Acute chest pain is sudden onset and includes cardiac chest pain, heart attack, a torn muscle or bruised rib. Most chest pain in sport, however, has musculoskeletal causes. If you suspect cardiac chest pain then seek urgent medical attention immediately. Do not take chances.
Most common causes of chest pain in sport
Rib fracture – or broken rib is common in contact sports. It usually occurs following a hard impact to the chest by an elbow or similar. Your breathing will often be painful and be a particular point on the ribs will be especially tender. It is possible that the fracture may cause internal damage so seeking medical advice is recommended. A rib contusion will have similar symptoms but is unlikely to last as long as a fracture.
Referred chest pain – can be caused by problems in the back or neck. Pain will be felt in the chest but the cause of the problem may be in the upper (thoracic) spine. Chest pain when taking a deep breath can also be a symptom of a back/spinal problem.
Sternoclavicular joint – injury is a sprain of the ligament which holds the breast bone (sternum) to the clavicle (collar bone). Symptoms will include pain when pressing in specifically at the sternoclavicular joint where the collarbone meets the sternum. Pain may radiate into the shoulder and it is likely there will be a visible bony lump over the joint.
Side stitch – this is a common symptom which can usually be felt to one side of the abdomen, near the lower ribs. Many people suffer from stitches when doing sport, particularly running based activities. We examine the possible causes and what you may be able to do about it.
Jogger’s nipple – is a friction burn caused by constant rubbing or chafing of a T-shirt over the nipple.
Jogger’s nipple symptoms
- The main symptom is a sore nipple which develops during a run.
- It may begin as mild discomfort get progressively worse. Eventually, pain becomes severe.
- Your nipple may start to bleed.
Other causes of chest pain
Costochondritis – is an inflammatory condition that occurs at the joints between the ribs and the sternum (breastbone). The condition is sometimes also known as Tietze’s syndrome. It can be caused by overuse as the cartilage between the joints becomes damaged. Younger people are particularly affected by this condition, which causes chest pain.
Intercostal muscle strain – is a tear to the intercostal muscles found in between the ribs.
Rib stress fracture – is rare but has been known in a number of sports including Tennis, Golf, Rowing, and Gymnastics. It is a gradual onset overuse injury caused by traction of the intercostal muscles between the ribs.
Sternum fracture & contusion – direct trauma or impact can cause a contusion or in more severe cases a sternum fracture may occur. A bruised sternum, or sternum contusion as it is also known, occurs after an impact to the chest or breastbone. This most frequently occurs after road traffic accidents, although collision sports and those with hard balls or rackets etc can also impact the sternum.
Side strain – is a tear of the internal oblique muscle, often at its attachment to the ribs.
Pectoralis muscle strain – is a tear of the large powerful muscle at the front of the chest. Its weak point is at the tendon, where it attaches to the arm (humerus bone). The front of your shoulder will be painful and swell up quickly. An obvious deformity will be visible, especially if it is a complete rupture.
Important – do not miss!
The following are not common in sport, however, it is important they are not missed when diagnosing chest pain in athletes. They can be potentially fatal.
Pneumothorax – or collapsed lung occurs when there is a build-up of air in the space between the lungs and the rib cage – known as the pleural space. Symptoms include a sharp chest pain and shortness of breath. This condition can be caused by a specific injury like broken ribs, or just happen for seemingly no reason.
Cardiac chest pain – is rare, however, it should always be considered with symptoms of acute chest pain where the cause is not obvious. Chest pain could originate from the muscles, but it could also signify a more serious cardiac problem, even in young athletes.
Peptic ulcer (stomach ulcers) – are open sores that develop on the inside wall of the stomach. They may sometimes arise in the small intestine as well. Symptoms include a burning stomach pain which may expand through the body. Although in many cases treatment can be straightforward, there can be complications depending on the cause of the ulcer and how bad it is.
- Evans G, Redgrave A. Great Britain rowing team guideline for diagnosis and management of rib stress injury: part 1. Br J Sports Med 2016;50(5):266–9. doi: 10.1136/bjsports-2015-095126.