October 19, 2010
Dear Doctors:
A couple of times a year, a patient is referred to us for L pectoral pain that radiates to the LUE. The patient had been through a thorough cardiac workup and learned that the heart is fine. These people are nearly always suffering from myofascial pain due to trigger points in the left pectoral muscles.
In Myofascial Pain and Dysfunction:The Trigger Point Manual, Drs. Travell and Simons state,
When on the left side, pectoralis major trigger points refer pain in patterns that
are easily mistaken for the pain of ischemic heart disease…Pain from either
pectoral muscle and specifically the pectoralis minor, can closely mimic the pain
of cardiac ischemia.
We perform a trigger point examination by palpating the clavicular, sternal, and costal sections of the pectoralis major muscle. We perform a pincer palpation of the pectoralis minor by grasping it beneath and through the pectoralis major. Compressing the taut bands in the muscles usually reproduces the patient’s symptoms.
Assuming there is no other involvement, treatment is simple. Gentle ischemic compression of the trigger points followed by manual stretching of the individual muscles brings about significant relief. We show the patient how to stretch the muscles and insist that they do this several times a day. We also instruct them in correct posture. The patient is usually painfree in two to three visits.
Please call me if you have questions about this or any aspect of physical therapy.
Sincerely,
Chris Cotter, P.T.