Sternum pain is most often caused by inflammation where your ribs connect to your breastbone, a condition called costochondritis. About 16% of all chest pain cases that reach the emergency department turn out to be musculoskeletal, meaning the pain comes from bones, cartilage, or muscles rather than the heart or lungs. While that’s reassuring, several other conditions can produce pain in the same area, and some of them need urgent attention.
Costochondritis: The Most Common Cause
Your sternum isn’t one solid piece of bone. Strips of cartilage connect each rib to the breastbone, and when that cartilage becomes inflamed, you feel a sharp or dull ache right at the front of your chest. This inflammation, called costochondritis, typically affects the joints at your second through fifth ribs, though it can happen at any of them.
The hallmark feature is that you can reproduce the pain by pressing on the sore spot. It also tends to flare with movement: deep breaths, coughing, stretching your arms overhead, or twisting your torso. You won’t have shortness of breath, dizziness, or nausea alongside it, and your chest will look normal with no swelling, redness, or warmth.
Costochondritis is more common in women over 40, though it can affect anyone. Most cases resolve within a few days to a few weeks with rest and over-the-counter anti-inflammatory pain relievers. Full recovery is the norm, with no lasting effects. If your symptoms haven’t improved after a few weeks of rest and pain management, that’s worth a follow-up visit.
Tietze Syndrome: When There’s Visible Swelling
If you notice actual swelling at the spot where a rib meets your breastbone, you may have Tietze syndrome rather than standard costochondritis. The two conditions feel similar, but Tietze syndrome produces a noticeable lump or puffiness at the joint. It tends to show up in teenagers and young adults and affects men and women equally. The treatment approach is similar: rest, anti-inflammatories, and time.
Acid Reflux and Heartburn
Pain behind the sternum doesn’t always originate in the chest wall. Gastroesophageal reflux disease (GERD) causes a burning sensation directly behind the breastbone, typically within an hour of eating. That burning often starts in the upper abdomen and radiates upward toward the neck. Lying down, bending over, or exercising after a meal can bring it on.
The key difference from musculoskeletal pain is that reflux-related sternum pain doesn’t change when you press on the area or move your arms. It’s an internal burning rather than a sore spot on the surface. Common triggers include chocolate, caffeine, alcohol, and spicy foods. If your sternum pain tends to follow meals or gets worse when you lie flat, acid reflux is a likely explanation.
Muscle Strain Near the Sternum
The large chest muscles (the pectorals) attach directly to the sternum, so a strain or tear in these muscles can feel like the breastbone itself hurts. This is especially common during exercises like bench presses or push-ups, where the muscle is under maximum stress as it lengthens. People who experience a pectoral strain often feel a pop or ripping sensation during the movement, followed by immediate pain and weakness.
Other signs include bruising on the chest or inner arm, difficulty raising the affected arm, and visible unevenness in the chest or armpit area. Partial strains heal with rest, while complete tears sometimes need surgical repair. If you felt a sudden pop during exercise and your chest looks asymmetrical afterward, that warrants prompt evaluation.
Pain at the Bottom Tip of the Sternum
The xiphoid process is a small, flexible piece of cartilage at the very bottom of your breastbone, right where your ribs meet in the center. Pain localized here is called xiphodynia, and it can result from a direct blow to the chest, rapid deceleration (like a car accident), or even repeated irritation from crunches or sit-ups. The joint at this spot can become inflamed or slightly displaced.
Xiphoid pain is easy to identify because it sits lower than typical costochondritis, right at the base of the sternum near the top of the abdomen. Pressing firmly on that spot reproduces the pain. Underlying conditions like acid reflux and gallbladder disease can also make the xiphoid area more sensitive.
Pleurisy and Breathing-Related Pain
Pleurisy is inflammation of the thin tissue that wraps around your lungs and lines the inside of your chest cavity. When these layers become irritated, they rub against each other with every breath, producing a sharp, stabbing pain that gets noticeably worse when you inhale deeply, cough, or sneeze. While pleurisy pain is often felt more to one side of the chest, it can radiate toward the sternum.
The distinguishing feature is that pleurisy pain is tightly linked to the breathing cycle. It spikes on inhalation and eases when you hold your breath or breathe shallowly. Pleurisy is usually triggered by a viral infection, pneumonia, or other lung conditions and typically requires a medical evaluation to identify the underlying cause.
How to Tell It Apart From Heart Pain
This is the question behind the question for most people searching about sternum pain. The differences are fairly reliable:
- Musculoskeletal sternum pain stays in one specific spot, hurts more when you press on it or move your chest, gets worse with coughing or deep breaths, and tends to be constant rather than coming in waves.
- Cardiac chest pain feels like pressure, squeezing, or clenching. It often spreads from the chest to the neck, jaw, or down one or both arms. It may come with sweating, shortness of breath, or tingling and numbness. It typically worsens with physical exertion and improves with rest.
No self-assessment is foolproof. If your chest pain came on suddenly, feels like pressure or tightness, radiates to your arm or jaw, or is accompanied by sweating, nausea, or difficulty breathing, treat it as a potential cardiac event and get emergency help immediately.
Managing Sternum Pain at Home
For the common musculoskeletal causes, recovery is straightforward. Rest is the foundation: avoid movements that aggravate the pain, including heavy lifting, twisting motions, and intense upper-body exercise. Over-the-counter anti-inflammatory medications help reduce both pain and inflammation at the cartilage joints.
Applying heat to the sore area can loosen tight chest muscles, while ice may help if there’s acute inflammation. Gentle stretching of the chest and shoulders, done carefully and within your pain tolerance, can prevent the surrounding muscles from tightening further. Movements that open the chest, like standing in a doorway and gently pressing your arms against the frame, are commonly used for this purpose.
If your pain is related to acid reflux, eating smaller meals, staying upright for at least an hour after eating, and avoiding known trigger foods can make a significant difference. Sleeping with your upper body slightly elevated also helps keep stomach acid from rising into the esophagus.