Sternum pain: What it is and when to see a doctor

sternum pain

Experiencing sternum pain? Learn what it is, what causes it, and when it could be serious. A complete guide to help you decide when to seek medical help.

What is sternum pain?

Sternum pain refers to discomfort or aching in the chest area, particularly along the breastbone, also known as the sternum. This type of pain can vary in intensity and may be sharp, dull, burning, or pressure-like. Understanding the potential causes and implications of sternum pain is essential, as it may be linked to both benign and serious conditions.

Anatomy and function of the sternum

The sternum is a long, flat bone located in the anterior midline of the thorax, forming the central part of the chest wall. It acts as a keystone structure in the rib cage, connecting to the first seven pairs of ribs through the costal cartilages and serving as a central support for thoracic stability. Its main role is to protect vital thoracic organs, including the heart, lungs, aorta, and vena cava.

Anatomically, the sternum is composed of three distinct sections, each with specific structural and functional roles:

1. Manubrium (upper portion)

The manubrium is the broad, superior segment of the sternum. It articulates with:

The clavicles at the sternoclavicular joints, allowing shoulder movement and upper limb stability.
The first pair of ribs and partly the second pair through the costal cartilages.

The jugular notch, a visible depression at the top of the manubrium, is a palpable anatomical landmark used in clinical assessments.

2. Body of the sternum (gladiolus)

The sternal body is the largest portion and extends downward from the manubrium. It articulates with:

The second to seventh ribs through costal cartilages.
The manubrium at the sternal angle (angle of Louis), a critical anatomical landmark used to locate the second rib and intercostal spaces during examination.

This segment provides a wide surface area for muscular attachment, including:

The pectoralis major
The sternocleidomastoid
Parts of the rectus abdominis

3. Xiphoid process (inferior tip)

The xiphoid process is the smallest and most variable part of the sternum. In youth, it is cartilaginous and gradually ossifies with age. Although often overlooked, it serves as an attachment point for the:

Diaphragm (important in breathing)
Transversus thoracis muscle
Linea alba, which contributes to abdominal wall integrity

Because of its location and variability, blunt trauma to the lower sternum may risk damaging the xiphoid and underlying diaphragm or liver tissue.

The role of the sternum in thoracic protection and biomechanics

Functionally, the sternum acts as a protective shield for organs of the mediastinum (central chest cavity), including:

The heart and pericardium
The ascending aorta and pulmonary trunk
The trachea and major bronchi

Additionally, the sternum helps maintain structural rigidity of the rib cage, which is essential for effective respiration. The expansion and contraction of the rib cage during breathing is directly supported by the sternum’s anchoring of costal cartilages.

Any trauma—such as a blunt force impact, fall, or high-speed collision—can disrupt this complex structure and lead to sternum pain. Inflammatory conditions like costochondritis or degenerative changes can also irritate the sternal region, resulting in radiating pain to the ribs, upper back, shoulders, or even the epigastric region (upper abdomen).

In cases of sternal fracture, the integrity of the chest wall may be compromised, posing a risk to the organs beneath. According to NCBI anatomical studies, injuries to the sternum must be carefully evaluated, especially if accompanied by symptoms like shortness of breath or cardiovascular instability.

Common symptoms associated with sternum pain

People experiencing sternum pain often describe sensations such as:

Localized tenderness or pressure along the breastbone
Pain that worsens with deep breathing, coughing, or movement
Swelling or bruising (especially after trauma)
Tightness or heaviness in the chest
Pain that mimics heart-related conditions

In some cases, sternum pain is accompanied by anxiety or shortness of breath, leading patients to suspect a cardiac event.

Is sternum pain dangerous?

While sternum pain is frequently caused by non-serious issues like muscle strain or inflammation, it can occasionally signal life-threatening conditions such as a heart attack or pulmonary embolism. For that reason, sudden or severe chest pain should always be evaluated by a medical professional. According to NCBI Clinical Overviews, distinguishing between musculoskeletal and visceral causes of chest pain is crucial for appropriate treatment.

Common causes of sternum pain

Costochondritis and cartilage inflammation

Costochondritis is one of the most common causes of sternum pain. It involves inflammation of the cartilage where the ribs attach to the sternum. Patients often report localized tenderness, worsened by pressing on the chest or deep breathing. Though it can be alarming, costochondritis is usually harmless and tends to resolve with rest and anti-inflammatory treatment.

