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. 2025 Jul 3;39(1):2–8. doi: 10.1002/ca.70004

The Myofascial Continuum: Anatomical Insights Into Noncardiac Chest Pain

Prabu Raja G 1,✉, Rohini Punja 2, Antony Marie Cruz 3, Anupama Prabhu 4
PMCID: PMC12747589  PMID: 40607636

ABSTRACT

Angina, commonly known as chest pain, is the primary symptom of ischemic heart disease and can also present as pain in the neck, shoulder, jaw, arm, or back. Noncardiac chest pain (NCCP) is a common disorder with various causes, marked by recurrent chest pain that mimics ischemic heart pain. While gastroesophageal reflux disease is recognized as the most common cause, the symptoms can also arise from musculoskeletal disorders of the chest wall and upper limbs. Although spinal dysfunction, Tietze syndrome, costochondritis, and slipping ribs have been associated with chest pain, the myofascial etiology of NCCP remains unclear and underdiagnosed. This review explores the structural myofascial continuum (MC) connecting the segments of the upper quadrant, including the neck, chest, and upper limbs. It also highlights the plausible role of the myofascial continuum in NCCP and its associated plethora of symptoms. Although studies have demonstrated myofascial expansions in which the deep fascia connects the various muscles of the upper quadrant, their role remains unclear. Painful symptoms concomitant with musculoskeletal chest pain arise from impairment of the myofascial continuum. Comprehending the intricate myofascial connections between the neck, chest, and upper limbs is crucial for clinicians seeking to improve the evaluation and treatment of NCCP.

Keywords: chest pain, chest wall pain, musculoskeletal chest pain, myofascial chains, myofascial continuum, myofascial link, myofascial pain syndromes, noncardiac chest pain, precordial catch syndrome, trigger points

1. Background

1.1. Cardiac and Noncardiac Chest Pain

Cardiac chest pain is primarily linked to myocardial ischemia, which is often experienced as referred pain in the chest and left arm and sometimes radiates to the neck, shoulder, jaw, arm, or back (Foreman et al. 2015; Ketterer et al. 2022). Noncardiac chest pain (NCCP) is characterized by recurrent pain and discomfort that resembles angina but shows no signs of coronary heart disease in standard diagnostic tests. Pain signals from the intrathoracic organs converge with those from the joints and muscles on the same spinal cord interneurons. The overlap of pain pathways causes visceral pain to be felt in regions distant from the source, making it difficult to distinguish between musculoskeletal and visceral causes of chest pain (Ayloo et al. 2013).

1.2. The Prevalence of Noncardiac Chest Pain

The prevalence of NCCP could be as high as 70%, highlighting its common occurrence in various healthcare settings (Frieling 2018). A study has indicated that the global prevalence ranges from approximately 14%–33%, with NCCP patients constituting over 50% of all individuals presenting with chest pain in the emergency department (Teragawa et al. 2020). Although NCCP typically has a favorable prognosis, it can lead to significant morbidity and high healthcare costs (Saitta and Hebbard 2022).

1.3. Common Etiology of Noncardiac Chest Pain

Research indicates that gastroesophageal reflux disease (GERD) and esophageal motility disorders are the most common causes of NCCP (Durazzo et al. 2018). However, the role of musculoskeletal factors in NCCP is underexplored, leading to many patients with musculoskeletal‐related chest pain (MRCP) remaining undiagnosed and untreated (Stochkendahl and Christensen 2010). Diagnosis and treatment of MRCP often require interdisciplinary approaches. Chest pain due to musculoskeletal disease is typically a diagnosis of exclusion for other severe visceral disorders (Sturm and Witte 2017).

1.4. Myofasciae and Their Significance

The traditional view of skeletal muscle is that it generates force in its fibers, which is transmitted to the skeleton via tendons. Recent research indicates that muscles are intricately interconnected with surrounding connective tissue structures and should not be regarded as standalone actuators (Finni et al. 2023). The myofascial system (MS) is a continuous matrix that surrounds muscles, linking myofilaments, muscle fibers, and fascicles, and is crucial for controlling human movement (Purslow and Delage 2012). The MS forms a continuum with no discontinuity, thus forming an anatomical and functional link between the different body segments (Blottner et al. 2019). Studies have indicated that the mechanical interactions between synergistic muscles are derived from both intermuscular and extramuscular connective tissues (Maas et al. 2006; Maas and Sandercock 2010) in both physiological and pathological conditions (Maas and Sandercock 2010). In addition, numerous authors have examined myofascial continuity, elucidating the interconnectedness of myofascial structures throughout the body, thereby establishing a link between the trunk and the upper limbs (Myers 2009), (Raja et al. 2023).

