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Chest Abdominal Pain

Chest pain and abdominal pain can be caused by direct trauma to the ribs and soft tissue or can come from internal factors.

Below we outline some of the more common causes of chest and abdominal pain in athletes as well as some of the less common causes and important conditions which should not be missed.

Common causes of abdominal and chest pain

Side stich abdominal pain


Joggers nipple is a friction injury caused by clothing rubbing repeatedly against the nipples. It is common in runners causing pain, soreness, inflammation and sometimes bleeding. It is also known as an ‘exercise-related transient abdominal pain’ or ETAP.

Side stitch can usually be felt to one side of the abdomen (more often the right side), around the area of the lower ribs

Winded refers to what happens when you are subjected to a sudden forceful impact to the abdomen. This causes difficulty breathing and is often described as ‘having the wind knocked out of you’

Rib contusion or bruised ribs occur following a direct impact to the chest. This may be because of a fall or direct impact from a hard object such as a ball, but the most common cause is a car accident.

Rib fracture or broken rib is common in contact sports and usually occurs when you have a hard impact to the chest such as an elbow.

Steronclavicular jointSternoclavicular joint sprain is an injury or separation of the ligament which joins the sternum or breast bone to the clavicle or collar bone at the front of the chest. It may become damaged from a sudden trauma either directly or through the shoulder. Symptoms include pain and tenderness when pressing in on the joint and there may be a visible bony lump.



Abdominal strain is a tear or rupture to part of the abdominal muscles which run from the bottom of the ribs to the pelvis. Symptoms include tenderness and inflammation over an area of the rectus abdominis muscle, usually at the bottom. There may have been a sudden sharp pain at the time of injury which might indicate a muscle strain. Pain will most likely increase when performing abdominal crunch exercises.Abdominal muscles

Stomach problems or gastrointestinal problems include stomach ache, diarrhea, general abdominal stomach ache, gastrointestinal bleeding and gastrointestinal diseases such as lactose intolerance, irritable bowel syndrome and celiac disease.

Referred pain from the upper back is pain originating from a problem in the upper back and is probably one of the most common causes of chest pain, particularly in young athletes. The athlete may also have upper back pain and tenderness over the spine.

Less common causes of chest pain

Tietzes syndrome


Costochondritis or Tietze’s syndrome is where the joints between the sternum and ribs become painful and inflamed. Symptoms include chest pain which comes on during exercise and which may get worse when breathing deeply. A sternocostal joint sprain is a sprain or tear of the ligament which holds this joint in place.

Stress fracture of the ribs can be caused by excessive contraction of the muscles that attach to the ribs. Symptoms include a gradual onset of chest or back pain which may be felt on one side but be difficult to pin point. Pain is usually worse when taking deep breaths or couching and sneezing. Pain also usually gets worse with activity and eases with rest.

Fractured sternum is a break or fracture of the breast bone at the front middle of the chest. It is most often caused by a direct impact or blow to the front of the chest. There will be a sudden pain at the time of fracture which will be very tender to touch. Bruising may appear after a few hours and up to 20% of patients will experience breathing difficulties.

Chostochondral separation occurs when a rib comes away from the sternum or breast bone. It usually occurs following an impact or trauma.

Intercostal muscle strain is a strain of the muscles which sit between the ribs. Symtoms may be similar to a stress fracture of the rib with pain and difficulty when breathing deeply. Treatment is mostly rest, applying ice or cold therapy in the acute stage. Deep massage between the ribs may be beneficial.

Side strain is a strain or tear of the internal oblique muscles which support the back and facilitate twisting movements. It is particularly common in cricket fastbowlers, javelin throwers and rowers. Symptoms include a sudden sharp pain in the side with tenderness over the point of injury. In most cases the muscle tears close to the ribs or can even pull the sheath surrounding the bone away. Treatment involves rest and strengthening exercises with a recovery time of around 4 to 6 weeks.


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