Sternum fracture or chest trauma

A sternum bone fracture is a more serious cause of sternum pain and typically results from blunt chest trauma, such as car accidents or sports injuries. The pain is often sharp and localized, with visible bruising or swelling. A CT scan is usually required to confirm the fracture, as stated in JECCM trauma guidelines. Recovery may include rest, pain relief, and in some cases, surgical intervention.

Muscle strain and intercostal tension

Strained intercostal muscles—those located between the ribs—can cause persistent sternum pain, particularly after heavy lifting, coughing, or intense upper-body workouts. Muscle strain often presents as soreness that worsens with certain movements and improves with rest or gentle stretching.

When to consider physiotherapy

If muscle tension is the cause of ongoing sternum pain, physiotherapy may help restore mobility and alleviate discomfort. A structured program may include breathing exercises, postural correction, and soft tissue techniques.

Heart-related conditions that mimic sternum pain

Several cardiovascular conditions can present as sternum pain, including:

Angina – chest discomfort due to reduced blood flow to the heart
Myocardial infarction (heart attack) – often described as crushing pain behind the sternum
Pericarditis – inflammation of the sac surrounding the heart, causing pain that may mimic musculoskeletal discomfort

Because these conditions can be life-threatening, immediate medical evaluation is recommended for any chest pain associated with sweating, dizziness, nausea, or radiating discomfort.

Acid reflux and gastrointestinal causes

Gastroesophageal reflux disease (GERD) is another common contributor to sternum pain. Acid from the stomach backs up into the esophagus, causing a burning sensation that may feel like heart or chest pain. The discomfort often worsens after meals or when lying down and may improve with antacids or dietary changes.

Lung infections and respiratory issues

Pneumonia, pleuritis, and bronchitis can all lead to sternum pain, particularly when coughing or taking deep breaths. These conditions cause inflammation or infection in the lungs or surrounding tissues, which can irritate the structures near the sternum.

Recognizing respiratory-related chest pain

Pain related to the lungs may also be accompanied by symptoms such as fever, chills, shortness of breath, and productive cough. If sternum pain is linked to breathing difficulties or infection, prompt medical evaluation is essential.

Anxiety and psychosomatic chest pain

Anxiety and panic attacks can lead to sternum pain through muscle tension and shallow breathing. Patients often describe a sense of tightness or pressure in the chest, sometimes mistaken for a heart problem. Though the cause is psychological, the pain is very real and may require a combination of mental health support and physical relaxation techniques.

As described in JECCM case reports, differentiating between psychosomatic and physiological chest pain is vital in choosing the right therapeutic path.

👉 Suspect a sternum bone fracture after an injury or impact? Discover how to recognize it and what treatment options are available.

Rare or overlooked causes of sternum pain

While many cases of sternum pain are related to common conditions like costochondritis or musculoskeletal tension, some less frequent but clinically important causes should not be overlooked. These rare conditions may require more advanced diagnostic tools and a multidisciplinary approach to treatment.

Tietze syndrome

Tietze syndrome is a rare inflammatory disorder that causes painful swelling at the junction of the upper ribs and the sternum. Unlike costochondritis, which typically presents without swelling, Tietze syndrome causes visible and palpable enlargement of the costal cartilage, most often near the second or third rib.

The sternum pain associated with this condition is usually localized, unilateral, and may worsen with deep breaths or physical activity. Though the exact cause remains unclear, it is often linked to repetitive trauma, upper respiratory infections, or excessive coughing.

Management typically involves non-steroidal anti-inflammatory drugs (NSAIDs), local cold application, and in some cases, corticosteroid injections. A detailed musculoskeletal and systemic assessment is essential to exclude more serious pathology.

Bone tumors or metastases

Primary bone tumors in the sternum are rare, but the region can be a site of metastatic disease, particularly from cancers such as breast, lung, thyroid, or prostate. These lesions can erode the bone structure and cause deep, persistent sternum pain, often unrelated to movement or palpation.

Patients may also experience systemic symptoms such as unexplained weight loss, night sweats, or fatigue. In such cases, imaging techniques like MRI or CT scan are critical for diagnosis. According to NCBI medical data, prompt recognition of metastatic spread to the sternum is crucial for staging and treatment planning in oncology.

Osteomyelitis of the sternum

Osteomyelitis refers to a bacterial or fungal infection of the bone, and when it involves the sternum, it is considered a serious condition. It is most often seen post-surgically (especially after open-heart surgery), or in individuals with compromised immunity.

