Chest pain

Chest pain is an enigma that baffles the understanding but can be explained.

Are you in a hurry? Come back later, as this page is going to take at least twenty minutes to digest. It's a busy page! Chest pain is a vital subject, and it behooves you to do it justice... Certainly pain in the chest is not uncommon and, of course, it may be serious.

Unless you are ABSOLUTELY SURE to the contrary, it is best to assume that you are having a heart attack. After all, 50% of persons having their first heart attack will die very suddenly within a short period of time, with no prior warning, and if you are wrong ...

This page was last updated by Dr Barrie Lewis on 29th May, 2019.

Heart attack man.

However, there are many other causes of pain in the chest. Here we will discuss a few that are relevant to chiropractic, since about 25% of chest pain complaints stem from the joint between the ribs and the breastbone.

Harvard University reports that 6 million Americans with chest pain were seen in hospital emergency departments in 2009. Only 20% of them were having a heart attack. So what about the 80%?

Certainly it is best to consider whether your chest pain could be coming from source other than your heart before having expensive, and sometimes unnecessary procedures, like having a stent fitted, should you be experiencing pain in the chest.

But first, what ARE the symptoms of an impending heart attack?

HEART ATTACK aka Myocardial Infarction or MI.

Painful chest may be caused by a blockage in the heart's arteries which reduces or completely cuts off the blood supply to a portion of the heart muscle.

This can cause a blood clot to form and totally stop the blood flow in a coronary artery, resulting in a heart attack usually with much associated chest pain (also called an acute myocardial infarction or MI).

Irreversible injury to the heart muscle usually occurs if medical help is not received promptly. Unfortunately, it is common for people to dismiss heart attack symptoms. Doctors use two blood tests, looking for Creatine kinase and Cardiac troponin, that are a sure sign of heart muscle damage.

So, what are the warning signs of a heart attack?

EVERYONE should know these signs. Print this out and stick it up on the fridge.

Key signs are...

  • The gradual onset of pain over the course of a few minutes and
  •  pain that appears during or after physical exertion or emotional stress are also red flags. On the other hand, sharp or stabbing pain lasting only a few seconds, or pain confined to one small spot is less likely to be a heart attack. For example, sharp pain or a dull ache over a rib-breastbone joint is more likely to be Tietzes syndrome (more lower down).
  • You should also keep in mind that pain from a heart attack isn’t always confined to the area around the heart. For example, a heart attack may cause pain, numbness or other unusual sensations in
  •  one or both arms,
  • the back,
  • neck,
  • jaw or
  • stomach.
  • Other symptoms that can accompany a heart attack include nausea, dizziness, shortness of breath and breaking into a cold sweat.
  • Remember, too, that a person can have a heart attack without any pain. In particular, women often have symptoms of stomach distress or back pain instead of chest pain.


In all of health,"Prevention is better than a cure", but nowhere more so than in regard to heart disease. For starters, think delicious fish soup ... the Heart Foundation recommends "fatty" fish AT LEAST twice a week. Read more: FISH SOUP ... loaded with Omega-3 fatty acids.

Read more: SMOKED SALMON DIP RECIPE ... also full of those Omega-3 fatty acids.

Perhaps you're a vegetarian, or even a red meat consumer who wants even more omega-3:

While it is common knowledge, it is worth repeating: obese persons, particularly fat around the belly, and smokers are at high risk. As are diabetics who are not disciplined. Are you an obese, smoking diabetic? A medical disaster waiting to happen, I'm afraid. You should be afraid too!

Should you be in this high risk category we strongly recommend you visit our olive garden nutrition page for a few things that could put off the impending disaster. It's surely the desire of each and every one of us to go to our graves smiling, in our dotage, rather than, in our prime, leaving broken hearts behind. Yes? Read more about how the olive can help you. OLIVE GARDEN NUTRITION ....

