When chest pain is “just” costochondritis

~ Carolyn Thomas

Costochondritis-7by Carolyn Thomas  ♥  @HeartSisters

Many female heart patients become familiar with the word “costochondritis” only while being misdiagnosed with the condition during an actual cardiac event, as in:

  • “My MD said it was just costochondritis and a  pinched nerve, because my ribs were sore.” (LH, age 51, New York: heart attack)
  • “At first, we looked at musculoskeletal causes. It had to be costochondritis; my chest wall seemed tender to touch, so I even had steroid injections in my chest wall.” (ZM, age 59, Arizona: heart attack, 12 stents, triple bypass surgery)
  • “Pains in chest radiating down arm and up to my chin. My GP reluctantly sent me to a cardiologist who was dismissive, said that my age was a big factor and that it was 99% likely to be just costochondritis as I also have fibromyalgia” (BT, age 42, U.K: heart attack, 90% blocked LAD coronary artery, two stents)  

Costochondritis is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone, or sternum. The condition causes localized chest pain that you can often reproduce by pushing on the cartilage in the front of your ribcage.  

* Read on to learn about how New Zealand physiotherapists are treating costo with manual (hands-on) physiotherapy to unlock the rib hinges around the back, as explained by expert Steve August.

Costochondritis can be extremely painful yet, mercifully, it’s often relatively benign. Much of the medical literature suggests that it will usually go away on its own within a few days, but some patients report symptoms that can linger for weeks or even months. It can also be a recurring condition that appears to have little or no warning of onset. Pneumonia can be misdiagnosed as costochondritis. Many patients living with fibromyalgia or chronic fatigue syndrome complain of chest wall pain and restriction of movement, often identified by their health care providers as costochondritis.

Chest pain in adults is considered by most doctors to be a potentially serious sign of a heart problem until proven otherwise. Reporting chest pain usually leads to a battery of medical tests to rule out heart disease. If those tests are normal and your physical exam is consistent with costochondritis, your doctor may diagnose costochondritis as the culprit. It may, however, be difficult to distinguish between the two without specific testing. 

Never assume chest pain is “just costochondritis”.

Here’s an example: Emergency physician Dr. Seth Trueger described this study as one that “might be the coolest chest pain study ever done.”

The study found that when rheumatologists using the American College of Rheumatology criteria for diagnosing costochondritis evaluated patients in the E.R. complaining of chest pain:

“Six per cent of the patients the doctors diagnosed with costochondritis actually had an acute myocardiardial infarction (heart attack).”

What rheumatologists were doing in the E.R. was not explained . . .

Most (real) cases of costochondritis seem to have no clear cause. Occasionally, however, the diagnosis might be correlated with:

  • Injury. A blow to the chest
  • Physical strain. Heavy lifting and/or strenuous exercise
  • Arthritis. In some people, costochondritis has been linked to specific problems, such as osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.
  • Joint infection. The rib joint itself can become infected by viruses, bacteria or fungi. Examples include tuberculosis, syphilis and aspergillosis.
  • Tumours. Non-cancerous and cancerous tumours also can cause costochondritis. Cancer may travel to the joint from another part of the body, such as the breast, thyroid or lung.

Costochondritis may also occur as the result of an infection or as a complication of surgery on your sternum.  Sometimes patients with a severe cough can develop this as a result of continued coughing and rapid expansion/contraction of the rib cage.

THE NEW ZEALAND DIFFERENCE

In New Zealand, physiotherapists like Steve August (see his detailed comments below) not only suffered himself for seven years with costochondritis after a serious climbing fall, but has been successfully treating the backs of his costochondritis patients manually for the past 30 years with non-drug, non-invasive physiotherapy, as he discusses in his video. Yes, you read that right: it is the back that is treated.

He sees costochondritis as often a straightforward musculoskeletal mechanical problem in which the costovertebral rib joints at the back are somehow jammed. This requires the anterior rib joints around the front to work excessively to compensate, leading to irritation, then to the inflammation that doctors call costochondritis.

Watch Steve’s second video in which he describes:

  • exercises and treatments recommended by New Zealand physiotherapists to unlock the rib hinges in the back to ease the symptoms of costochondritis
  • massage therapy for affected shoulder muscles
  • how to stretch tight, scarred muscles in between the ribs
  • gentle stretching exercises you can do at home to help open up the ribcage
  • use of anti-inflammatory gel to apply on the rib hinges at the front of your chest

      If you are a physiotherapist or massage therapist, please watch this video and read this 2017 research paper published in the International Journal of Sports PhysioTherapy (from Zaruba and Wilson).

This condition affects females more than males (70% versus 30%).

