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Repetitive Strain Injury/constant Chest pain for 4 months

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pain location
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QUESTION: i started to have chest discomfort at the beginning of 2013 along with anxiety ,but changing my pos would make this discomfort feeling go away , then few months later this discomfort changed into a feeling like there is something stuck under my chest then 2 weeks later it has changed into a constant pain , when i say constant i mean its always there 24 hours a day every minute every second , sometimes it s very severe ,i visited 5 doctors 4 of them were cardiologists had ekc , Echo , chest x-ray , blood work  and checked all my organs with ultrasound every test came back fine the reason i did all these tests was my racing heart rate it made me feel i was having heart attack anyways , all doctors confirmed there is nothing physically wrong with me , one doctor told me its anxiety related pain and he put me on anti-depressions but it didn't work for my pain ,the pain feels like something strained right under my heart , the pain location is on the left side of my chest right under my left chest muscle its horizontal line starting from the beginning of lowest rib attached to the sternum bone and goes along till the nipple of my left chest muscle when i press my ribs there the pain feels different and is right under the ribs , when i drink cold water i feel the cold sensation going through my stomach and and i feel this layer of pain between my stomach and ribs , its very hard to describe it
i noticed few things about it
1- it becomes very severe when i sit still for more than 15 mins specially in bus and i get numbness in my chest when i sit for long times
2-when i walk i almost feel it
3-when i lay down its there but bearable
4-when i sit my chest close to my knees it subsides
5-xanax used to help alot with it 0.5 mg pill used to take care of the pain and completely eliminate it ,but now i got used to xanax so i have to increase the dosage and i don't wanna do that so i stopped taking it
6-hot shower helps alot but for a very short time

im very confused about this pain it increased my anxiety to the maximum ,i cant do anything because of it and always scares me

im a freelancer programmer and i sit for more than 12 hours a day in wrong positions one thing i remember is i always had my torso twisted while my legs were spread on another chair and after a year of this weird position i used to take i started to have this discomfort feeling , i still sit in this way i got used to it , i noticed when i sit in a good poster the pain decreases so i wonder what could it be , right now i started taking ibuprofen cause i think its chest wall related pain, its been 5 days since i started but i feel no improvements
i will upload a picture of the exact location of the pain
red dot is there most painful spot , blue lines is where the pain radiates
i hope someone can give me an advice
thanks in advance

ANSWER: Hi Adel,

To begin, I'm very happy that you told me you have seen all the physicians and had every test they can offer because this eliminates all the serious and life-threatening possibilities.  The next good thing is, with all the medical problems eliminated it means that muscles are very likely the cause of your pain.  The position you sit in while working on your computer can definitely be the cause of everything so I suggest you do everything in your power to change your position.  

Sitting twisted this way is totally contracting some muscles, over-stretching other muscles, and putting a strain on your organs, vertebrae, and spine (including putting pressure onto your spinal cord).  A big hint was when you said that you get relief when you bring your body all the way down to your legs - this tells me that your iliopsoas is totally contracted.  That's a very long story and it will be better if you go to http://www.julstro.com and read all about repetitive strain injuries, including the sections titled "Muscles and Pain" and "What's Happening Exactly."  Then go to http://forum.julstrointernational.com/viewtopic.php?f=9&t=762 and read about each muscle you are straining and why they are causing the list of pains you are describing.  There is an ebook titled "Treat Yourself to Pain-Free Living" that will teach you how to self-treat each of the muscle.

The area you shaded tells me that your diaphragm is also is spasm, but before you can do anything about it you need to first eliminate all the spasms in the muscles listed in the thread mentioned.

If you are already doing yoga, or if you have a good yoga teacher in your area, it is important to stretch AFTER you have released all the spasms.  If you don't have a yoga teacher in your area, then I also suggest you go to http://www.TriggerPointYoga.com because this program not only teaches you (via a DVD) how to do each of the self-treatments mentioned in the thread and the ebook, but then move forward and do yoga to stretch each muscle.  

It's also important to learn to relax so tension isn't compounding the problem.  I'm sure you've already come to that conclusion, but I'm just re-stating it here because it really is important.

Please feel free to come back here again if you need any more assistance.  I really think that if you release the spasms and then stretch that you'll overcome this problem.

Wishing you well,
    Julie Donnelly

---------- FOLLOW-UP ----------

QUESTION: i read this post http://forum.julstrointernational.com/viewtopic.php?f=9&t=762
but i dont know how its related , i dont have pain in any of those areas !
also i would like to point out that i think its chest wall or trapped nerve  related problem (the question is how to know for sure if doctors couldnt tell )
because i feel this pain right under the ribs (it feels like a thin layer under the ribs) and when i stand up straight or straight my posture and fill my lungs with air the pain is much less,sometimes it dose not feel painful but rather feels like a cramp
i read about diaphragm spasm and i didnt find anything that says it can cause constant pain or it can be only on one side ! so i dont know how i can relate to that, could you please explain to me more about why you think its diaphragm spasm ?