Signs may include sternum pain, local redness or warmth, fever, and in severe cases, drainage from the sternal wound. The diagnosis is confirmed through blood tests, imaging (CT/MRI), and bone biopsy. Treatment involves long-term antibiotics and sometimes surgical debridement.

Though rare, sternal osteomyelitis requires urgent medical intervention due to the risk of spreading infection to adjacent organs like the heart and lungs.

Thoracic joint dysfunctions

The sternocostal and manubriosternal joints can become restricted or inflamed due to poor posture, repetitive strain, or degenerative changes. This can lead to sternum pain that mimics cardiac discomfort.

Manual assessment by a physiotherapist or osteopath may reveal hypomobility in these joints, and symptoms often improve with joint mobilization, postural correction, and therapeutic exercises. In some cases, thoracic spine dysfunction can refer pain to the anterior chest, making differential diagnosis essential.

When to see a doctor for sternum pain

Understanding when sternum pain requires professional attention is essential, as some presentations may be harmless while others could signal life-threatening conditions.

Emergency symptoms that require immediate attention

Certain symptoms in combination with sternum pain should prompt immediate medical evaluation. These include:

Sudden, severe chest pain with pressure or squeezing sensation
Pain radiating to the jaw, left arm, or back
Shortness of breath, dizziness, or fainting
Sweating, nausea, or vomiting
Chest pain that worsens during exertion or does not improve with rest

These signs may indicate a myocardial infarction (heart attack) or pulmonary embolism, both of which require emergency care. As emphasized by JECCM emergency medicine reports, timely identification of red-flag symptoms significantly improves patient outcomes.

When sternum pain is linked with breathing difficulties

Sternum pain that intensifies during breathing, coughing, or sneezing can point to pleuritic or musculoskeletal origins. However, if accompanied by shortness of breath, wheezing, or cyanosis (blue lips), it may suggest:

Pneumothorax (collapsed lung)
Pneumonia or bronchitis
Pulmonary embolism

If breathing difficulties occur with sternum pain, immediate medical evaluation is advised to rule out respiratory or cardiovascular emergencies.

How long should sternum pain last before consulting a professional?

Minor cases of sternum pain, such as those caused by muscle strain or poor posture, typically resolve within a few days to a week with rest and self-care. However, you should consult a healthcare provider if:

The pain persists longer than 7–10 days
Symptoms worsen over time
Pain interferes with sleep, breathing, or daily activities
There’s no identifiable cause (no trauma or illness)

Persistent or unexplained sternum pain warrants professional assessment to exclude conditions that require specific treatment or intervention.

How is sternum pain diagnosed?

Diagnosing sternum pain accurately is essential, as it can stem from various musculoskeletal, cardiac, gastrointestinal, or pulmonary origins. A structured clinical approach allows healthcare professionals to distinguish between benign and serious causes. In many cases, the diagnosis is based on a combination of history taking, physical examination, laboratory testing, and imaging.

Physical examination and palpation

The diagnostic process begins with a thorough clinical examination. A doctor will typically:

Inspect the chest for visible signs such as swelling, redness, or asymmetry
Palpate the sternum and costosternal joints to identify localized tenderness or swelling
Assess for pain reproduction during movement or deep breathing
Evaluate postural alignment and thoracic mobility

In cases of musculoskeletal origin, sternum pain is often reproduced with palpation or trunk movements. In contrast, cardiac or gastrointestinal pain usually is not affected by touch.

Blood tests and inflammatory markers

Blood tests may help rule out systemic causes of sternum pain, especially when infection or inflammation is suspected. Relevant tests include:

C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) for inflammation
Complete blood count (CBC) to detect infection or anemia
Cardiac enzymes (e.g., troponin) to rule out myocardial infarction
Autoimmune markers in suspected rheumatologic disorders

Elevated inflammatory markers may point toward conditions like costochondritis, Tietze syndrome, or even osteomyelitis, while normal levels suggest mechanical or functional causes.

Imaging tests (X-ray, CT scan, MRI)

When physical findings are inconclusive or red-flag symptoms are present, imaging is the next step in assessing sternum pain.

Chest X-ray is used to detect fractures, visible masses, or lung pathology
CT scan provides detailed images of the sternum, ribs, and adjacent organs; especially useful in trauma cases
MRI is ideal for identifying soft tissue lesions, bone marrow edema, or tumors

According to NCBI imaging guidelines, early imaging is crucial in identifying hidden fractures or metastases to the sternum.

