Flu, head and chest colds understandably cause frequent coughing, sneezing, or nose blowing. You might even experience difficulty breathing. As time passes, the infection and inflammation subside, but shortness of breath may persist and leave you feeling baffled.
Your sense of “air hunger” is most likely due to tightness in the chest wall, or intercostal muscles, that encase your lungs (see Figure 1). During the infectious stage, you placed a lot of strain on these respiratory muscles with the chronic coughing and other actions. Overworked muscles can rebel by developing tiny little knots or nodules that limit muscle elasticity. So when you try to breathe, it hurts, especially if you try to take a deep breath. These tiny knots, which may be hard to feel with the bony rib cage are called myofascial trigger points.
Trigger points contain a reservoir of pain-producing chemicals, irritating the nearby nerves. When pressed or overstretched during breathing, these little knotted areas in the muscles can cause pain to shoot or radiate to other areas. Naturally, this type of pain can be alarming when it is in the chest area.
Patients whose chest pain is associated with trouble catching their breath usually end up in their doctor’s office. However, if the cause is tight chest wall muscles, your breathing will appear normal and your chest X-ray will show your lungs are clear of infection. If you complain about chest pain, your doctor may order a cardiac work-up, but the results will probably be normal as well.
The negative test results are actually a good sign. Unfortunately, they do not resolve your symptoms, and you may be left feeling like a hypochondriac. An increasing number of physicians are now aware that trigger points can restrict deep breathing, and will refer you to a physical therapist who can pinpoint and correct these painful muscle restrictions. If your doctor is not familiar with trigger points or how they might be associated with tight chest wall muscles, ask for a referral to a physical therapist skilled in treating myofascial pain. The self-help measures at the end of this article will also benefit you.
Abnormal breathing, or what David Simons, M.D., author of the Trigger Point Manual, refers to as paradoxical breathing, may also create shortness of breath.1 Paradoxical breathing patterns frequently follow abdominal surgery or any situation that causes pain during inhalation, such as tight chest wall muscles with trigger points. It leads to a pattern of shallow breathing (only expanding the upper chest and not the lower abdominal muscles) and overloads the respiratory muscles. Trigger points develop in the rib cage muscles, and breathing becomes further restricted and painful.
If the source of your out-of-breath feeling cannot be identified with medical tests, pay attention to the way you breathe. Your abdomen as well as your chest should expand when inhaling and contract when exhaling. This can help take the load off of your upper chest muscles, but it still won’t resolve your painful trigger points.
What else can you do? Apply moist heat to your chest to help loosen the muscles. In fact, if you can submerge your entire upper body in a hot bath, tub or sauna, it will help ease the painful tension caused by the trigger points. If you do this daily, a study shows your breathing will greatly improve within three weeks.2 However, a faster, more effective approach would be to stretch the rib cage muscles after relaxing them with heat.
Physical therapist Ken Lamm, P.T., of the Respect Pain Program in Tucson, Arizona, recommends a few simple stretches to keep your rib cage muscles loose and relaxed. Perform each of these stretches shown at right three to five times, then place your left wrist on your head to stretch the muscles on your left side.