Just as important make a decision as to when you are going to stop smoking. Put a date to it. January 1 is a good day to turn over a new leaf. Otherwise it may well be the last leaf. Read that delightful story? Take this little cul-de-sac - I'll be waiting for you to finish our Chest Pain tour! The last leaf by O Henry/1303 ... My favourite short story.

But even if you're not in the high risk category a good walk has much benefit, on your bone strength, for your back and on your Exercise and Cholesterol profile.

Din dins

Research is revealing the importance of what we eat is vital in the management of heart disease. In particular foods that lower homocysteine perhaps even more important than foods that lower cholesterol ... and certainly just as vital as foods to avoid high cholesterol.

Homocysteine? What on earth is that?

  • Homocysteine cardiovascular = heart disease ...

Really, is adding brocooli, eggs florentine, spinach, lettuce, avocado, beetroot and asparagus regularly to your diet that onerous? Read more at heart stroke diabetes; an astonishing 45% is caused by poor diet.

Cholesterol alcohol is one of the more pleasant stories.

Chest pain

Chest pain is common and maybe serious so it is best to assume it is; however there are many other causes of a painful chest than a heart attack. Your chiropractor will most likely be running late; a thorough examination is called for.


'Doctor, I have pain in my chest. It started three months ago.'

'Have you seen your doctor, Mr Jones?'

'Yes, I have had extensive tests. They were all negative. Nobody seems to know what's wrong with me?'

'What made you decide to come here for chest pain?'

'My doctor says that it could be muscular. It cost me a packet, and the pain is getting worse not better ...'

For interesting cases from the Chiropractic Coalface (late on Friday I call it the salt mines! It's hard work being a miner!)

Overweight? Free weight loss programs ... It doesn't take genius to realise that obesity and chest pain are first cousins. There are 101 reasons to lose weight if you are obese.

Terrible knee arthritis, degenerative change  in the ankle joint, chest pain, heart attack and diabetes, just to mention a few. At least one of them will get you, perhaps two-or-three. Cheerful aren't I?!

But seriously, please consider our free weight loss programs ...

It's really not that difficult.


Costochondritis occurs at the breastbone; it's a common cause of chest pain.


(Costo-sternal Syndrome = Tietze's Syndrome)

Chest pain is commonly caused by a subluxation of the joint between the rib and the sternum or breast-bone. In anatomical mumbo-jumbo it's called the costo (rib)- sternum (breastbone) syndrome (mixture of signs and symptoms), or in medicalese just Tietzes syndrome. It may be associated with pain along the course of the rib, and in the midback, but this is not necessarily the case. However on deep palpation, the whole rib is painful, from the subluxated rib between your shouderblades, under the armpit, and finally to the breastbone where you experience the pain. Read more: COSTOSTERNAL CHEST PAIN ...

It is easy to test yourself: Press firmly on the breast bone, and then let your fingers slide right and left over the junction with the ribs. In this syndrome it will be very tender over some of the joints, on one or both sides, if you have this musculo-skeletal, non-heart, condition. You are almost certainly not having a heart attack!

Another term for the costo sternal syndrome is costochondritis; see here more about the treatment for costochondritis.

More about the anatomy of the chest. COSTOSTERNAL ANATOMY ...

Tietzes syndrome

Like many medical conditions Tietze's syndrome is treatable but not curable; it's a non uncommon cause of chest pain.

Tietzes syndrome is frankly a difficult condition with no proven remedy; however it responds reasonably well to a very specific chiropractic regimen that should not include heavy manipulation in the midback.

Just how common are these other causes of musculo-skeletal chest pain, you may be asking?

Deep breathing may aggravate musculo-skeletal chest pain, giving sharp stabs of pain in the midback with every breath.

This is a common condition which responds well, and usually very quickly to chiropractic. While your chiropractor should know it, it may be worth repeating that a heavy adjustment in the middle of the back may well aggravate this problem. It took me quite a few years to work that one out. I was napping the day we had that lecture!

