Feeling pain in your chest when you exercise? Worried that it’s your heart? Dr Low Wye Mun clears the myths on chest pain. 

Here’s the scenario: you head to the gym for your usual fitness work-out. Kick boxing and yoga enwrap your cardio/strength sessions. Out of the blue, you feel a sudden sharp pain in your chest. In the same place that you felt it while cycling on the weekend. It’s on the left side, and isn’t there where the heart is? Forgotten for a couple of days until you are seated at your computer e-mailing, when the pain comes on again. Panic !! It must be my heart !! 

Before you get worked up and worried, read on and find out what that chest pain could be due to.

Myth #1: All chest pain (especially on the left side) comes from the heart

Wrong. There are several conditions that can give you chest pain and the heart is indeed one of them. But the nature of the pain or ache will tell you a lot about what is causing it, and may help you avoid needless worry.

• The heart actually sits in the center of the chest under that hard flat bone on the front of your chest. This is called the sternum and is used to compress the heart when trying to resuscitate someone in an emergency situation. The heart extends a little ways to the left of the sternum giving the notion to a lot of people that the heart is on the left side of your chest. 

• If there are problems with the blood supply to your heart, you may indeed get chest pain but this is commonly felt in the center of the chest and is related to the amount of physical exertion you are undergoing. As you start to exercise harder, the pain or deep ache gets worse. When you rest, it goes away. In a heart attack, there may be a sudden chest pain but this has been described as a deep painful pressure in the middle of your chest, possibly radiating to your left arm. You may also feel breathless, nauseous, and break out in a cold sweat. In both conditions, see your doctor NOW.

• Most people do not actually experience this type of chest pain (we won’t talk about heartache­ as that is far more complicated !!). Some key questions can help a doctor to decide what might be causing the sudden pain that you have been experiencing.

Have you been exercising harder than usual? Have you increased your exercise or sports work-outs, or added more weight to your gym sets?	The pain you are feeling may be just from a strain of the muscles on the front of your chest. These muscles are used in press-ups, bench press, punching, and exercises which bring your arms towards the middle of your body.
Are you having a cough or a fever?	Perhaps this is a chest infection. It may have started as a sore throat, cold and cough. And the infection has spread downwards towards your lungs.
Have you had a fall recently?	The pain you are feeling could be from the force of the fall damaging some of the structures on your chest. This includes your ribs, joints, and even the skin (a bruise).
Is the pain worse as your monthly period approaches? Are your breasts a little tender or sore? Is there any discharge from your nipples?	The breasts can give rise to chest pain if there is an infection. If the pain is related to your period, then this may be part of a condition that is related to having certain types of breast lumps.
Have you been crouched over a computer a lot more recently? Is the pain worse when you try to breathe in deeply? And then get better after a few minutes of shallower breathing?	Probably the most common cause of that alarming chest pain involves stiffness in the joints of your rib cage. This is called costochondritis, and you can read more about it now.

Myth #2: I need to stop my exercise and sports, and see a doctor immediately 

Not necessarily. The doctor can certainly discover what the pain is due to and relieve any worries and start the right treatment. But it may help you to decide on whether to consult him/her by asking yourself the questions shown above, and deciding if there is an urgent need .

• Most people don’t like seeing doctors. If you have the type of pain which is typically related to the heart, or if there are signs of an infection (fever, cough) or fall, then you should indeed see your favorite doctor. However, if the pain is only occasional and may be related to poor posture, insufficient or too much exercise, then there are a few things you can try.

• If you have a costochondritis, one or more of the joints between your ribs and front of your rib cage may be injured. This is rather like a mini-sprain of these joints and results in something called inflammation. Certain factors make this more likely: cramping up those joints as you would if you have been hunched over your computer or some books for hours at a time, or having to sleep in a constrictive position (such as on a long airplane flight). Or over-doing those chest exercises in your work-outs.

• Under these circumstances, the pain you feel will be pretty much at the same place. It can be on the right side of your chest or the left, and when it comes on, you feel as if breathing in deeply makes the pain worse. This is because a deeper breath disturbs the joint that is inflamed. You may also be able to feel certain points on near the place of pain that are tender when you press on them.

• If this is what you are feeling, then try this: take a simple pain killer such as paracetamol. Slowly stretch out your arms and think of opening up the front of your chest. What you are doing is stretching joints that may be a little stiff. Sit back in your chair and rest your back against the seat. Re-position your computer or books so that you are sitting more upright and not hunched over your work or pastime activity. Stretch that chest regularly if you are going to be working or sitting down for hours at a time. And on the exercise and sports front, reduce the number of repetitions of chest exercise you are doing, and the force you exert in doing them. This may mean changing from freestyle to breast stroke, or sitting more upright when cycling. Or even taking a short break from it all.

• If all this helps and the episodes of pain lessen or stop, then you have not only managed the pain; you have learnt how to keep it away as well. Tell your friends !!

Myth #3: Exercise and sports have made this happen, and are bad for me … 

No, no, no. Quite the contrary: exercise and sports – if properly managed – can help you to prevent such aches and pain. And there are some prevention steps that you can take to help yourself stay out of the doctor’s office:

• Your exercise and sports activities must be seen in totality. That means that in looking at the physical exercise that may have caused some chest pain, all your activities must be considered: yoga, kick boxing, gym, carrying groceries, etc. Instead of looking at each one as a separate activity, think about the overall physical stress that is taking place. If your muscles are used and fatigued from one activity, they may not have recovered sufficiently before your next set of demands is placed on them. This may increase your risk of a muscle strain or joint sprain.
• Staying physically active and achieving a degree of fitness can help to prevent chest pain related to muscles and joints. This is because your activity can build strength and encourage full movement of your rib cage. A key factor in all activities that you do is to ensure that you make time for flexibility. That means stretching muscles and joints, in this case, the muscles on the front of your chest, and keeping the joints of rib cage freely mobile.

• A key prevention step apart from ensuring that you are not overdoing things is to have any injuries managed early. The sports medicine approach is a sound one: if there is pain and loss of function (eg.being able to take deep breaths or carry out certain exercises), there may be an injury. Finding out about the injury early allows for it to be treated with the greatest chance of quick healing and return to exercise. A meeting with your sports physician will also allow him/her to show you how to prevent the injury from happening again.

Here’s hoping that should you ever develop chest pain, the tips shared will help you to take a positive look at what it might be, and then resume your walk along the path towards pain-free exercise and sports as quickly as possible.