How to tell if chest pain is muscular or lung?

September 22, 2025 •

4 min read

With chest pain accounting for millions of emergency room visits annually, it is a common yet frightening symptom with many possible causes. Determining how to tell if chest pain is muscular or lung-related can be challenging without understanding the subtle differences in their presentation.

Quick Summary

Muscular chest pain is often localized, reproducible by touch, and worsened by specific movements, often following physical activity or strain. In contrast, lung-related pain is typically sharp or stabbing, worsens with deep breaths or coughing, and may be accompanied by fever, cough, or shortness of breath.

Key Points

Differentiating Pain Type: Muscular chest pain is typically a localized ache that is reproducible by touch, while lung-related pain is often a sharp, stabbing sensation worsened by deep breathing or coughing.
Reproducibility is Key: If you can pinpoint the exact spot of the pain and pressing on it makes the pain worse, it's more likely to be a muscular issue.
Breathing Affects Lung Pain: Pain that intensifies specifically with deep inhalation or coughing is a strong indicator of a lung-related problem, such as pleurisy.
Associated Symptoms are Clues: Accompanying symptoms like fever, persistent cough, or shortness of breath point toward a lung condition like pneumonia, while a noticeable physical strain or injury suggests a muscle issue.
When in Doubt, Seek Help: Any new, severe, or persistent chest pain, especially with symptoms like sweating or shortness of breath, requires immediate professional medical evaluation to rule out serious cardiac issues.
Costochondritis vs. Lung Infection: Costochondritis, an inflammation of chest cartilage, is often confused with lung issues, but it is typically tender to the touch and lacks the fever and respiratory symptoms of an infection.

Understanding the Source of Chest Pain

Chest pain can arise from a wide range of sources, including the chest wall (muscles, ribs), lungs, heart, or even the digestive system. The key to differentiating between muscular and lung-related pain lies in carefully observing the nature of the discomfort and any accompanying symptoms. While self-diagnosis is not a substitute for professional medical advice, this guide can help you understand the common characteristics of each type of pain.

Characteristics of Muscular Chest Pain

Pain originating from the chest wall's muscles, bones, or cartilage is known as musculoskeletal chest pain. It often has distinct features that can help distinguish it from internal organ-related pain.

Location and Sensation: Muscular pain is typically localized to a specific area and can often be reproduced or worsened by pressing on that spot. It may feel achy, sore, or like a stiffness in the muscle.
Triggers: This pain is frequently linked to specific actions or events, such as strenuous exercise (especially with the upper body), lifting heavy objects, or a recent injury. Even forceful coughing during an illness can strain intercostal muscles, which run between the ribs.
Movement-Related: The pain often intensifies with certain movements of the torso, like twisting, stretching, or raising an arm.
Examples: Common causes of muscular chest pain include a strained pectoral or intercostal muscle, or costochondritis—inflammation of the cartilage connecting the ribs to the breastbone.

Characteristics of Lung-Related Chest Pain

Pain from lung-related issues, such as infections or inflammation, behaves differently than muscular discomfort. While the lungs themselves do not have many pain-sensing nerves, the surrounding pleura (the lining) does, which is why lung conditions can cause significant pain.

Sensation and Triggers: This type of pain is often described as sharp, stabbing, or knifelike, and is characteristically worse when you take a deep breath, cough, or sneeze. This is known as pleuritic pain.
Associated Symptoms: Lung-related chest pain is often accompanied by other respiratory symptoms, including fever, persistent cough (sometimes with phlegm or blood), and shortness of breath.
Tenderness: Unlike muscular pain, lung pain is not typically reproducible by pressing on the chest wall.
Examples: Conditions like pleurisy (inflamed pleura), pneumonia (lung infection), or a pulmonary embolism (blood clot in the lungs) can cause this type of pain.

Muscular vs. Lung Chest Pain: A Comparison


Symptom	Muscular Chest Pain	Lung-Related Chest Pain
Sensation	Dull ache, soreness, or stiffness.	Sharp, stabbing, or knifelike pain.
Reproducibility	Often reproducible by pressing on the area.	Not typically reproducible by touch.
Worsens With...	Specific movements, stretching, or heavy lifting.	Deep breathing, coughing, or sneezing.
Location	Localized to a specific muscle or joint.	Can be diffuse or concentrated, sometimes radiating to the shoulder.
Associated Symptoms	May include swelling or bruising if from an injury.	Often includes fever, persistent cough, and/or shortness of breath.
Onset	Often has an obvious cause like recent physical exertion or trauma.	Can have a gradual onset with infections or come on suddenly with more serious conditions.

Beyond Muscular and Lung Pain: When to Be Concerned

It is crucial to be aware of other potential causes of chest pain, especially cardiac-related issues, which can be life-threatening. The pain from a heart attack can feel like pressure, squeezing, or fullness in the center of the chest and may radiate to the arm, neck, or jaw.

Always seek immediate emergency medical care if you experience any of the following:

Sudden, severe, or worsening chest pain.
Chest pain accompanied by shortness of breath, nausea, sweating, dizziness, or lightheadedness.
A feeling of pressure, tightness, or a crushing sensation in the chest.

The Importance of a Medical Diagnosis

Because many causes of chest pain share symptoms, it is difficult to determine the exact cause without professional medical evaluation. Healthcare providers use a combination of physical exams, medical history, and diagnostic tests (like an electrocardiogram, chest x-ray, or blood tests) to make an accurate diagnosis. For instance, a chest x-ray can reveal signs of pneumonia, while a physical exam can check for specific points of tenderness, indicating a musculoskeletal issue. As the National Institutes of Health explains in its research, certain cases of pleuritic pain may even be accompanied by tenderness, making clinical evaluation even more essential for an accurate diagnosis.

Conclusion

While distinguishing between muscular and lung pain can provide some initial clues, it is never a substitute for a professional medical diagnosis. Paying close attention to the characteristics of your pain—whether it's localized and tender to the touch (muscular) or sharp and worsens with breathing (lung-related)—can be helpful information for your doctor. For any new, severe, or concerning chest pain, seeking immediate medical attention is the safest course of action to rule out a serious underlying condition.

Frequently Asked Questions

Yes, persistent or forceful coughing can strain the intercostal muscles located between your ribs, leading to muscular chest pain that can feel sore and achy.

Pleurisy, or inflammation of the lung lining, can cause sharp chest pain that may sometimes be mistaken for a pulled muscle. However, it is typically accompanied by other respiratory symptoms like fever and cough.

While uncomfortable, chest pain from a simple muscle strain is not typically dangerous. However, because it can be difficult to distinguish from more serious issues, any new or severe chest pain should be evaluated by a medical professional.

Pleuritic pain is a sharp, stabbing chest pain that is specifically triggered or worsened by breathing, coughing, or sneezing. It is caused by inflammation of the pleura, the membranes lining the lungs.

Heart-related chest pain often feels like squeezing, pressure, or tightness and may radiate to the arm or jaw. It is also more likely to be accompanied by shortness of breath, nausea, or sweating. If you have any doubt, seek immediate medical attention.

Yes, anxiety and panic attacks can cause chest tightness, pressure, or other discomfort that can be difficult to distinguish from physical causes. Stress can also increase muscle tension in the chest wall, causing pain.

It is always recommended to see a healthcare provider for any new, persistent, or unexplained chest pain to ensure an accurate diagnosis and rule out any serious underlying conditions.