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I have a client who says she has been having chest pains. She says that there is nothing that causes the pain but it just hits her from time to time. There is no pain when palpating. But she does suffer from HA. There was some tightness which felt like fascial tightness in her upper traps. I thought they some of the pain may be due to some neuromuscular dysfunction along with the tightness. Her dr. says that it was muscularskeletal though

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For this I usually do MFR stretches upper back shoulders and chest along with racking the ribs and abdominal massage. This usually works when their doctor hasn't found any "physical" cause. It almost always gains me another frequent client. Not because it requires repeat therapies but because they never knew they could feel so limber and pain free.
Have you tested for pectoralis major and minor injury with resisted abduction of the arms, or for intercostal muscle strain with very deep breathing?

You might also want to check for trigger points along the medial border of the scapulae, near the pec insertions, and traps. She could also have very tight scalenes which could be causing her to raise her shoulders, creating tightness in the rib case and chest wall. Triggers can also be found in the intercostals.
There can be an anatomy chain that goes from the upper traps to the serratus anterior. It is often missed in palpation because of avoiding getting to close to the breasts. This often involves a rotational subluxation in the thoracic spine and the attendant antalgic posture.

Hans Albert Quistorff, LMP
Antalgic Posture Pain Specialist

I didnt try any resisted movements of the shoulder at all. but i test the intercostals with deep breathing. I will try all these suggestions when she comes in this week
Ben Benjamin said:
Have you tested for pectoralis major and minor injury with resisted abduction of the arms, or for intercostal muscle strain with very deep breathing?

Hard to tell without knowing the exact location of chest pains, and other particulars of the client. Something that just comes to mind is a chest pain that I get every once in a great while. Every once in awhile I get heartburn. Seemingly right after that I get chest pains that sometimes radiate around to posterier rib cage. I assume it is a muscle guarding effect. I've figured out to massage and relax the area will get rid of it. Just an idea.

Yea those are the hard ones... For me.....No matter what their presenting symptoms are.. I do a body search for trigger points... Head to toe...And where ever they are at...I work to eliminate them...When I do that... More often then not....All their symptoms that they came in with go away...The difficult ones for me, are the ones like your client...No trigger points...At least not yet anyway....If there is only pain on movement...I have them go through the movement, work the trigger point from there...But gosh,,,If you cant find a sore spot??   I usually just flow into an over all massage in that case..  Keep us posted as to how it goes? 

I was working on a case study for my NMT class who was having chest pains that radiated down the arm and heart palpitations.  He went to ER twice and to a cardiologist only to be found as one of the healthiest people they know.  I found trigger points in his left pec major.  Cardiologist later came back and said his electrolytes were low which may have been causing the problems - he's taking magnesium and perscription strength potassium now.


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