1.5. The Anatomical Myofascial Continuity of the Upper Quadrant

The upper quadrant (UQ) encompasses the cervical and thoracic spine, along with the upper limb. UQ pain is usually characterized by discomfort in the neck, shoulder, and arm with no recognizable pathoanatomical abnormalities (Prabu Raja et al. 2022). The deep fascia connects various segments of the upper quadrant, including the head, neck, pectoral girdle, and upper limbs (Prabu Raja et al. 2022). The brachial fascia of the arm connects to the fasciae of the pectoral girdle muscles, which then extends proximally to the deep fascia (DF) of the neck and head. Distally, the brachial fascia connects with the forearm's antebrachial fascia, which continues into the fasciae of the hand, forming an anatomical myofascial continuum of the upper quadrant (Prabu Raja et al. 2022; Stecco et al. 2009) as shown in Figure 1.

FIGURE 1.

FIGURE 1

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The anterior myofascial continuum of the upper quadrant.

In addition, Myers outlined two myofascial pathways in the anterior upper limb, consisting of deep and superficial front arm lines that connect the trunk to the upper limb. The deep frontal arm line (DFAL) starts at the pectoralis minor, extends through the biceps brachii and coracobrachialis, and connects to the radial collateral ligament and the periosteum of the radius, ending at the thenar muscles. The superficial frontal arm line (SFAL) originates from the latissimus dorsi, pectoralis major, and teres major, connecting to the medial intermuscular septum of the arm (MISA), which continues distally from the elbow to the palm along the flexor digitorum superficialis (Myers 2009).

1.6. The Myofascial Link Between the Head and Neck

The epicranial aponeurosis (EA), also known as the galea aponeurotica, is a broad fibrous layer that encompasses the entire convex surface of the skull (Paoletti 2002; Raja et al. 2023). The EA connects the frontalis muscle anteriorly to the occipitalis muscle posteriorly, forming the occipitofrontalis muscle complex (OFMC). Posteriorly, the superficial layer of the deep cervical fascia (SLDCF), called the superficial investing cervical fascia, is continuous with the OFMC, forming a posterior myofascial continuum. Laterally, the investing fascia is continuous with the masseteric and temporal fascia, forming the lateral myofascial continuum, thus linking the neck and head (Fernandes et al. 2020; Paoletti 2002; Prabu Raja et al. 2022), as shown in Figure 2.

FIGURE 2.

FIGURE 2

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The lateral myofascial continuum of the upper quadrant.

1.7. The Myofascial Link Between the Neck and the Pectoral Girdle

The SLDCF envelopes the sternocleidomastoid and the descending part of the trapezius muscle in the cervical region and continues into the thorax as the pectoral fascia anteriorly and the latissimus dorsi fascia posteriorly (Prabu Raja et al. 2022; Stecco et al. 2008). Laterally, the SLDCF transitions into the fascia of the deltoid muscle, which continues with the upper limb (Fernandes et al. 2020). The middle layer (pretracheal fascia) of the deep cervical fascia (DCF) envelopes the trachea, esophagus, and infrahyoid muscles in the cervical region. It extends inferiorly, forming the clavipectoral fascia, enveloping the subclavius and pectoralis minor muscles. Thus, there is also a myofascial continuity between the deep muscles of the neck and the pectoral girdle (Fernandes et al. 2020; Prabu Raja et al. 2022). The pretracheal fascia continues posteriorly with the fascia associated with the muscles, including the levator scapulae, rhomboid major and minor, and serratus posterior (Natale et al. 2015). The deep layer of the DCF, also called the prevertebral fascia or the deep investing cervical fascia, surrounds the vertebrae and the deep muscles associated with the spinal column anteriorly and posteriorly (Stecco 2015). Thus, the different layers of the DCF extend proximally and distally, thereby linking the segments of the UQR, as shown in Figures 1 and 2.

1.8. The Myofascial Link Between the Pectoral Girdle and Arm

Few authors have investigated and reported the myofascial expansions of the pectoral girdle muscles (pectoralis major, latissimus dorsi, and deltoid) with the brachial fascia. The clavicular and sternocostal heads of the pectoralis major connect to the anterior brachial fascia and MISA, respectively (Stecco et al. 2008). The latissimus dorsi, along with the posterior deltoid, extends to the posterior brachial fascia of the arm (Fernandes et al. 2020; Stecco 2015). Thus, there is a myofascial continuity between the fasciae associated with the muscles of the pectoral girdle and those of the arm, as shown in Figure 3.

