every breath, we take in half a litre of fresh air.

If just one of these flexible components is injured, or its function is impaired, this can hinder the function of the entire chest. And that’s exactly what can happen with the thoracic spine, which is often thus affected.

That’s no surprise because the thoracic spine is not only part of a complex system, the chest region itself, but also a vital part of the spinal column, which protects the spinal cord. It is one of the most important skeletal regions of the human musculoskeletal system.

Inflammatory, degenerative, and infectious diseases often occur here, and these can lead to vertebral blockages. These may impact the entire joint system and cause nerve disorders and discomfort, and impairments in the chest region.1)

There are many causes of chest and back pain, and we look at the most common ones in the next section:

2.1 Main Cause: Muscular Tension and Muscular Shortening

The same muscle groups are responsible for breathing and supporting your trunk posture. The main problems here are due to excess tension and muscle shortening. And the main reasons for this are one-sided movements, incorrect posture, and lack of exercise.

A woman is bent over a laptop working.

© Andrey_Popov | shutterstock.com

One-Sided Movements and Sedentary Lifestyles

Have you thought about what you do all day long? In the morning, you might prepare your breakfast, get on your bike or into your car, and drive to work. When you get there, you might bash away on a computer keyboard before driving home nine hours later and taking to the couch with a comfort snack. Then, in a few hours, everything starts all over again.

Pretty monotonous, isn’t it? It is also striking that your upper body is always leaning forward during these activities! Your arms and shoulders are constantly pulling your body from the front: When buttering your toast with a knife, when gripping the steering wheel, when operating the keyboard, the TV remote, while you’re eating, and so on. This is particularly so when you’re sitting, and the effects of this sedentary lifestyle eventually result in a rounded or hollow back.

So that you can manage such tasks quickly and efficiently, almost automatically, your muscles and fasciae get used to these one-sided movements. The result is tension and shortening. Your front and chest muscles get shorter, while your back muscles still try to keep you as upright as possible, which constantly stretches them. Due to this, your muscles are in permanent imbalance. Over the longer term, and unless you do something to compensate, these muscles lose their flexibility and become inflexible.

Efficiency in your everyday life comes at the expense of your muscles and the health of your chest and back!

  • Strong tensile forces on your back increase the pressure on the vertebrae. They can move and become wedged, which is conventionally described as a vertebral blockage.
  • Your intervertebral discs are equally affected by such pressures and wedging, which increases the risk of herniated discs.
  • The muscles between your ribs (intercostal muscles) also contract and shorten, which potentially reduces your chest area. This creates pressure on the joints between the ribs and the breastbone, as well as on the internal organs. This, in turn, can cause disorders affecting the many nerves present in this region. This medical condition is termed intercostal neuralgia.

Shallow Breathing

A tight diaphragm can lead to shallow breathing and symptoms such as shortness of breath, chest and back pain. The diaphragm is a breathing muscle at the lower end of the chest, which flexes and moves when inhaling and exhaling. If it is overstretched and shortened, this essential elasticity is no longer present. Your chest volume won’t then increase enough when you breathe in to allow your lungs to take in sufficient air. And what is more, your diaphragm’s upward movement is similarly restricted, which means it can no longer inflate sufficiently to trigger the expulsion of used air.

As a result, the torso is no longer completely stable, so those affected find it difficult to maintain an upright posture. That means it becomes more difficult to deal with stresses. Poor posture develops, the chest becomes constricted, and breathing becomes difficult.

📌 What problems muscular-fascial tension can cause and where your pain mostly comes from

Shortened front (pectoral and abdominal) muscles and tension in your back muscles and the diaphragm pull on your thoracic spine from different directions. These muscular tensile forces increase pressure: Firstly on the chest cavity and organs, and secondly on the vertebrae and intervertebral discs. Vertebral blockages and blocked joints can occur, resulting in restricted movement, as well as chest and back pain.

