Costochondritis Treatments: Chest Pain Relief
Important! Treat any chest pain as serious and urgent, and get checked out by a licensed doctor.
It's better to be safe than to ignore chest wall pain in case it's a heart problem!
Note: I am not a doctor. I write from many years of experience, having managed this illness since I was 14 years old.
What is costochondritis?
Costochondritis (costo) is a painful inflammatory condition in which the cartilage and area around the rib cage and sternum is swollen and sore.
It can be a frightening pain—especially when it's on the heart side of the breast bone.
Very little research, other than to report case studies, has been done to examine costochondritis and rib cage pain.[1,2]
Doctors don't understand the causes, which means they can't treat the underlying cause of the condition. The only thing they can treat are the symptoms.
What does costochondritis feel like?
There are two main types of costochondritis pain.
In the background is a dull, throbbing ache around your breast bone and constant low-level rib cage pain. As if there is a tight band around your chest and back.
Certain movements, including deep breaths, coughing and laughing, causes an acute, dreadful sternum pain—like a knife is twisted, or an ice pick is driven into beast bone.
Pressing on and around the sternum, where the inflammation is centered, results in sharp, stabbing pain.
Doctors will run a host of other tests and X-rays to rule out heart disease.
Tietze's syndrome is similar to costochondritis; however the Tietze's syndrome pain also shoots into the shoulder and arm, and the soft tissue of the chest around the breast bone is noticeably swollen.
Tough at school and work
I've had costo since a combined bout of bronchitis and shingles at age 14.
Triggered by the viral infections, it lingered for many years. I had to stop playing music instruments and tennis, and struggled through the later years at school, university and at work.
Later, rheumatologists and neurologists have suggested the rib cage pain may be a symptom of fibromyalgia.
Most recently, it's been discovered that I have had spondyloarthritis since I was a teenager, and costochondritis is a common symptom.
These days, my symptoms are mostly manageable, and I'm regaining my rusty piano skills. If I forget to stretch, or catch a viral illness, it still flares.
How do you get costochondritis?
Doctors don't know the causes of this debilitating sternum pain. Some people develop it after a virus, such as bronchitis, pneumonia, shingles or chicken pox.
Injuries, surgery, or repeated strain on the chest wall, by unsafe movements, poor posture or even strong coughing can cause costochondritis symptoms.
It may also be caused by another inflammatory condition, such as arthritis especially ankylosing spondylitis and psoriatic arthritis.
Costochondritis, or non-specific chest wall pain, can affect children and adults, although women are more than twice as likely to develop it than men.
Athletes such as baseball players, golfers and rowers are more prone to develop costochondritis symptoms.
How often do you get a cold, bronchitis or flu virus?
How do doctors treat costo?
Doctors normally prescribe NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen (Advil) or naproxen (Aleve), or anti-inflammatory gels containing diclofenac (Voltaren).
Normal over-the-counter analgesics such as paracetamol (Tylenol) and sometimes anesthetic patches (Lidoderm) are also often used to relieve chest wall pain.
For persistent cases, stronger anti-inflammatory medications are prescribed. These affect the digestive system, and must be taken on a full stomach. There are a number of serious side effects with prolonged anti-inflammatory use.
Local steroid or anesthetic injections are used when NSAID medications don't work.
Cortisone of biologics like sulfasalazine may be used when the underlying problem is arthritis.
When all treatments fail, the inflamed cartilage may be removed in surgery.
Costochondritis symptoms may go away quickly, or may last for months or years, with chest wall pain appearing and disappearing randomly.
Home remedies and natural treatments for costochondritis
Heat and or ice: Use heat packs or ice packs on the chest and back to reduce the stabbing breast bone pain, and relax the muscles around the chest wall and shoulders.
Heat packs, saunas and warm baths work very well for my sternum pain, anything cold makes my symptoms worse.
Tip: make your own microwaveable heatpack out of 100% cotton material filled with whole wheat or brown rice.
Menthol sports rubs: Use mentholated heat rubs (Tiger Balm, Deep Heat, Icy Hot), or even a chest rub with menthol (Vicks VapoRub), to warm and relax the muscles, improve blood flow to the area, and speed the healing process.
Massage: Most costo sufferers don't benefit from massage - it's too painful. I find light massage good when the sternum pain is not acute, as it helps blood flow and muscle relaxation.
I've found a massage oil with arnica helps prevent the bruised feeling from getting too bad after a massage.
Capsaicin plasters: Using patches infused with the heat-compound from hot chili peppers, capsaicin, can improve blood flow.
Although, the delicate skin in the chest area may react badly to the adhesive and/or capsaicin.
Acupuncture: Some people find relief, as the needles increase blood flow to the surrounding areas. However, clinical studies are inconclusive.
Cough medicine: A cough suppressant (antitussive) is useful when chest wall pain develops from a viral infection or strong, persistent coughing. Please check with your doctor before using any type of cough medicine.
Important: If the underlying cause is spondyloarthritis, it is recommended NOT to see a chiropractor. Manipulating the bones can cause further injury.