FIGURE 3.

FIGURE 3

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The myofascial link between the pectoral girdle and arm.

1.9. The Myofascial Link Between the Arm and Forearm

The brachial fascia that envelopes the arm continues with the fasciae of the shoulder musculature proximally and inserts into the olecranon and epicondyles of the elbow (Paoletti 2002). Studies have revealed myofascial expansions that typically broaden at their attachment points and link the tissues of the adjacent body segments. Numerous authors have described the myofascial expansion, referred to as bicipital aponeurosis, that originates from the tendon of the biceps brachii and integrates with the DF of the antebrachium (Benjamin 2009; Raja G et al. 2021; Stecco et al. 2009), as shown in Figure 4. This anatomical arrangement establishes a myofascial continuity between the brachial and antebrachial fasciae, effectively linking the upper arm to the forearm (Stecco 2015). Few studies have shown that forearm muscles, including the palmaris longus and flexors, originate from the antebrachial fascia (Stecco 2015; Stecco et al. 2009), as shown in Figure 5.

FIGURE 4.

FIGURE 4

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The myofascial link between the arm and forearm.

FIGURE 5.

FIGURE 5

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Attachment of forearm muscles to the antebrachial fascia.

1.10. The Myofascial Link Between the Forearm and Hand

The antebrachial fascia of the forearm is an extension of the brachial fascia of the arm. At the wrist, the flexor and extensor retinacula reinforce the antebrachial fascia (Stecco 2015). Distally, the antebrachial fascia extends into the palmar fascia, forming a myofascial link between the segments of the upper limb (Marshall 2001), as shown in Figure 6.

FIGURE 6.

FIGURE 6

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The myofascial link between the forearm and hand.

1.11. The Plausible Role of the Myofascial Continuum in Left Upper Quadrant Pain

The deep fascia (DF) is considered to transmit the contractual forces of the muscles in all directions and participates in improving muscle function (Kamani et al. 2021; Shah et al. 2019). Alterations in the ground substance between the different layers of the DF can result in musculoskeletal dysfunction, leading to myofascial pain (Mathew et al. 2020). A recent systematic review reveals that fasciae have specific and localized nerve distributions, primarily of proprioceptors and more abundant nociceptors, especially under pathological conditions (Suarez‐Rodriguez et al. 2022).

1.12. The Myofascial Origin of Musculoskeletal Chest Pain

Myofascial pain syndrome (MPS) is a prevalent musculoskeletal condition marked by pain stemming from trigger points (TP) in the muscles and their associated fasciae (Lam et al. 2024). Symptoms include pain, muscle spasms, restricted motion, increased sensitivity, and weakness, often in areas distant from the trigger points (Şengül and Tekeli Şengül 2024).

The diagnosis of MPS can be difficult, as symptoms often arise in areas distant from the affected body segments (Bordoni and Zanier 2014; Prabu Raja et al. 2022). MPS affecting the chest, neck, and shoulder muscles represents one of the underlying causes of atypical chest pain, an aspect frequently understated in the assessment of patients experiencing chest pain (Jalil et al. 2010).

Rosenthal reported a patient with MPS radiating pain to the chest and highlighted the relationship between the masticatory apparatus and the postural muscles of the head and neck (Rosenthal 1975). A case report has indicated a link between cervical myofascial pain and an imbalance in masticatory muscle activity, suggesting a functional interrelationship between neck and jaw (Ginszt et al. 2022).

A study reported a patient experiencing pseudo‐angina pectoris triggered by a trigger point (TP) in the pectoralis minor (PM) caused by cross‐country skiing. The case was treated successfully using a myofascial‐directed approach (Lawson et al. 2011). Another study presented a patient who experienced left‐sided chest and arm pain while running. The symptoms resolved following treatment aimed at the pectoralis minor muscle, suggesting that such symptoms are not always related to cardiac pathologies (Fitzgerald 2012).

Jalil et al. reported two cases of myofascial pain syndrome in the subscapularis muscle, both patients experiencing atypical chest pain that resolved after TP injection therapy (Jalil et al. 2010).