However, as we see it, these are usually not “genuine” blockages. It’s not wedges or displacements that cause the pain, but rather muscular-fascial tension and shortening. And neither is this an injury pain because the thoracic spine and associated structures have signs of wear and tear. These symptoms are, in fact, signal pains:

Receptors on the periosteum (tissue surrounding bones) register muscular-fascial tensions that are far too high and report this to your brain. As a result, a pain message is sent to the precise point where the tension overload has occurred. Thus the pain is meant to warn us of impending wear and gives us clear evidence that something is wrong with our movement and posture.

2.2 Misalignment of the Spine

Diseases such as scoliosis and kyphosis very often affect the thoracic spine and can also lead to what is conventionally described as a vertebral blockage or to pain in the chest and thoracic spine.

Scoliosis

Among other things, scoliosis causes a lateral curve of the spine in the chest region. This can cause breathing problems because the internal organs of the chest and abdominal cavity are constricted.

Scheuermann’s Kyphosis

Scheuermann’s kyphosis is the term used to describe the pathological changes and curvature of the thoracic spine which can occur in adolescence. And unlike scoliosis, the twisting is not sideways but to the front. This means that the normal curvature of the thoracic spine is exaggerated, which tends to produce a very rounded back (hyperkyphosis). The reason for this is the formation of the so-called wedge vertebrae, for example, due to excess tension and poor posture. These vertebrae are flattened at the front and higher at the back. As a result, the thoracic spine bends too much during growth, causing the upper body to lean forward more and more. The result of excess tension on the back can be vertebral blockages, back pain, breathing problems, herniated discs, and discomfort in the chest region. Lung diseases can also develop because of the increased pressure on internal organs.2)

You can see a woman with a deformed spine projected onto her back.

© Albina Glisic | shutterstock.com

2.3 Other Skeletal & Muscular Triggers

Sternal muscle tension: This is a muscle to the left and right of the sternum (breastbone), which only a minority of Europeans possess. If it is severely overloaded, this can lead to intense pain in the sternum.

Twelfth Rib Syndrome: Symptoms include pain in the middle and lower abdomen. Doctors suspect the cause may be a blockage of the costal vertebrae. Because this rib is not connected to the breastbone and thus floats in the chest, it is particularly sensitive to pressure. So these symptoms could be the result of pressure on the nerves in the intercostal space.

2.4 Inflammation

Viruses or bacteria can cause inflammation of the thoracic spine. Foreign bodies enter our system, for example, through body openings. Transported via the bloodstream, they can reach the spine, spinal cord, intervertebral discs, joints, soft tissues (muscle, ligaments, nerves), vertebral bodies or the spinal canal, and attack the structures there. Inflammation can even destroy entire vertebral bodies. Inflammation can also be a potential cause of autoimmune and metabolic diseases, in which your immune system attacks healthy cells in your own body.

Typical “inflammatory diseases” which lead to chest pain are:3)

Illustration of an inflammed spine.

© Hamara | shutterstock.com

Rheumatoid arthritis: A metabolic disorder that leads to inflammation and joint pain. Arthritis, or joint wear, is a common outcome of this condition.

Axial Spondyloarthritis (axSpA): This term summarises several rheumatic diseases. The most common infection is on the axial skeleton – i.e. on the spine. Ankylosing spondylitis is a well-known form of spondyloarthritis.

Psoriatic arthritis: This is common with psoriasis and usually leads to inflammation of the joints.

Costochondritis/Tietze Syndrome: Inflammation of the costal cartilage in the region of the sternum-costal joints. The cartilage becomes extremely sensitive to pressure.

2.5 Degenerative Diseases

Various diseases can cause degenerative changes in the body’s structures and gradually break them down. This usually happens due to the effects of increased wear or ageing. The thoracic spine can be affected, as can all other joints in the body. Osteoporosis and arthritis are typical examples of such diseases.