Referral to specialists (cardiologist, pulmonologist, physiotherapist)

If the origin of sternum pain is unclear or the condition persists despite initial management, referral to a specialist may be necessary:

A cardiologist can assess for angina, pericarditis, or other cardiac issues
A pulmonologist investigates lung-related causes, such as pleuritis or infection
A gastroenterologist may explore acid reflux or esophageal disorders
A physiotherapist can evaluate posture, thoracic joint mobility, and muscle imbalances, and propose a personalized treatment plan

Treatment options for sternum pain

Treatment for sternum pain depends on the underlying cause. Most musculoskeletal and inflammatory conditions respond well to conservative care, while other cases may require medication, targeted therapy, or—in rare instances—surgical intervention.

Self-care and lifestyle adjustments

For many patients, especially those with postural or mechanical causes of sternum pain, conservative self-care can be highly effective. Recommendations include:

Improving posture, especially for individuals who sit for long periods
Avoiding heavy lifting or strenuous upper body activity during the acute phase
Using heat or cold packs to reduce local pain and inflammation
Practicing gentle stretching and breathing exercises

Lifestyle changes, such as quitting smoking, reducing stress, and maintaining a healthy weight, can also help reduce strain on the chest wall.

Medications: NSAIDs, proton pump inhibitors, muscle relaxants

Pharmacologic treatment is often a first-line approach in managing sternum pain. The most commonly used medications include:

NSAIDs (e.g., ibuprofen, naproxen) – reduce pain and inflammation, especially in costochondritis and muscle strain
Proton pump inhibitors (e.g., omeprazole, pantoprazole) – used when acid reflux is suspected as a contributor to sternum pain
Muscle relaxants – may be prescribed in cases of muscular spasm or intercostal tension

These medications should be used under medical supervision, particularly in patients with gastrointestinal sensitivity or cardiovascular risk factors.

When antibiotics are indicated

Antibiotics are not typically used for sternum pain, but they become essential when the pain is due to osteomyelitis, infected wounds, or bacterial costochondritis. Signs that infection may be present include:

Persistent fever
Redness and warmth over the sternum
Pus or drainage from a surgical or trauma site
Elevated CRP and WBC count

According to JECCM clinical findings, early administration of antibiotics can prevent sepsis or bone necrosis in patients with sternal infections.

Invasive options: injections or surgery (in rare cases)

In rare cases where sternum pain is severe, persistent, and resistant to conservative treatment, more invasive procedures may be considered:

Corticosteroid injections into inflamed costosternal joints or surrounding tissues
Nerve blocks for chronic, neuropathic pain
Surgical intervention for:
- Displaced sternal fractures
- Removal of tumors
- Drainage of infected bone (osteomyelitis)

These interventions are generally reserved for specific diagnoses and require collaboration between orthopedic surgeons, radiologists, and pain management specialists.

Physiotherapy approach to sternum pain

Physiotherapy is often an effective and safe approach in managing sternum pain, especially when the cause is musculoskeletal. It focuses on restoring thoracic mobility, reducing muscular tension, improving posture, and enhancing respiratory function. A tailored rehabilitation plan may significantly speed up recovery and reduce the likelihood of chronic pain.

Manual therapy techniques for thoracic mobility

Restricted movement of the thoracic spine or costosternal joints may contribute to persistent sternum pain. Physiotherapists often use:

Joint mobilization techniques to improve rib and spinal mobility
Myofascial release to target intercostal tension
Soft tissue mobilization over the pectoralis major and minor muscles

These manual therapies are designed to restore symmetry and reduce pressure on the sternum. In cases where sternum pain results from postural dysfunction or repetitive strain, manual therapy may provide significant relief.

Breathing exercises for chest expansion

Shallow breathing and chest tightness are common in individuals with sternum pain. Breathing dysfunction can contribute to tension in the chest wall and increase discomfort. A physiotherapist may incorporate:

Diaphragmatic breathing to reduce upper chest tension
Thoracic expansion exercises to maintain lung function and rib mobility
Inspiratory muscle training in post-surgical or sedentary patients

According to NCBI guidelines on chest physiotherapy, breathing retraining may prevent pulmonary complications and facilitate pain-free movement.