Travell et al. noted that trigger points (TP) in the scalene muscles could refer pain to the chest anteriorly, to the upper limb laterally, and to the medial border of the scapula posteriorly (Travell and Simons 1999). Few other authors have reported a case of chest pain caused by TP in the scalene muscles, diagnosed after excluding other cardiac and pulmonary conditions. The patient improved significantly with targeted injections to the scalene muscles (Choi et al. 2007).

The clinical presentation of pectoralis major muscle trigger points is similar to that of cardiac angina and can therefore be considered during the evaluation of chest pain (Şengül and Tekeli Şengül 2024).

A comprehensive understanding of the structural myofascial continuity within the left upper quadrant is essential for elucidating referred pain patterns. This understanding will facilitate the effective evaluation and management of myofascial‐related NCCP.

2. Conclusion

Despite inconsistencies in the representation of fascia across the upper quadrant, there is evidently anatomical myofascial continuity between the muscles of the head, neck, pectoral girdle, and upper extremities. Concurrent pain in the chest and arms is often considered to have a visceral origin. However, a comprehensive understanding of the structural myofascial connections and their potential functional relationships can significantly aid clinicians in the diagnosis and treatment of painful conditions in the upper quarter region. Implementing treatment strategies that focus on the myofascial continuum could improve the effectiveness of interventions in patients presenting with NCCP.

Acknowledgments

The authors extend their heartfelt gratitude to those who generously donated their bodies to science, facilitating crucial anatomical research. Such research has the potential to deepen our understanding and enhance patient care, making us profoundly grateful to these donors and their families.

Raja G, P. , Punja R., Cruz A. M., and Prabhu A.. 2026. “The Myofascial Continuum: Anatomical Insights Into Noncardiac Chest Pain.” Clinical Anatomy 39, no. 1: 2–8. 10.1002/ca.70004.

Funding: The authors received no specific funding for this work.