Osteoporosis: A change in the metabolism causes osteoporosis, which leads to bone loss. The bones become porous and fragile and can easily break when the disease becomes advanced.

Osteoarthritis: Osteoarthritis is an increase in signs of wear in the joints as the cartilage degrades. It can be a result of rheumatism, in which the joint decomposition is primarily caused by inflammation. However, osteoarthritis is more often the result of muscular-fascial tensions around the affected joint.

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3. Symptoms of General Chest and Back Pain


People often experience this as a pain that sits between the shoulder blades and radiates forward over the ribs into the chest. The pain often feels dull and/or heavy.

This progress seems logical because if the articulated and muscular connections in the chest and also in the thoracic vertebrae are blocked, this blocking can trigger a chain reaction. Thus, inflammation, spinal misalignment, or other skeletal causes affecting the thoracic spine can also be felt in the front of the chest. The same applies in the more common instance: with excess musculofascial tension, tensile forces act in several directions and can thus trigger signal pain in both the chest and back.

💡 Chest pain is one of the most typical symptoms of a blockage of the thoracic spine. In fact, various studies have shown a direct relationship between the thoracic spine and pain in the posterior chest wall. To demonstrate this, researchers injected medical contrast media into the facet joints and rib vertebrae of the rib cage to investigate where pain subsequently occurs. Many participants reported pain in the front, rear, and side of the chest.4)

3.1 Typical Symptoms

As well as chest pain, the following symptoms are also particularly noticeable:

  • Back pain: When vertebral blockages occur, the rib-vertebral joints, intervertebral discs, and muscles are affected, and pain between the shoulder blades is typical. The back pain can sometimes also radiate to the legs, suggesting a thoracic herniated disc may also be involved. This mostly arises because the pressure created by excess muscular tension can compress the vertebrae and intervertebral discs.
  • Pain when breathing: If the joints are blocked and constricted, they will no longer be flexible enough to lift the chest when breathing.
  • Rib pain: Tense intercostal muscles can cause pain in the ribs during movement or when breathing.
A woman is having troubles breathing.

© Image Point Fr | shutterstock.com

  • Hardness and tension in other muscles: All the muscles in the body are directly or indirectly linked. Thus, adjacent muscles in regions such as the pelvis, lumbar and cervical spine can also experience painful strains.
  • Bent posture: With scoliosis or Scheuermann’s kyphosis, a misaligned spine can constrict the chest and exert pressure on the internal organs.
  • Restricted thoracic spine movement: Because it is connected to the ribs, the thoracic spine has limited mobility. A vertebral blockage exacerbates this immobility even further, so you may only be able to turn your thoracic spine in one direction.
  • Clicking in the thoracic spine and sternum: This is caused by joint blockages and is usually painless.

3.2 Chest and Back Pain or a Heart Attack?

Because there may also be gynaecological, gastroesophageal (stomach and oesophagus-related), or even cardiological (heart-related) reasons for chest pain, it’s important to understand how the symptoms of a thoracic spine blockage differ from those of other serious conditions. Of course, you should always seek medical advice to confirm this, but concerns about a heart condition quickly arise with the onset of chest symptoms. That’s why we will now take a closer look at heart attacks and common cardiovascular diseases.

An old man clutching his chest in pain.

© Rawpixel | envato.elements.com

For many, tightness with an oppressive and sometimes massive feeling of constriction in the chest naturally arouses the fear that this could herald a heart attack. And that’s not surprising because the symptoms are similar to those of a thoracic spine blockage: pain in the back, in the chest, and especially in the region around the breastbone – after all, the heart lies directly underneath.

If this pain persists significantly longer than five minutes, radiates into the shoulder, arms, jaw, neck and upper abdomen, and the following symptoms also appear, these would suggest a heart attack:

  • nausea
  • shortness of breath
  • a cold sweat
  • cold and pale skin (on the face, for example).

Heart attacks also occur during physical activity and can be associated with stress, including emotional stress.