Movement and fitness during and after costochondritis
When movement causes pain spikes, you stiffen your posture, lock muscles, and round shoulders to protect the painful area - your chest. Unfortunately, poor rigid posture can make a flare last longer, and prevent healing.
Gentle stretching has been shown in several cases to help with recovery from costochondritis.
Avoid contact sports and any strenuous activities that use the upper body, such as tennis, golf, baseball, rowing or lifting weights at the gym while you are healing.
Other activities I've found that can cause extreme pain include:
- driving vehicles without power steering
- carrying heavy shopping bags
- kneading bread or pasta, chopping vegetables or stirring for a long time
- tai chi with hands held far from my body
Avoid anything that overly strains the chest muscles.
Avoiding sternum pain
- Ask for help when carrying or lifting.
- Keep heavier items that you use daily at hip height.
- Lighten your bag as much as possible.
- Use a backpack, not a side-bag - this sits evenly on your back and chest.
- Avoid heavy, hinged doors or open them with your legs to avoid straining your chest muscles.
Costochondritis and Exercise is a detailed stretching and exercise plan to treat and prevent chest wall pain.
Stretches for costochondritis
During a costochondritis or Tietze syndrome flare, stretches are better than exercises to help reduce pain, increase mobility and encourage healing.
- Gently shrug and rotate your shoulders to maintain mobility. Move very slowly and carefully.
- Gently stretch your arms back against a door frame. Stop the stretch before it hurts.
Gentle chest opening stretches relax the muscles around your sternum and ribcage, and allow better blood flow.
- Go for short walks, but nothing too strenuous.
Breathing more evenly and naturally while walking can help relax the chest muscles and improve blood flow to the inflamed areas.
Exercises to prevent costochondritis
Exercises that improve or maintain good posture, and strengthen your back and core muscles will help prevent costochondritis
- A fit ball is a great tool for developing core muscles, improving posture while sitting, and lying over to open and stretch your chest muscles.
- A Pilates foam roller can be a great tool to help with chest stretches and posture correction.
Always use good posture when carrying or lifting.
The Alexander technique helps prevent chest wall pain, back and sciatic pain caused by poor posture.
Lifestyle modifications to reduce chest pain
Stress management techniques: meditation, progressive relaxation, journaling, mindfulness, a relaxing hobby, cognitive therapy and even personal organization techniques help you manage the pain, decrease anxiety and deal with depression (common when suffering from a chronic pain condition).
During a flare, avoid tight clothing - compressing corsets, tight shirts and even underwire bras can put additional pressure on the sensitive and inflamed joints between the ribs and the sternum.
An ergonomic desk layout encourages good posture. Use a separate keyboard and mouse if you are using a laptop, and raise monitors to eye height.
Keyboard shortcuts reduce mouse work - I find reaching for and using the mouse painful during a costo flare.
Organize your home and workplace to minimize reaching, lifting and carrying:
- Leave oft-used heavy kitchen appliances on the bench during a flare.
- Use a clothes horse instead of an overhead clothes line to dry the washing.
- Keep heavy books and office materials at bench height.
Eat healthily and move regularly to reduce pain
Eat healthily, with an adequate intake of all vitamins and minerals, and get enough exercise. This will lower the risk of catching viral illnesses and speed up the body's healing processes.
A diet with natural anti-inflammatory foods and spices may help reduce and prevent pain.
Low vitamin D levels have been linked to chronic pain may increase the risk of costochondritis - ask your doctor to test your levels.
Lose weight to help reduce chest wall pain
Losing weight can help reduce the severity of sternum pain in costochondritis, especially in women. It's harder to lose weight when in chronic pain, so stay away from people who make you feel bad for being ill.
How to sleep with costochondritis
When my costo flares, the pain from laying on my side can cause serious insomnia.
Keeping my chest open is important, so I hug a long, thick, fluffy pillow. This stops my shoulders from rounding and compressing the area around the sternum.
Develop a good sleep routine to reduce pain caused by tension and insomnia.
- Switch off TVs and computers a few hours before bed.
- Take a bath with Epsom salts.
- Gently stretch your shoulders and chest.
- Give yourself a light shoulder and neck massage, or use a heat pack.
- Wind down with soft music or a book.
These will relax your mind, neck, back, chest and shoulder muscles - less pain and stress as you fall asleep.
How much do you know about your sternum (breast bone) and ribs?
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- PubMed search for costochondritis, Tietze's syndrome, and costal chondritis, performed July 2012.
- "Musculoskeletal causes of chest pain," S. Jensen, Australian Family Physician, September 2001, 30(9):834-9.
- "Stretching exercises for costochondritis pain," G. Rovetta, et.al., Giornale Italiano di Medecina del Lavoro ed Ergonomia, April 2009, 31(2):169-71.
- "Chest Pain and Costochondritis Associated with Vitamin D Deficiency: A Report of Two Cases," R.C. Oh, et.al., Case Reports in Medicine, 2012:375730.
What has helped you?
How did you develop costochondritis?
What treatments have helped you the most?
Let us know in the comments below!