We propose activities to improve health services for people with musculoskeletal chest pain. Chest pain is a common reason to see a doctor and is not always a heart attack. Musculoskeletal causes are recognised as the second most common cause of chest pain, yet there is a surprising lack of international research on this condition. For example, no clinical trials to guide management. Observational research and the experience of our team indicates that physiotherapy is likely to be effective. The research activation activity we propose is to build the foundation of prevalence data, relationships and processes required to perform a clinical trial comparing medical and physiotherapy care of musculoskeletal chest pain. This will involve a retrospective case notes review of the prevalence of musculoskeletal chest pain in key clinics, then engaging further with these clinics to scope a pathway for the physiotherapy management of musculoskeletal chest pain.