And if, in your case, the above symptoms are atypical and have never occurred before, then as a precaution, you should call a doctor at once.

📌 Chest pain associated with other conditions
Pneumothorax, pulmonary embolism, pleurisy, or acid reflux – such lung or stomach conditions have chest pain as a common symptom. Thus, sudden shortness of breath, a cough accompanied by reddish-brown sputum, and acute, one-sided pain when breathing can indicate a life-threatening condition. In such cases, you should again not hesitate to call emergency medical assistance or visit a doctor to get a medical examination.

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4. Treatment of Chest and Back Pain


Treatments for pain in the thoracic spine region can vary greatly because they are usually dependent on the cause. In our opinion, nutrition is also an important component in treating chest and back pain, especially if the causes involve rheumatic, degenerative, or osteoporotic diseases.

Once serious conditions of a gynaecological or cardiological origin are ruled out, manual therapy methods are primarily used to release a thoracic spine blockage and relieve pain in the chest and back. Classic back therapies can also be deployed, such as:

  • heat applications,
  • physiotherapy,
  • strength building,
  • a back school, or
  • physiotherapy with mobilisation exercises.

You can find out about the advantages and disadvantages of these methods by reading the comprehensive article on back pain in our Pain Encyclopedia.

We will look at the most common ones in this section, in the context of chest and back pain. Before that, we will review further conventional medical treatment methods, of which we are particularly critical. Some doctors are very quick to resort to pain medication and surgery to treat a patient’s short term symptoms.

4.1 Pain Relief and Surgery

When prescribing pain relief, the main focus is on controlling the symptoms. Ibuprofen, paracetamol or diclofenac are all well-known active medications designed to numb pain. And where it is particularly severe, chronic pain, opioids such as morphine or tilidine are also effective. However, these are only short-term solutions. Besides the fact that these medications have numerous side effects, none of them can address the cause of your chest pain. Therefore, we advise against their long-term use.

The same applies to most surgical procedures. They also involve risks such as infections, bleeding, or nerve damage and often only help for a short time thanks to the muscle-relaxing effects of an anaesthetic.

The actual success rate for back surgery is just 35 per cent, and patients often complain about persistent pain afterwards.5)

Three surgeons operating.

© Idutko | shutterstock.com

That’s why, pre- and post-surgery, such operations are supported by medicinal, psychological, and physiotherapeutic measures, such as a back school.

Doctors usually carry out surgery to remove the cause of a blockage – in their opinion to correct a spinal curvature or address signs of wear, joint friction, or displacement. However, in our opinion, in most cases, the cause is excess muscle tension and muscle shortening. Even degenerative diseases are often caused by a lack of exercise and the fact that our movement patterns are too one-sided.

So if you don’t make changes to your movement patterns or specifically rebalance them with our exercises, your chest and thoracic spine pain could recur again and again. But don’t worry. For a permanent improvement, you only need to spend a few minutes each day working on them in the comfort of your own home. We’ll show you just how easy this can be in the exercise section below.

4.2 Manual Treatments and Physical Therapies

Three black hot stones on a person's back.

© Nestor Rizhniak | shutterstocks.com

Thermo-Therapies: Heat and Cold

Thermotherapy can also achieve a short-term but effective and thus cost-efficient solution. Heat plasters, thermal baths, heat packs with mud or volcanic mud, or simply hot water bottles and grain pillows: The fact is, heat frees up your muscles and connective tissue and also stimulates your blood circulation and metabolism. This promotes the supply of nutrients to the tissue and can help considerably to relieve your pain.

And incidentally, massages using our foam rollers and massage balls have the very same effect. And unlike heat therapies, this approach also enables you to move the intercellular fluid, allowing you to stimulate your fasciae in a much more targeted way to achieve relaxation. Just give it a try: You can apply a foam rolling massage to your thoracic spine blockage both before and after our exercises.