References

  1. Ayloo, A. , Cvengros T., and Marella S.. 2013. “Evaluation and Treatment of Musculoskeletal Chest Pain.” Primary Care; Clinics in Office Practice 40, no. 4: 863–887. 10.1016/j.pop.2013.08.007. [DOI] [PubMed] [Google Scholar]
  2. Benjamin, M. 2009. “The Fascia of the Limbs and Back – A Review.” Journal of Anatomy 214, no. 1: 1–18. 10.1111/j.1469-7580.2008.01011.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blottner, D. , Huang Y., Trautmann G., and Sun L.. 2019. “The fascia: Continuum linking bone and myofascial bag for global and local body movement control on Earth and in Space. A scoping review.” REACH 14–15: 100030. 10.1016/j.reach.2019.100030. [DOI] [Google Scholar]
  4. Bordoni, B. , and Zanier E.. 2014. “Clinical and Symptomatological Reflections: The Fascial System.” Journal of Multidisciplinary Healthcare 7: 401–411. 10.2147/JMDH.S68308. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Choi, Y. J. , Choi S. U., Shin H. W., Lee H. W., Lim H. J., and Chang S. H.. 2007. “Chest Pain Caused by the Trigger Points in the Scalenus Muscle ‐ A Case Report.” Korean Journal of Anesthesiology 53, no. 5: 680. 10.4097/kjae.2007.53.5.680. [DOI] [Google Scholar]
  6. Durazzo, M. , Gargiulo G., and Pellicano R.. 2018. “Non‐Cardiac Chest Pain: A 2018 Update.” Minerva Cardioangiologica 66, no. 6: 770–783. 10.23736/S0026-4725.18.04681-9. [DOI] [PubMed] [Google Scholar]
  7. Fernandes, S. , Cruz A. M., and Prabhu A.. 2020. “The Plausible Role of Deep Cervical Fascia and Its Continuum in Chronic Craniofacial and Cervicobrachial Pain: A Case Report.” Heliyon 6, no. 7: e04560. 10.1016/j.heliyon.2020.e04560. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Finni, T. , de Brito Fontana H., and Maas H.. 2023. “Force Transmission and Interactions Between Synergistic Muscles.” Journal of Biomechanics 152: 111575. 10.1016/j.jbiomech.2023.111575. [DOI] [PubMed] [Google Scholar]
  9. Fitzgerald, G. 2012. “Thoracic Outlet Syndrome of Pectoralis Minor Etiology Mimicking Cardiac Symptoms on Activity: A Case Report.” Journal of the Canadian Chiropractic Association 56, no. 4: 311–315. [PMC free article] [PubMed] [Google Scholar]
  10. Foreman, R. D. , Garrett K. M., and Blair R. W.. 2015. “Mechanisms of Cardiac Pain.” Comprehensive Physiology 5, no. 2: 929–960. 10.1002/cphy.c140032. [DOI] [PubMed] [Google Scholar]
  11. Frieling, T. 2018. “Non‐Cardiac Chest Pain.” Visceral Medicine 34, no. 2: 92–96. 10.1159/000486440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ginszt, M. , Szkutnik J., Zieliński G., et al. 2022. “Cervical Myofascial Pain Is Associated With an Imbalance of Masticatory Muscle Activity.” International Journal of Environmental Research and Public Health 19, no. 3: 1577. 10.3390/ijerph19031577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Jalil, N. A. , Prateepavanich P., and Chaudakshetrin P.. 2010. “Atypical Chest Pain From Myofascial Pain Syndrome of Subscapularis Muscle.” Journal of Musculoskeletal Pain 18, no. 2: 173–179. 10.3109/10582452.2010.485021. [DOI] [Google Scholar]
  14. Kamani, N. C. , Poojari S., and Prabu R. G.. 2021. “The Influence of Fascial Manipulation on Function, Ankle Dorsiflexion Range of Motion and Postural Sway in Individuals With Chronic Ankle Instability.” Journal of Bodywork and Movement Therapies 27: 216–221. 10.1016/J.JBMT.2021.03.024. [DOI] [PubMed] [Google Scholar]
  15. Ketterer, M. W. , Lumley M. A., Schairer J., et al. 2022. “Chest Pain: Cardiac and Non‐Cardiac.” In Handbook of Cardiovascular Behavioral Medicine, edited by Waldstein S. R., Kop W. J., Suarez E. C., Lovallo W. R., and Katzel L. I., 1093–1106. Springer. 10.1007/978-0-387-85960-6_45. [DOI] [Google Scholar]
  16. Lam, C. , Francio V. T., Gustafson K., Carroll M., York A., and Chadwick A. L.. 2024. “Myofascial Pain – A Major Player in Musculoskeletal Pain.” Best Practice & Research. Clinical Rheumatology 38, no. 1: 101944. 10.1016/j.berh.2024.101944. [DOI] [PubMed] [Google Scholar]
  17. Lawson, G. E. , Hung L. Y., Ko G. D., and Laframboise M. A.. 2011. “A Case of Pseudo–Angina Pectoris From a Pectoralis Minor Trigger Point Caused by Cross‐Country Skiing.” Journal of Chiropractic Medicine 10, no. 3: 173–178. 10.1016/j.jcm.2011.01.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Maas, H. , and Sandercock T. G.. 2010. “Force Transmission Between Synergistic Skeletal Muscles Through Connective Tissue Linkages.” BioMed Research International 2010, no. 1: 575672. 10.1155/2010/575672. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Maas, H. , Meijer H. J. M., and Huijing P. a. J. B. M.. 2006. “Intermuscular Interaction Between Synergists in Rat Orignates From Both Intermuscular and Extramuscular Myofascial Force Transmission.” Cells, Tissues, Organs 181: 38–50. [DOI] [PubMed] [Google Scholar]
