Costochondritis and Exercise
Why exercise can help costochondritis
Costochondritis, or Tietze's Syndrome, is pain and inflammation in the chest, around the cartilage that joins the ribs to the sternum (breast bone). It can be painful even to breath, let alone exercise!
However, studies have shown that many chronic pain and inflammatory conditions, such as back pain, sciatica and even costochondritis improve with exercise, especially when the exercises and stretches are chosen to relieve tension in and around the painful areas.
- Exercise causes the release of pain-relieving and relaxing endorphins.
- When you exercise, blood flow improves, which helps the injured areas to heal.
- Exercise increases mobility and decreases tension in the muscles and joints, which can block blood flow and healing nutrients from fighting the inflammation.
Of course, you should avoid any strenuous exercise, or those which put too much pressure on the muscles in the inflamed areas.
Disclaimer: I am not a doctor or physiotherapist, and take no responsibility for your use of this information.
However, I have suffered from costochondritis on and off for the past 20 years as a secondary symptom of fibromyalgia.
These are the exercises and stretches, given to me by physiotherapists, that have helped me the most.
Sports and exercises to avoid when you have costo pain
Any sport or exercise that has you reaching across your chest with your arms, especially if there is any tension or weight load, should be avoided.
Also avoid any movements that require your chest and shoulder muscles to be squashed or strongly used.
Sports to avoid: tennis and other racquet sports, golf, baseball/softball, basketball/netball, kendo, karate, kung fu
Exercises to avoid: push up, pull up, row, any type of press for the upper body, lat raise or pulldown, tricep dip, press and extension, fly, back extension, lateral raise, any fitball or resistence band movements that put pressure or strain on your chest muscles.
Other movements to avoid: pulling heavy doors open across your body, heavy lifting and holding (including of children), turning non-powered steering wheels, gardening and cleaning (reaching and pulling)
One thing I found impossible to do when in a costochondritis flare, was walking my friend's (large) dog. When the strong dog pulled against the leash, especially when my arm was across my body, the pain was so intense!
These should be ok, but be careful!
Be careful with the following sports and exercises - continue with them only if they cause no pain, or worsening of symptoms, and avoid any poses that cause pain (such as hand-supported poses in yoga).
Aerobic exercises: swimming, running, cycling, tai chi, yoga (some poses), cross training machines
Muscle exercises: sit ups, bicep curls, most leg exercises
Other light aerobic movements, such as walking, are encouraged!
Returning to strenuous sports and exercises
When the pain levels have dropped enough, start with gentle movements, common in your sport, to loosen the muscles.
Take tennis for example:
- Start with long and fluid ground strokes for a week or two, and make sure your symptoms do not worsen after your practice sessions.
- Then add volleys, which are shorter, stronger movements, to your training routine, for another week of two. As always, watch your symptoms and back off if pain starts to return.
- Finally add the overhead shots to your training. These are typically the most painful for recovering costochondritis sufferers.
Stretch to relieve costochondritis pain
Stretching the pectoral muscles (pectoralis major and minor) - the muscles in your chest below your shoulders - helps to increase blood flow to the inflamed areas, and decrease tension.
You will be able to breathe easier after these stretches.
Note: As with all stretches take them slowly and gently, breathing evenly. Don't strain against the stretch!
Pectoral muscle stretch
- Stand with your side facing the wall or in the doorway.
- Raise your arm to the side, and bend your elbow to a 90 degree angle.
- Rest your forearm against the wall, with your elbow at shoulder height, and lean a little forward to stretch your chest muscles open gently.
- Breathe, relax into the stretch and hold for about 30 seconds, then release.
- Repeat on the other side.
Tip: The video below has a great example of how to stretch with the correct alignment in the shoulder, so that you don't hurt your shoulder socket.
Double-sided strong pec stretch
By placing both arms on either side of a door frame, with elbows bent, hands raised, you will get a stronger stretch through your chest muscles.
You do need to be careful not to rotate your shoulders forward to avoid putting the wrong pressure on your shoulder socket.
Important: do this stretch carefully and gently. It can hurt too much when the costochondritis pain is severe.
By repeating with a slightly different angle, your pectoral muscles will be stretched more thoroughly.
- Rest your elbow and forearm on the wall or door higher or lower than your shoulders.
- Stretch with your arms directly above your shoulders on the top of the door frame.
Stretching when your pain is gone
Don't forget to keep stretching after your costochondritis pain has disappeared!
This is one of the common causes for recurring costo pain, and one that I always fall into when I'm lazy.
A series of stronger stretches in the corner of two walls will relax tight chest muscles.
With active or dynamic stretching, you are moving rhythmically and holding the stretch for a short time. This both strengthens and stretches the muscles around your shoulders, chest and upper arms.
These are good for improving posture and range of motion, and also for preventing the costo from returning.
Tip: I find active stretching very useful for managing fibromyalgia stiffness and pain, both at home and at work.