also i would like to know why xanax used to eliminate the pain when i first started taking it and eases it to a point after i got used to the 0.5 mg dose ?
the only thing increase the pain is sitting for long periods or sitting in bad position ,but when there is no pain there is always a weird/discomfort feeling there like something is stuck to my ribs or a cramp
i use to take ibuprofen for 2 weeks but im not sure if its working ,maybe i should take it for longer period !? or combine it with other drug?
i would like to try some exercises and stretches
im completely lost here and 5 months of pain is something i cant stand anymore :(

dont know what else to do

Answer
Hi Adel,

I can understand your confusion so I'd like to clarify why your iliopsoas muscle is the likely cause of your pain.  The psoas muscle originates on the front side of your lumbar vertebrae and then merges with the iliacus muscle on the inside of the curve of your pelvis, and it's now called the iliopsoas muscle. The iliopsoas muscle inserts into the very top of your thigh bone. When this muscle contracts you will either sit down or bend over forward, and when you stand up the iliopsoas has to fully lengthen or you can't stand up straight as it is pulling down on your lumbar vertebrae.  

There is a third muscle, the quadratus lumborum (QL for short) that originates on the top of your posterior pelvis and inserts into your 12th rib (last rib). This muscle is the one that will pull you into the twisted position you described in your original message.  

As you are sitting and staying in the same position for long periods of time, the muscles shorten to this new length, so when you then try to stand up straight they are pulling on all of the bones and joints.  You feel the tension as something being stuck to your ribs because the muscles are stuck and pulling on your ribs and on the lumbar vertebrae that is the base of your ribcage.

A diaphragm spasm will definitely cause a constant pain, and depending on which side of the body is tighter, that's the side you will feel it the most.  The odds are the side you are feeling the most pain is the side that is twisted - for example, if you twist to the right then it will be your right side that is tighter. Rarely are you feeling the pain from the spasm at exactly the same place as the spasm is occurring. The analogy I use is, when you pull your hair you feel it at your scalp, but rubbing your head won't help ease the pain, only letting go of your hair will work.  It's the same with muscles, when the muscle is pulling you'll feel it where it inserts.

As for the question about medications, I'm not a doctor so that isn't my area of expertise and I don't want to guess at an answer.

I believe you'll be able to self-treat each of the muscles causing your discomfort. The reason for giving you the link I mentioned in my other message is because these are the muscles that need to be treated and in this case the order of treatment is important.  After you treat each muscle and release the spasms, then you can stretch effectively.

Wishing you well,
    Julie Donnelly

Repetitive Strain Injury

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Julie Donnelly, LMT

Expertise

I can accept questions that relate to chronic or acute pain caused by muscle spasms and contractions. Repetitive Strain Injury is actually Cumulative Trauma to muscles. Releasing the spasm &/or contraction will relieve the strain that is felt at the insertion point on the bone. I am the co-developer of the unique safe-stretching program "Focused Flexibility Training," which combines easy instruction for self-treating spasms throughout your body with proven yoga stretches. I have recently authored two new books: "The 15 Minute Back Pain Solution," and "The Secret to Your Best Golf Game EVER!

Experience

Since 1989 I have been working with endurance athletes and individuals suffering from chronic pain conditions. I have authored seven self-treatment books and three self-treatment DVDs and I have developed the Julstro System for the treatment of carpal tunnel syndrome, Trigger Finger, and other Hand/Wrist pain. I am a national and international presenter at conventions, seminars, and workshops. Principle topics are "Work Shouldn't Hurt," and "The Pain Free Athlete." In 2005 and 2006 I was the massage therapist for ultracyclists competing in the Race Across America (RAAM) 3000+ mile race from San Diego, CA to Atlantic City, NJ. I've taught the Julstro techniques to physical therapists at the Cleveland Clinic, to massage therapists in areas around the USA, and I've taught Julstro self-treatment clinics to dancers at Juilliard School of Performing Arts (NYC),the sprinting team at NC State, and I am working closely with several Olympic-hopeful. We have successfully eliminated the repetitive strain injuries that could keep them out of the Olympic Games, and the best part is they know how to do the self-treatments so they can stay pain-free and flexible.

Publications
Triathlete Magazine, Endurance Magazine, multiple national and international trade journals.

Education/Credentials
Swedish Institute of Allied Health, NY, NY - Initial education in massage therapy Licensed NYS Massage Therapist since 1989. SUNY Empire State College, Saratoga Springs, NY - B.Sc. degree in Interdisciplinary Health Education I was an Associate Professor helping to develop the massage training program for SUNY Rockland Community College

Past/Present Clients
Privacy prevents me from filling in this section without prior consent from my clients. Life Experience: I have been specializing in the treatment of chronic pain and sports injuries since receiving my NY massage license in 1989. A personal bout with carpal tunnel syndrome was the catalyst to my developing a self-treatment that heals the symptoms of carpal tunnel syndrome quickly and without surgery. My work with endurance athletes was the inspiration to teach people how to self-treat so they could stop pains even during a race or heavy training day. Both of these situations ultimately became the products that are sold on my websites: http://www.FlexibleAthlete.com and http://www.julstro.com. I currently treat people in my offices in Sarasota, FL, Cary, NC, or Pearl River, NY

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