The Middle of My Chest Hurts When I Do Push-Ups or Lift Weights

When it comes to exercise, there's more than a little truth than the old adage, "no pain — no gain." But there's a difference between pain or soreness that's a sign that you're building muscle and pain that results from injury, inflammation or muscle strain.

The middle of the chest has got a lot of muscles and nerves, including the pectoral muscles, the intercostal muscles that run in between the ribs, and several abdominal muscles that attach near the rib cage. So it's easy to tweak them in a way that can cause pain in the center of the chest.

Musculoskeletal causes of chest pain are common. However, there are other causes of pain in the middle chest that exercise might wake up without directly causing. A look at some of the underlying reasons for middle chest pain after push-ups may help you decide how to proceed.

​Read more:​ Exercises to Strengthen Chest Muscles to Alleviate Pain

If your chest is sore after push-ups and it worsens with activity, it could be costcochondritis, or inflammation of the costal cartilage. That's the connective tissue between the ribs that gives them their elasticity, and it's vulnerable to repetitive injury from overuse.

Costal cartilage runs from the breast bone outward, an inflammation of these structures can cause sternum pain with push-ups. The hurt is usually felt toward the front of the upper chest and you may feel it more acutely with deep breathing, direct pressure to the joints such as with push-ups or weight-lifting.

Costochondritis tends to occur more in younger people and is most likely to affect the fourth, fifth and sixth ribs. It usually runs its own course, but the first order of business is to back off from exercising it for awhile. Ice and non-steroidal anti-inflammatories may also help.

When acid reflux becomes chronic and affects daily life, it's called gastroesophageal reflux disease, or (GERD). What's that got to do with pain in the center of your chest? GERD is what happens when the muscular valve that normally closes tightly to protect the esophagus from the stomach's acidic digestive juices stops functioning properly.

The lining of the esophagus isn't equipped to handle stomach acid, and over time the tissue can become damaged and extremely irritated — quite enough to cause some pretty severe chest pain smack in the middle of your sternum. When you exercise, gravity can assist those gastric juices in traveling into your esophagus, triggering pain. If it's GERD, you'll most likely feel a burning sensation along with the chest pain.

GERD is treated with acid-blocking drugs called proton pump inhibitors. They're available both by prescription and over the counter under names like Nexium, Prilosec and Prevacid.

​Read more:​ Causes of Burning Pain in the Chest & Back

If you were having a heart attack, you'd probably be getting medical attention rather than self-diagnosing on the internet, but let's have a look under the hood anyway. A crushing pain in your chest or a sensation of heavy pressure, as well as pain that radiates to your shoulders, arms, neck and jaw is not a good sign.

It could be a heart attack or it could be angina, which is chest pain caused by the heart muscle not getting enough blood. It could also be a sign that you have acute indigestion. No joke — even doctors have a hard time telling without running tests.

If you are an older adult or a smoker or have overweight or high blood pressure and are having chest pain of any kind, please call your doctor. However, pain that persists over weeks or months is usually not a symptom of something life-threatening. Pains that are sharp, brief and intermittent are rarely a sign of something serious. No, this kind of pain is more likely to be caused by — you guessed it — something in the musculoskeletal department.