Costochondritis (Chest Wall Pain)

Overview

Costochondritis is irritation of the cartilage that joins the upper ribs to the breastbone (sternum), at the front of the chest. It causes a sharp, aching or pressure-like pain beside the breastbone, usually on one side, that is tender to press and often worse with deep breaths, coughing, twisting or lifting. When there is also visible swelling over the joint, doctors sometimes call it Tietze syndrome.

Chest pain should always be checked by a doctor first, to rule out heart and lung causes, before anyone assumes it is coming from muscles or joints. If your chest pain has not been assessed medically, please do this before booking with us, and read the red flags below carefully.

Once serious causes have been ruled out, costochondritis is generally considered harmless, but it can be worrying and uncomfortable. Many cases settle over a few weeks to months, although some people have flare-ups for longer. It is different from rib joint dysfunction, which affects the joints at the back of the ribs beside the spine.

Causes and risk factors

• Repeated or forceful coughing, for example during a chest infection
• A sudden increase in upper-body exercise such as push-ups, bench press or rowing
• Heavy lifting or carrying, including lifting young children
• A minor knock to the chest, such as from a seatbelt or contact sport
• Prolonged slouched sitting that stiffens the upper back and ribcage
• A stiff thoracic spine, which increases strain at the front of the ribs
• Often no clear cause is found

How we may be able to help

Before treating, we check that your chest pain has been assessed by a doctor and screen again for warning signs such as breathlessness, fever, sweating or pain that does not change with movement. If anything points to a medical cause, we direct you to 999, 111 or your GP. If you have not yet had a medical check, we can arrange an online private GP consultation. We then examine the front of the chest, the ribs, the thoracic spine and the shoulders to see which movements reproduce your pain.

Physiotherapy focuses on settling the irritated area: advice on adjusting exercise and lifting, gentle mobility and breathing exercises, and gradual strengthening once symptoms allow. Our chiropractor may use gentle thoracic and rib mobilisation, which many people find eases the stiffness that adds load to the front of the chest; we do not use forceful techniques directly over the tender cartilage.

Interferential therapy may help with pain in the early stage, and kinesiology taping can offer short-term comfort. We do not use dry needling over the chest wall.

What you can do at home

• Take a break from the activities that aggravate it, such as push-ups or heavy lifting
• Apply a warm pack to the front of the chest for 15 minutes a few times a day
• Keep breathing normally and take a few slow, deep breaths each hour
• Support coughs and sneezes by hugging a cushion to your chest
• Break up long periods of slouched sitting with gentle upper-back stretches
• Return to upper-body training gradually; your GP or pharmacist may discuss pain relief options