02/02/2026
Chest pain is alarming and should always be medically evaluated first. However, once cardiac causes are ruled out, many people are surprised to learn that muscular and fascial dysfunction can closely mimic heart-related symptoms. In clinical practice, myofascial trigger points commonly reproduce chest tightness, shortness of breath, arm pain, and numbness—sensations that feel serious and frightening.
One common contributor is the anterior scalene. This muscle runs from the cervical spine to the first rib and assists with neck stability and breathing. When chronically tight, it can refer pain into the upper chest near the clavicle, send symptoms into the shoulder and arm, and create numbness or tingling due to irritation of the brachial plexus. Because rib movement is restricted, many people feel they cannot take a full breath. This pattern is often mistaken for anxiety or heart-related pain and may resemble thoracic outlet–type symptoms.
Another frequent source is the subscapularis, a deep shoulder stabilizer located on the front surface of the scapula. Trigger points in this muscle can cause deep aching or sharp pain across the chest and armpit, with radiation into the upper back or down the arm. The sensation often feels internal and pressure-like rather than muscular. These referral patterns are well documented and can be intense enough that individuals believe they are experiencing a heart attack, even though the pain is referred through shared spinal nerve pathways.
These muscles commonly become overactive due to forward head posture, rounded shoulders, prolonged desk work, chronic stress, shallow breathing, repetitive pushing or lifting, and unbalanced upper-body training. Over time, these patterns overload the anterior neck and shoulder stabilizers while limiting proper rib and scapular movement.
Once serious medical conditions are ruled out, effective care focuses on targeted soft-tissue release, restoring rib and shoulder mobility, breathing retraining to reduce accessory muscle overuse, and skilled manual therapy to normalize tissue tone. When the source is muscular, improvement is often noticeable quickly.