Generally speaking, heat treatments can help relieve muscle tension and osteoarthritis. However, if the cause of your pain is inflammation, cold therapies are recommended. You can use ice packs and ice cubes, or try special cryotherapy using a cold chamber. If you suffer from rheumatic inflammation and pain conditions as well as with fibromyalgia, short-term success can be achieved via this method.

Physiotherapy and Physical Therapy

In physiotherapy, muscular imbalances are compensated on the one hand by muscle relaxation methods and on the other hand by strengthening. The aim is to free the joints from tense muscles and get people to abandon their protective postures with the help of mobilisation exercises.

While some physiotherapy exercises train the back muscles to stabilise the torso, other exercises serve to stretch the muscles. In addition, physiotherapists also use physical measures such as thermotherapy. Electro-therapies are also said to work on musculoskeletal and tendon pain in the musculoskeletal system. The electrical impulses stimulate nerves in the back in order to suppress pain.

A woman training.

© Kzenon | shutterstock.com

Ultimately, these physical measures don’t treat the cause of the pain but aim to mute its severity temporarily. Furthermore, we are not very keen on strengthening exercises as a treatment strategy because our experience shows this only stretches the muscles even more.

Your back muscles constantly work throughout your everyday life to keep your upper body upright. They are permanently overstretched and thus already quite strong enough. Any further strength training would simply increase the tension in the thoracic spine. And, of course, this would again be at the expense of your joints and vertebrae, so your pain and breathing difficulties could even get worse.

So, unlike physiotherapy and physical therapy, we are against one-sided strength training for thoracic spine blockages and associated chest and back pain. Our pain therapy focuses on stretches within the context of an active muscle relaxation method. And here, the stretches themselves provide the strengthening.

A woman is facing the corner of a wall and stretches out her arms to either side of the wall.

Muscle Relaxation Through Controlled Stretching and Breathing

You will remember from the section on causes that excess musculofascial tension and shortening are the most likely cause of a thoracic spine blockage and the resultant symptoms in the chest region. The reason this occurs tends to be a lack of exercise and predominantly one-sided movements in our everyday lives.

So that means you’ll have to change the movement patterns in your everyday life and add more diverse activities and movements. Alternatively, you can complete our exercise program of just a few minutes a day, designed specifically to balance this one-sidedness.

Dealing with this kind of chest and back pain is about adopting angles of movement you probably didn’t even know existed. This is especially true where pain is involved because otherwise, we tend to be overly careful, and so our muscles become even more inflexible.

That is why your active involvement is crucial. Your muscles, ligaments, and fasciae will only remain supple if you regularly commit to our stretching exercises for muscle relaxation. Thus, you can create fresh stimuli, remove excessive tension from your muscles, and take preventive measures to protect the bones, joints, and nerves in your chest region. And then a signal pain will be no longer necessary.

And naturally, this means you should stretch your back, chest, and abdominal muscles, but don’t forget that the diaphragm is also a vital muscle for your torso and for your breathing!

Controlled breathing has proven particularly useful for patients suffering from chronic obstructive pulmonary disease (COPD), in which the airways are narrowed, and the lungs can become hyperinflated. Because their diaphragm is weak, they often have to rely on respiratory muscles (abdomen and chest) for postural support. Thus, they tend to be plagued with breathing difficulties and back problems.

Controlled breathing – via physiotherapy, through lung-development activities, or using special respiratory therapy devices (cornet, flutter) – helps COPD patients to stretch their muscles again. Research shows that these strategies provide a means to improve their posture, relieve back pain, and finally breathe more freely.

The good news is that you don’t have to go to a physiotherapist or buy any special equipment for effective respiratory training. We have some breathing exercises which are very simple and just as effective to help you combat muscle tension. You can do them at home and should find it easy to integrate them into your everyday life.

Roland Liebscher-Bracht is performing a pain-free exercise.