Yoga poses to relieve costochondritis pain
Many yoga poses will worsen costochondritis symptoms, including any poses where a lot of your body weight is supported on your hands (downward dog, bridge, upward dog).
Restorative yoga poses and sequences are great for costo sufferers for a number of reasons:
- the resting postures encourage the muscles to relax, with little tension
- deep breathing relaxes the ribcage muscles and improves blood flow
- the relaxation helps you release stress, a major component in increasing costo pain.
Important - avoid any poses and movements which cause pain!
Savasana (corpse pose) - lying on your back, deep breathing and relaxation to reduce pain.
Viparita karani (legs up the wall pose) - another restorative lying pose, focusing on breathing.
Bharadvajasana (bharadvaja's twist) - a gentle seated twist with an open, relaxed chest.
Virasana (hero pose) - a kneeling pose with an open chest.
Balasana (child's pose) - a kneeling pose with your arms forward to keep your chest open and stretched.
Tadasana (mountain pose) - the basic standing pose, open chest, focusing on breathing.
Urdhva hastasana (upward salute) - a chest and abdomen opening standing pose.
Virabhadrasana (warrior pose) - a strong standing pose, with open arms, or arms up and chest stretches.
Belt-assisted yoga stretches for opening the chest
Stability ball stretches for costochondritis
Using a fit ball can give you a stronger stretch than the standing wall or doorway stretches, but you can also ease into these swiss ball stretches gently.
You can use an exercise ball to stretch the pectoral muscles instead of the wall.
- Kneel with the ball to one side and lean forwards.
- Bend your arm to 90 degrees and keep your elbow at shoulder height.
- Rest your forearm on the ball.
- Bring your upper body down to stretch the pec muscles.
You can also do this stretch with a straight arm, and vary the angle of your arm to shoulder to stretch the muscle fully.
This lying chest stretch is much stronger, but also relaxes your upper back and shoulders.
Note: If I am in a costo 'flare', this stretch is too strong for me. If you feel pain, please stop and stick with the gentle wall stretches.
- Sit on the ball, and roll down until your upper back is lying on the ball, and your legs form a bridge.
- Lay your arms out to your sides - they will drop below your body and stretch your chest open. Relax them!
- Roll back and forth, to massage and relax your back, and keep breathing evenly.
Tip: This is a fantastic stretch for getting rid of tension from too much computer work.
Foam roller stretches for tight chests
These stretches are quite strong, letting your back curve around the foam roller to stretch the chest muscles.
If you feel pain, stop immediately. Instead do the more gentle pectoral stretches as described above, until your symptoms reduce.
Other techniques to reduce costochondritis pain
Physical therapy (stretching, exercise) is one way to treat costo pain and help prevent it from returning. But there are many other ways to help reduce costochondritis pain.
Stress can greatly increase the amount of pain felt, and is definitely a component of costo. Any and all stress reduction techniques can help manage pain without medication!
Meditation - laying with arms to your side or stretched out, or sitting in a relaxed pose.
Progressive relaxation - relaxing each body part progressively, starting from the toes, and working upwards. You can tense each muscle before relaxing them.
Deep breathing - stretching your chest muscles gently and improving blood flow to the chest area.
mindfulness - living with full awareness, your mind and attention is present in each moment.
Medications and liniments
Menthol based sports rubs like tiger balm, may provide a little relief, especially when used before stretching.
NSAIDs (ibuprofen, etc.) will help to reduce the inflammation, but need to be taken carefully - always take anti-inflammatory tablets on a full stomach!
When the underlying cause is arthritis, cortisone or biologics may be used to limit the inflammation.
Last year, two cases of costochondritis were linked to vitamin D deficiency, plus many other studies have linked a deficiency in vitamin D to chronic pain - it might be an idea to get your vitamin D levels checked.
Heat or ice
When the costo pain is extremely bad, ice can help numb the area. But after the initial spike of pain is retreated, applying moist heat is useful for encouraging healing blood flow.
You may find it useful to use a microwavable heat pack or apply ice after stretching or exercising.
A long heat pack is an essential for me - it helps both with my occasional sciatica, pain from endometriosis, and also with the costochondritis chest pain. These can be placed in the freezer for a non-wet ice pack, or heated in the microwave. The long length is perfect!
Costochondritis pain is worsened by a hunched posture - using a computer, slouched on the sofa.
Therefore exercises to correct posture are useful, both to help a costo flare and to prevent it from returning.
The Alexander Technique or the Feldenkrais Method are two popular and gentle systems for drawing your attention to your posture, and fixing bad habits.
Pilates can also help improve your posture, but may be too strong when you have bad costochondritis pain.
- Stretching exercises for costochondritis pain, G. Rovetta, et.al., G Ital Med Lav Ergon. 2009 Apr-Jun;31(2):169-71
- Chest pain and costochondritis associated with vitamin d deficiency: a report of two cases, RC Oh, et.al., ePub June 2012
What are your favorite stretches and exercises to help costochondritis?
Do you have an exercising with costo horror story?
Let us know in the comments below!