Posture correction to reduce sternal pressure

Poor posture—especially prolonged thoracic kyphosis (slouched back)—places constant pressure on the sternum and anterior chest wall. Physiotherapists address this by:

Teaching ergonomic strategies for sitting and standing
Strengthening scapular stabilizers and thoracic extensors
Instructing on core activation to support spinal alignment

Postural correction not only helps in relieving sternum pain but also prevents recurrence, especially in sedentary individuals.

Gradual return to movement and functional training

Once acute pain subsides, a gradual return to physical activity is important. This includes:

Gentle thoracic stretching
Progressive resistance exercises for the upper body
Functional movement training for lifting, reaching, and breathing coordination

A physiotherapist can guide safe progression, ensuring sternum pain does not worsen due to premature or excessive load.

Can sternum pain be prevented?

Preventing sternum pain involves maintaining good musculoskeletal health, minimizing risk of trauma, and optimizing daily habits that affect the chest wall and posture.

Correct posture and ergonomic habits

Sustained poor posture—such as slumping over a desk—can lead to mechanical stress in the thoracic region and anterior chest. Preventive strategies include:

Using ergonomic chairs and desks
Taking regular movement breaks during long periods of sitting
Strengthening postural muscles to support the rib cage

Maintaining spinal alignment reduces undue load on the sternum, minimizing the risk of chronic pain.

Breathing patterns and stress reduction

Anxiety, poor breathing habits, and chronic stress can manifest as sternum pain due to shallow breathing or excessive upper chest activation. Prevention strategies include:

Practicing deep diaphragmatic breathing
Engaging in mindfulness or meditation
Reducing lifestyle stress to prevent muscular guarding in the chest

Breathing awareness and relaxation techniques may also reduce psychosomatic sternum pain, particularly in individuals with panic attacks or high stress levels.

Safe sports practices and injury prevention

Contact sports, poor technique, or overtraining can increase the risk of sternum trauma or intercostal strain. Preventive tips include:

Wearing protective gear in high-impact sports
Warming up properly before exercise
Avoiding overuse and ensuring recovery between training sessions

Coaching and technique optimization play a key role in avoiding sports-related sternum pain.

Nutrition and bone health

Bone strength is essential in minimizing fracture risk. To prevent sternal injuries, especially in older adults or individuals with bone density issues:

Ensure adequate intake of calcium and vitamin D
Maintain hormonal balance (especially in postmenopausal women)
Stay physically active to support bone remodeling

Nutritional support and weight-bearing exercise contribute to overall sternal health and reduce vulnerability to pain or injury.

Frequently asked questions about sternum pain

Why does my sternum hurt?

Sternum pain can result from many causes, including costochondritis, muscle strain, postural imbalance, reflux, or even cardiac issues. Identifying the cause is key to proper treatment.

What is the fastest way to heal a sternum?

The fastest way to manage sternum pain is through rest, anti-inflammatory therapy, and targeted physiotherapy. Recovery also depends on the cause—fractures take longer than soft tissue strain.

How do you treat a pulled sternum?

Although the sternum itself cannot be “pulled,” pain in this area may stem from strained intercostal muscles or cartilage. Treatment includes NSAIDs, ice, gentle movement, and physiotherapy.

Can you massage your sternum?

Gentle self-massage around the sternum may relieve muscular tension. However, direct pressure on the bone should be avoided unless supervised by a qualified therapist.

Can anxiety cause sternum pain?

Yes, anxiety can lead to chest tightness, shallow breathing, and sternum pain. Stress-induced muscle tension often mimics other conditions but is not typically dangerous.

Is sternum pain always related to the heart?

No. While heart problems can cause sternum pain, most cases are due to musculoskeletal or digestive issues. A proper diagnosis is essential to rule out serious causes.

How to sleep with sternum pain?

To sleep better with sternum pain:

Use a supportive pillow
Sleep on your back with slight elevation
Avoid side-lying positions that compress the chest
Use heat or a mild analgesic before bedtime if approved

Is sternum pain common during pregnancy?

Yes, sternum pain during pregnancy can result from rib expansion, postural changes, or hormonal ligament relaxation. In most cases, it is benign and resolves postpartum.

⚠️ All health-related information and recommendations provided here are based on the professional experience of a licensed physiotherapist and kinesiologist with several years of international and local clinical practice. These insights aim to support general well-being and rehabilitation, but they do not replace medical advice.

Each individual is unique, and responses to treatment or exercise may vary. Therefore, it is strongly recommended to consult with a medical doctor or healthcare professional before starting any new therapy, exercise program, or making changes to your current health routine.

These guidelines are intended for educational and informational purposes only.