Heartburn and indigestion are a common feature of Tietze's syndrome.

Love to read? Chiropractor Bernard Preston loves to tell intriguing tales that challenge the chiropractor. His books are often described as a fun-read, but simulataneously you will find out much about the private world of chiropractors. Soaring in his glider, trout-fishing, hiking the mountains and his search for the unknown God make these delightful reads. For more about Bernard Preston's books.

Cover of Frog in my Throat.
Cover of Bats in my Belfry.
  • Frog in my Throat ...
  • Bats in my Belfry ...
Cover of Stones in my Clog.
  • Stones in my Clog ...

His third book, Stones in my Clog, is written from the polders of Holland. Enjoy a freebie: Priest in my Bed ...

Use the site search button in the navigation bar on your left to find these topics shown in bold.

Rib treatment

Rib treatment is not usually painful.

Chest pain is not uncommonly caused by a subluxated rib head. It can sometimes be extremely painful in the midback, between the shoulder blades. Where the rib joins the spine there are three small joints any of which can be sprained, causing severe discomfort.

The common sign is PAIN WITH DEEP INHALATION. In fact it is often described as though someone is stabbing a rusty knife in the back, between the shoulder blades.

The condition is often caused by a violent sneeze, particularly if it is unexpected, and you are twisting or in some unusual posture.

This very painful condition responds very quickly to a gentle highly specific chiropractic adjustment of the rib head.

Home treatment should include an ice pack over the joint for 20 mins (on a dry face cloth) followed by a hot shower. Gentle massage may help too.

More difficult is when the rib treatment involves the lower chest. Patients (and doctors) may think that it is renal colic (eg from a kidney stone). A careful, thorough exam is the only way to differentially diagnose this condition. It is a more difficult area to adjust chiropractically, and may take longer to resolve.

Despite the fact that a subluxation of a ribhead can cause extreme pain in the middle of the back, the treatment is surprisingly not really painful. Relief is often immediate. Not having it properly managed, the acute pain usually recedes, but a dull, gnawing ache often remains.

Pleurisy also causes pain with deep breathing. If you are feeling ill, running a fever or coughing, be sure to alert your chiropractor. When consulting a patient with chest pain, as you can see, he or she will soon be running late; there's much ground to be covered. 

Every chiropractor has had a red face when consulted by a patient with chest pain, it turns out to be the early stages of shingles before the lesions have appeared; what's inexplicable though is that they always seem to recover quickly from what can become a nasty, prolonged period of pain lasting sometimes years. Read more about it at chiropractic shingles.

For more information about chiropractic RIB PAIN TREATMENT ... click here.

This casefile might interest you if you are suffering from rib pain. RIB PAIN TREATMENT CaseFile ...

Thoracic outlet syndrome

This is another perplexing cause of chest (sometimes) and arm pain which confronts the chiropractor on a daily basis. The nerves to the arm and the chest muscles emerge from the lower neck, between the first rib, the collar bone, and some muscles, through a small triangular gap. The so-called brachial plexus of nerves may become entrapped in this triangle causing angina like symptoms, mimicking a heart attack. For more information, click here. THORACIC OUTLET SYNDROME ...

ASBESTOS / MesotheliomaSymptoms / Chest pain

I think we now all know to avoid asbesos like the plague. Mesothelioma is a type of lung cancer caused by exposure to asbestos. MesotheliomaSymptoms ...

Asbestos fibers that are ingested or inhaled can be lodged into the body, causing infections or swelling and ultimately lung cancer. Smoker too? Deadly. Double deadly. On a municipal water supply using asbestos pipes? Mesothelioma Centre ... MaaCenter

Free copies of the mesothelioma book, "Surviving Mesothelioma", are available to newly diagnosed mesothelioma patients. SurvivingMesothelioma ... the free book.


With one in seven women dying in the West of breast cancer it behooves every woman to consider what she can do to help herself.