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5. Stretching and Breathing Exercises: The Best Thing You Can Do for Your Chest and Back


Based on decades of experience as pain specialists, we have put together the three best exercises you can use to address your chest and back pain. These exercises will enable you to resolve the tension and shortening of all the muscles and fasciae throughout your chest and prevent the development of new ones.

  • The first exercise on the floor will have a muscle-relaxing effect on your thoracic spine.
  • The next one will stretch your pectoral muscles and open your chest.
  • And the last exercise focuses on the diaphragm and developing deep breathing.

You will soon notice you can breathe much more freely after our exercises and that your pain has definitely decreased. Now let’s just give them a try!

Exercise 1: Stretching the Thoracic Spine

A woman is lying on an exercise mat on her back.

1. Take the midi foam roller from our foam roller set. Sit with your bottom on the floor and place the foam roller behind your back.

2. Lie back on the foam roller in such a way that it rests under your thoracic spine.

3. Tip: The thoracic spine is found at approximately the same level as the nipples.

4. Make yourself as long as possible and stretch out your legs. Your neck and head will now be lying on the floor.

5. Check if the foam roller is correctly positioned: If it’s right, you will already feel some pain in the upper back.

6. Now, take a deep breath and decide whether you have already reached level nine on your personal pain scale. If not, then change your position by moving your upper body back and forth a little, repositioning the foam roller if necessary.

⏱ Hold your stretch for two minutes, and preferably a little longer. This is all about relaxing your rounded back – due to the shortened muscles at the front of your upper body – by stretching the muscles in your back.

Exercise 2: Opening the Chest

A woman is kneeling on an exercise mat, with her face towards the floor and her arms stretched out wide.

1. Place two chairs about as far apart as your two arms can reach.

2. Get into a kneeling position between the two chairs with your legs bent. Fully extend your arms on both sides. First, hold them out horizontally, i.e. at an angle of about 90 degrees, with your palms facing down and resting on the chair seats.

3. Now raise your outstretched arms about ten degrees and lean forward. It is now important that you hold the same angle while bending forward until your palms once again rest on the chair seats.

4. Stay in position while you inhale and exhale. Then, next time you exhale, you should try to bend a little lower. You should then feel a very clear stretch pain in your chest.

5. Breathe in once more, hold the position, and go a little deeper into the stretch the next time you exhale.

⏱ Continue likewise with each further breathing movement for about two minutes. Doing this exercise will stretch the area around your pectoral muscles.

Alternative: If you don’t want to move your upper body on the floor, you can do the same exercise standing up. Find a free corner of a room and do the same as for the chairs: Spread your arms horizontally, place them a little further up and against the two walls forming the corner, and then keep moving your upper body forward.

Exercise 3: Stretching the Diaphragm

A woman performing a sequence of exercises to help her diaphragm.

1. Sit upright on a chair with your buttocks as far forward as possible.

2. Inhale and exhale deeply. You will notice that your upper body automatically bends forward. We are now going to use this feature:

3. Take another deep breath.

4. Now blow the air out as hard as you can. While supporting your upper body, allow it to fall forward actively. Let the fall take your body down between your legs to force all the air out of your lungs.

5. Once this movement is complete, close your mouth and pinch your nose closed.

6. With your nose and mouth still closed, bring your body back upright on the seat.

7. Keep your nose and mouth closed. Keep trying to breathe in until you feel you have no oxygen left in your lungs. Meanwhile, move gently back and forth.

⏱ Try to complete several repetitions.

Explanation: By breathing in and out deeply, you create positive and negative pressures. So when you inhale, your diaphragm sinks into the abdominal cavity, and when you exhale, it rises again into the chest cavity. If you hold your nose and mouth closed while trying to inhale, you then create a vacuum. This uses up all of the residual oxygen in your lungs, allowing your diaphragm to expand even more. This exercise is worth its weight in gold to combat a muscular shortening of the diaphragm!

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Roland Liebscher-Bracht is performing a pain-free exercise.

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Sources & Studies [+]