  20. Marshall, R. 2001. Living Anatomy: Structure as the Mirror of Function. Melbourne University Press. [Google Scholar]
  21. Mathew, N. P. , Prabu Raja G., and Davis F., 2020. “Effect of Fascial Manipulation on Glenohumeral Internal Rotation Deficit in Overhead Athletes ‐ A Randomized Controlled Trial.” Muscle Ligaments and Tendons Journal 10, no. 1: 17–23. 10.32098/mltj.01.2020.03. [DOI] [Google Scholar]
  22. Myers, T. W. 2009. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Churchill Livingstone, Elsevier. [Google Scholar]
  23. Natale, G. , Condino S., Stecco A., Soldani P., Belmonte M. M., and Gesi M.. 2015. “Is the Cervical Fascia an Anatomical Proteus?” Surgical and Radiologic Anatomy 37, no. 9: 1119–1127. 10.1007/s00276-015-1480-1. [DOI] [PubMed] [Google Scholar]
  24. Paoletti, S. 2002. The Fasciae ‐ Anatomy, Dysfunction and Treatment. 2nd ed. Eastland press. [Google Scholar]
  25. Prabu Raja, G. , Shyamasunder Bhat N., Marie Cruz A., Prabhu A., Fernandes S., and Naaz N.. 2022. “The Anatomical Myofascial Continuum Between the Neck and Eyes.” Clinical Anatomy 35, no. 3: 340–346. 10.1002/ca.23835. [DOI] [PubMed] [Google Scholar]
  26. Purslow, P. , and Delage J.‐P.. 2012. Fascia: The Tensional Network of Human Body, edited by Robert H. P. S., Thomas F., and Leon C., 1st ed. Churchill Livingstone, Elsevier. [Google Scholar]
  27. Raja G, P. , Bhat N S., Fernández‐de‐Las‐Peñas C., et al. 2021. “Effectiveness of Deep Cervical Fascial Manipulation and Yoga Postures on Pain, Function, and Oculomotor Control in Patients With Mechanical Neck Pain: Study Protocol of a Pragmatic, Parallel‐Group, Randomized, Controlled Trial.” Trials 22, no. 1: 574. 10.1186/s13063-021-05533-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Raja, G. P. , Bhat S., Gangavelli R., et al. 2023. “Effectiveness of Deep Cervical Fascial Manipulation and Sequential Yoga Poses on Pain and Function in Individuals With Mechanical Neck Pain: A Randomised Controlled Trial.” Lifestyles 13, no. 11: 2173. 10.3390/life13112173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Rosenthal, R. L. 1975. “Chronic Myofascial Pain‐Dysfunction Syndrome With Chest Pain.” Journal of Prosthetic Dentistry 34, no. 4: 444–447. 10.1016/0022-3913(75)90164-x. [DOI] [PubMed] [Google Scholar]
  30. Saitta, D. , and Hebbard G.. 2022. “Beyond the Heart: Noncardiac Chest Pain.” Australian Journal of General Practice 51, no. 11: 849–854. 10.31128/AJGP-06-22-6467. [DOI] [PubMed] [Google Scholar]
  31. Şengül, M. , and Tekeli Şengül S.. 2024. “Efficacy of Trigger Point Injection Therapy in Noncardiac Chest Pain: A Randomized Controlled Trial.” Turkish Journal of Physical Medicine and Rehabilitation 70, no. 1: 98–104. 10.5606/tftrd.2024.12716. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Shah, S. G. , Choezom T., and Prabu Raja G.. 2019. “Comparison of Respiratory Parameters in Participants With and Without Chronic Low Back Pain.” Journal of Bodywork and Movement Therapies 23, no. 4: 894–900. 10.1016/J.JBMT.2019.03.008. [DOI] [PubMed] [Google Scholar]
  33. Stecco, A. , Macchi V., Stecco C., et al. 2009. “Anatomical Study of Myofascial Continuity in the Anterior Region of the Upper Limb.” Journal of Bodywork and Movement Therapies 13, no. 1: 53–62. 10.1016/j.jbmt.2007.04.009. [DOI] [PubMed] [Google Scholar]
  34. Stecco, C. 2015. Functional Atlas of the Human Fascial System, edited by Hammer W.. Churchill Livingstone, Elsevier. [Google Scholar]
  35. Stecco, C. , Porzionato A., Macchi V., et al. 2008. “The Expansions of the Pectoral Girdle Muscles Onto the Brachial Fascia: Morphological Aspects and Spatial Disposition.” Cells, Tissues, Organs 188, no. 3: 320–329. 10.1159/000121433. [DOI] [PubMed] [Google Scholar]
  36. Stochkendahl, M. J. , and Christensen H. W.. 2010. “Chest Pain in Focal Musculoskeletal Disorders.” Medical Clinics of North America 94, no. 2: 259–273. 10.1016/j.mcna.2010.01.007. [DOI] [PubMed] [Google Scholar]
  37. Sturm, C. , and Witte T.. 2017. “Musculoskeletal‐Related Chest Pain.” Der Internist 58, no. 1: 39–46. 10.1007/s00108-016-0166-z. [DOI] [PubMed] [Google Scholar]
  38. Suarez‐Rodriguez, V. , Fede C., Pirri C., et al. 2022. “Fascial Innervation: A Systematic Review of the Literature.” International Journal of Molecular Sciences 23, no. 10: 5674. 10.3390/ijms23105674. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Teragawa, H. , Oshita C., and Orita Y.. 2020. “Is Noncardiac Chest Pain Truly Noncardiac?” Clinical Medicine Insights: Cardiology 14: 1179546820918903. 10.1177/1179546820918903. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Travell, J. G. , and Simons L. S.. 1999. Myofascial Pain and Dysfunction: The Trigger Point Manual VOLUME 1. Upper Half of Body. 2nd ed. Williams and Wilkins. [Google Scholar]

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