If ever it was pertinent, with breast cancer an ounce of prevention is worth a couple hundred pounds of cure. Breast cancer and prevention ...

Many women with chest pain think they are either having a heart attack, or have breast tumour. Costochondritis needs to be considered too.


  • Did you know that the humble apple has been SCIENTIFICALLY PROVED to help with heart disease and diabetes? This apple salad recipe explains...
  • Eggplant has been SCIENTIFICALLY PROVED to lower cholesterol. Baba Ghanoush is dead easy to make.
  • These three authors will amuse and entertain you while you learn more about chiropractic. GOOD READS ...

  1. Chiropractic Help
  2. Thoracic Spine Pain
  3. Chest pain

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

Do you have a problem that is not getting better?

Are you looking for a different slant on your pain?

Do you want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.

You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong. Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what a DC does.

The quickest and most interesting way is to read one of my eBooks of anecdotes. Described by a reader as gems, both funny and healthful from the life and work of a chiropractor, you will love them. Priced right at $2.99, though Kindle fiddles the amount without telling me.

The Twelve days of Warning

Caldwell and Judge

(sung to the tune of "The Twelve days of Christmas)

  • On the 1st day of warning, the government said to me:

Change to a lower tar brand 

  • On the 2nd day of warning, the government said to me:

Take fewer puffs, And change to a lower tar brand

  • On the 3rd day of warning, the government said to me:

Leave a longer stub, Take fewer puffs, And change to a lower tar brand.

  • On the 4th day of warning, the government said to me:

Chronic heart disease,  Leave a longer stub, Take fewer puffs, And change to a lower tar brand.

  • On the 5th day of warning, the government said to me: 

Inhale less, Chronic heart disease, Leave a longer stub, Take fewer puffs, And change to a lower tar brand.

  • On the 6th day of warning, the government said to me:

Up go the taxes, Inhale less, Chronic heart disease, Leave a longer stub, Take fewer puffs, And change to a lower tar brand

  • On the 7th day of warning, the government sang to me: Tarry tarry lungs, furry furry tongues, Nasty yellow fingers, Everywhere I go, ashtrays overflow, A cancer victim lingers, In appalling vein.

Up go the taxes, Inhale less, Chronic heart disease, Leave a longer stub, Take fewer puffs, And change to a lower tar brand.

  • On the 8th day of warning, the government put its face right up to mine and said:

Horrid foetid breath, In appalling vein, Up go the taxes, Inhale less, Chronic heart disease, Leave a longer stub, Take fewer puffs, And change to a lower tar brand.

  • On the 9th day of warning, the government tried sex:

Nice girls don’t like it, Horrid foetid breath, In appalling vein, Up go the taxes, Inhale less, Chronic heart disease, Leave a longer stub, Take fewer puffs, And change to a lower tar brand.

  • And on the 10th day, the government hath remembered the 6th day and were exceeding glad:

Higher taxes yet, Nice girls don’t like it, Horrid foetid breath, In appalling vein, Up go the taxes, Inhale less, Chronic heart disease, Leave a longer stub, Take fewer puffs, And change to a lower tar brand.

  • On the 11th day of warning, the government had Saatchi & Saatchi in who came up with this witty ditty:  

Set yourself on fire

You’ll be left to die

a social pariah

Afflicted as predicted

Hopelessly addicted

Soon to be evicted

Loss of erection

Pain and dejection

Cancer and infection

Mental confusion

Blood and contusion

Pus in profusion

No buts or maybes

Kills unborn babies

Herpes, AIDS and rabies

Higher taxes yet

Nice girls don’t like it

Horrid foetid breath

In appalling vein

Up go the taxes

Inhale less

Chronic heart disease

Leave a longer stub

Take fewer puffs

And change to a lower tar brand

  • On the 12th day of warning I said to the government: (Cough cough collapse)

    With thanks to Dr Robert Caldwell, eminent physician specialist, comedian and performer, and Jeff Judge, musician.