Sternalis Trigger Points
Introduction
The sternalis is a rare and variable muscle found in some individuals, running along the anterior chest wall. When present, it assists in chest movement and breathing mechanics. Trigger points in this muscle can cause chest pain, rib tightness, and breathing discomfort, often mimicking costochondritis, rib dysfunction, or pectoral muscle strain.
Name and Area
Name: Sternalis
Area: Located in the anterior thorax, running parallel to the sternum, over the pectoralis major.
Indications
Sternalis trigger points may contribute to:
Pain in the Middle of the Chest (Mistaken for Costochondritis or Sternum Pain)
Tightness in the Chest That Restricts Deep Breathing (Can Resemble Anxiety-Related Chest Tightness)
Pain That Extends to the Upper Ribs and Collarbone (Can Mimic Pectoral Muscle Strain or Clavicle Dysfunction)
Chest Discomfort That Increases with Deep Inhalation or Postural Strain
Pain That Worsens with Forward Shoulder Posture or Slouching
Tenderness Along the Sternum, Worse with Pressure or Physical Activity
Pain from this muscle is often mistaken for rib dysfunction, heart-related issues, or musculoskeletal chest pain.
Muscle Action
Assists in Chest Expansion: Works with pectoralis major and intercostal muscles to support breathing.
May Contribute to Postural Stability: Potentially helps maintain chest wall tension and rib alignment.
The sternalis is an uncommon muscle, but when present, it plays a role in breathing mechanics and chest stability.
Signs and Symptoms
Individuals with sternalis trigger points often report:
Localized Pain Along the Sternum That Feels Like a "Pressure" or "Burning" Sensation
Tightness That Makes Deep Breathing Uncomfortable or Restricted
Pain or Discomfort That Spreads to the Upper Chest and Collarbone
Tenderness or Sensitivity Along the Breastbone (Can Be Mistaken for Costochondritis)
Pain That Worsens with Poor Posture, Slouching, or Hunched Shoulders
Mild Chest Discomfort That Feels Like Muscle Tension Rather Than Sharp Pain
Pain worsens with deep breathing, slouching, or prolonged chest compression.
Perpetuating Factors
Common causes of sternalis trigger points include:
Forward Shoulder Posture (Common in Desk Workers, Gamers, and Cyclists)
Chronic Stress or Anxiety (Can Lead to Increased Chest Tightness and Shallow Breathing)
Repetitive Upper Body Strain (Lifting, Pushing, or Overuse of the Chest Muscles)
Rib or Sternum Trauma (Bruising or Injury Can Lead to Muscle Tension in the Chest Wall)
Breathing Dysfunction or Asthma (Can Cause Overuse of the Chest Muscles for Respiration)
Trigger Point Referral Pattern
Trigger points in the sternalis refer pain to:
The center of the chest and sternum (Can Mimic Costochondritis or Rib Pain)
The upper chest and collarbone (Mistaken for Pectoral Tightness or Clavicle Dysfunction)
The lower neck and upper ribs (Can Resemble Breathing Dysfunction or Postural Strain)
Pain from this muscle is often confused with heart-related conditions, anxiety-related tightness, or rib dysfunction.
Differential Diagnosis
Sternalis trigger points may be mistaken for:
Costochondritis (Inflammation of Rib Cartilage, Causes Tenderness Along the Sternum and Ribs)
Pectoralis Major Dysfunction (Chest and Shoulder Pain, Worsens with Upper Body Exercises or Pushing Movements)
Thoracic Spine Dysfunction (Pain in the Upper Chest and Back, Can Affect Rib Mobility and Posture)
Anxiety-Related Chest Tightness (Can Cause a Feeling of Restricted Breathing or Chest Discomfort)
Cardiac-Related Issues (Always Rule Out Heart Conditions in Cases of Unexplained Chest Pain)
A thorough chest wall, rib, and postural assessment is necessary to rule out these conditions.
Associated Trigger Points
Sternalis trigger points often co-exist with:
Pectoralis Major (Chest and Shoulder Pain, Can Lead to Postural Strain and Breathing Dysfunction)
Intercostal Muscles (Rib and Side Pain, Common in Those with Chronic Shallow Breathing Patterns)
Sternocleidomastoid (SCM) (Neck and Chest Pain, Can Contribute to Forward Head Posture and Upper Chest Tightness)
Diaphragm (Lower Rib and Breathing-Related Pain, Common in Those with Stress-Induced Muscle Tension)
Anatomy and Innervation
| Muscle | Origin | Insertion | Innervation |
|---|---|---|---|
| Sternalis (if present) | Sternum and upper ribs | Pectoral fascia or clavicle | Intercostal nerves (T2–T6) |
The sternalis is innervated by the intercostal nerves (T2–T6), which also control rib movement, breathing mechanics, and upper chest function.
Patient Examination
A comprehensive examination should include:
Palpation: Identify tender nodules along the sternum, upper ribs, and chest wall.
Breathing Pattern Assessment: Check for shallow breathing or chest tightness that worsens with stress.
Postural Analysis: Look for forward shoulder posture, rib restriction, or excessive thoracic kyphosis.
Thoracic and Rib Mobility Testing: Rule out joint dysfunction, intercostal tightness, or muscle imbalances.
Corrective Actions
Dry Needling
Dry needling can release trigger points in the sternalis, reducing chest tension and improving breathing comfort.
Manual Therapy
Trigger Point Release: Apply gentle sustained pressure to tight spots along the sternum and upper chest.
Myofascial Release: Helps improve circulation and reduce muscle tension in the thoracic region.
Stretching
Chest Opener Stretch (Doorway Stretch): Helps release tension in the sternalis and pectoral muscles.
Rib Expansion Stretch: Encourages deep breathing and mobility in the upper chest.
Strengthening Exercises
Scapular Retraction Drills: Strengthens the upper back to counteract excessive chest tightness.
Diaphragmatic Breathing: Encourages proper rib expansion and reduces chronic upper chest tension.
Postural and Movement Adjustments
Avoid Prolonged Slouching (Maintain an Open Chest Position to Prevent Rib and Shoulder Strain)
Ensure Proper Breathing Mechanics (Diaphragmatic Breathing Can Reduce Overuse of the Sternalis for Respiration)
Use Ergonomic Workstation Adjustments (Prevents Forward Shoulder Posture That Can Exacerbate Upper Chest Tightness)
Conclusion
The sternalis (if present) plays a minor but supportive role in chest function, breathing mechanics, and postural alignment, but trigger points in this muscle can cause significant sternum, rib, and upper chest pain. By incorporating dry needling, manual therapy, stretching, and postural corrections, individuals can reduce pain, improve mobility, and prevent chronic thoracic dysfunction.
➡️ Learn more about Trigger Points
➡️ Explore our Trigger Point Index
Sources:
Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.
Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.