I'm an otherwise healthy individual with no known pre-existing conditions, and I can jog, run, and crawl without issues, but I experience chest burning and arm tightness when bending over or gorilla crawling, what could be causing these symptoms?

Chest Burning and Arm Tightness with Forward Bending Position

Your symptoms of chest burning and arm tightness occurring specifically when bending forward into a gorilla crawl position—but not during jogging, running, or regular crawling—most likely represent either exercise-induced laryngeal dysfunction (vocal cord dysfunction) triggered by the specific posture and breathing pattern, or musculoskeletal chest wall strain from the unusual position, rather than cardiac ischemia.

Why This Is Unlikely to Be Cardiac

Your symptom pattern argues strongly against angina pectoris or cardiac ischemia for several key reasons:

• Preserved exercise capacity: You can jog and run without symptoms, which indicates good functional capacity and suggests you do not have flow-limiting coronary disease 1, 2
• Position-dependent symptoms: True angina is triggered by increased myocardial oxygen demand from exertion, not by specific body positions 1
• Atypical symptom characteristics: While arm discomfort can be an anginal equivalent, the ACC/AHA guidelines specify that angina symptoms should be reproducibly triggered by physical exertion and relieved by rest, not triggered by postural changes 1, 3

The ACC/AHA specifically notes that symptoms NOT characteristic of cardiac ischemia include pain reproduced with movement or palpation of the chest wall or arms, and pain in very specific positions 3.

Most Likely Explanations

Exercise-Induced Laryngeal Dysfunction (Primary Consideration)

The gorilla crawl position forces you into a forward-bent posture with your head down, which can:

• Alter breathing mechanics: This position compresses the chest and abdomen, forcing rapid, shallow breathing patterns that can trigger paradoxical vocal cord motion 1, 4
• Create inspiratory stridor sensation: The "chest burning" and "tightness" you describe are classic presentations of laryngeal dysfunction, which the American Academy of Allergy, Asthma, and Immunology identifies as episodic shortness of breath and chest tightness during specific activities 4
• Explain the arm symptoms: The arm tightness likely represents referred sensation from the intense respiratory effort and accessory muscle recruitment needed to breathe in this awkward position 1, 4

Key diagnostic features supporting this diagnosis:

• Symptoms occur during the activity (not after, as with exercise-induced bronchoconstriction) 4
• Normal tolerance of other vigorous activities like jogging and running 4
• Positional trigger rather than exertional intensity 1

Musculoskeletal Chest Wall Strain (Secondary Consideration)

The gorilla crawl requires:

• Extreme forward flexion of the spine
• Weight-bearing on the arms in an unusual position
• Chest wall compression against the thighs
• This can cause costochondral or intercostal muscle strain that produces burning chest discomfort and arm fatigue 3

What You Should Do

Immediate Assessment

Rule out cardiac causes first (even though unlikely):

• If you have cardiac risk factors (smoking, family history of early coronary disease, diabetes, hypertension, high cholesterol), you should undergo basic cardiac evaluation 2, 3
• An ECG and basic cardiac risk assessment would be reasonable given your age and symptoms, though your preserved exercise capacity is reassuring 1, 2

Diagnostic Testing if Symptoms Persist

If cardiac evaluation is normal or you have no risk factors:

• Pulmonary function testing: Look for a flattened inspiratory flow loop, which is the hallmark of laryngeal dysfunction 4
• Exercise challenge with continuous laryngoscopy: This is the gold standard for diagnosing exercise-induced laryngeal dysfunction and would involve reproducing your symptoms during the gorilla crawl position 4
• The American Thoracic Society notes that normal expiratory findings (normal FEV1 and FVC) with inspiratory abnormalities strongly suggest upper airway dysfunction rather than asthma or cardiac disease 4

Management Strategies

If laryngeal dysfunction is confirmed:

• Speech therapy and breathing retraining are first-line treatments 4
• Learn to control breathing patterns during the provocative position 1
• Traditional asthma medications (β2-agonists) will NOT help and should not be used 4

If musculoskeletal:

• Modify the gorilla crawl technique to reduce chest compression
• Strengthen core and upper body muscles
• Use anti-inflammatory medications as needed

Critical Red Flags Requiring Urgent Evaluation

Seek immediate medical attention if you develop:

• Chest symptoms at rest or with minimal exertion 1, 3
• Symptoms that progressively worsen or occur with less activity 1
• Associated symptoms like lightheadedness, palpitations, or near-syncope 1
• Symptoms lasting more than 20 minutes 1

Common Pitfalls to Avoid

• Don't assume all chest discomfort is cardiac: The ACC/AHA emphasizes that many symptoms can mimic angina, including respiratory and musculoskeletal causes 1, 3
• Don't ignore the position-specificity: True cardiac ischemia doesn't turn on and off with body position changes 1
• Don't accept empiric asthma treatment: If this is laryngeal dysfunction, asthma medications won't work and may delay proper diagnosis 4

Given your ability to perform vigorous activities like jogging and running without symptoms, you most likely have a benign positional or respiratory mechanics issue rather than cardiac disease, but appropriate evaluation is warranted to confirm this and guide specific treatment 2, 4.