Kelly Young is a patient advocate, blogger, and president of the Rheumatoid Patient Foundation. She described costochondritis like this in her blog RA Warrior:

    “As early as 1964, the journal ‘Radiology’ published a study explaining that the effects of Rheumatoid Arthritis on the rib joints “have not been adequately described in the literature.”[1] Mayo Clinic’s description of costochondritis makes it clear the word describes a symptom, pain or inflammation of the rib joints that can be caused by various illnesses.[2,3]

“The term is also confusing because there can be varying diagnoses with similar symptoms.”

But Kelly says that she has also read some skeptical articles about costochondritis symptoms, considered by some physicians as the garbage can diagnosis of hypochondriacs.

Costochondritis is not associated with swelling, as opposed to Tietze’s syndrome, where swelling is characteristic.  Tietze’s syndrome is an inflammation of the costochondral cartilages of the upper front of the chest that involves swelling around the joint, the ribs or cartilage near the breastbone. Redness, tenderness, and warmth can also be present, but a localized swelling is the distinguishing finding, although even swelling can be variable from patient to patient. The pain can cause difficulty with sleeping, and even rolling over in bed is sometimes painful.

READER COMMENT:  “Thanks for this article. I did have ‘just’ costochondritis, but wound up in the ER four times feeling like I was having a heart attack. Turned out my diabetes medication was inhibiting my body’s production of DAO enzyme, thus giving me histamine intolerance. My body was inflamed head to toe with multiple symptoms. I switched to insulin and went on a low histamine diet and am getting better. Also, most of my menopause symptoms went away too. Take good care!” Melinda (August 15, 2021)

Besides physiotherapy as New Zealand physiotherapists use to treat this condition, possible treatments include heat or ice, and medications like NSAIDs to relieve pain and reduce inflammation. *  CAUTION:   Studies have found that, among those who had already had one heart attack, people who took the painkillers called NSAIDs (non-steroidal anti-inflammatory drugs) such as Vioxx, Bextra, Aleve, Advil, Motrin, etc. were at >40% higher risk of having a second heart attack compared with those who did not take them. If you’re in this group, do NOT take NSAIDS before asking your physician. 

And until there is improvement in your symptoms, avoid unnecessary exercise or contact sports activities. 

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*  CAUTION:  Studies have found that, among those who had already had one heart attack, people who took the painkillers called NSAIDs (non-steroidal anti-inflammatory drugs) such as Vioxx, Bextra, Aleve, Advil, Motrin, etc. were at >40% higher risk of having a second heart attack compared with those who did not take them. If you’re in this group, do NOT take NSAIDS before talking with your physician.

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NOTE FROM CAROLYN:   I wrote much more about diagnosis and misdiagnosis in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the JHUP code HTWN to save 30% off the list price).

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1  Alpert M, Feldman F. The rib lesions of rheumatoid arthritis. Radiology. 1964 May 82: 872-875

2  Mayo Clinic. Costochondritis. 2012 May 6.

3  HealthHype.com. Severe costochondritis – causes, symptoms, treatment. 2010 May 9.

4  Flowers LK. Medscape. Costochondritis. 2012 Apr 13.

Q:  Have you ever experienced costochondritis?

Published by Carolyn Thomas

215 thoughts on “When chest pain is “just” costochondritis”

  1. I’ve been diagnosed with costochondritis and I also have fibromyalgia. But I found a small lump, on the (rt) chest side, back in August 2016. It was small then. Now it’s about the size of maybe close to a quarter. I think it’s something else. I’m a breast cancer survivor (2013-2015). Triple Negative.

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  2. I went for my annual breast sonogram and when the tech pressed down on my right breast and center chest I saw stars. This never happened to me before so I made an appointment with my GI doctor for an endoscope. He took a biopsy and found I had h pylori. I took the antibiotics called pylera. He didn’t see any gastritus or ulcers and never said anything else about the pain. Could h pylori cause costochondritis? It also feels like my ribs on the right chest are swollen, inflamed and very sore. At the end of the bottom rib near the center of my chest it hurts in one spot when I press on it. It seems that when I exercise I feel a little better while doing the exercise. Could this be costo?
    I would really appreciate any comments.

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      1. The one thing I don’t understand is I get pain in my right chest under breast bone and center chest. With h pylori the pain is in the stomach. I was just wondering if anyone had h pylori and developed costochondritis after that.

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        1. Connie I just stumbled upon this post and I have chronic costochondritus as a result of h. Pylori and there are many others out there. No doctor will believe you though. Please email me and I will discuss further with you if you like at davidvelozzi (at) gmail (dot)com

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    2. Hi Mel and Carolyn. The answer’s yes.

      It’s really a diagnosis of exclusion. In practical terms, anyone with chest pain should see a doctor first – no question. It might be heart, or there are some other dire possibilities. A doctor, with all the medical resources available for testing, is certainly the first port of call. However (and I’ve checked this out with several doctor friends of mine here in New Zealand) if everything comes back normal (so it’s not the heart or anything else dire), the tendency is for the doctor to then relax, stand down from all the emergency stuff they were poised to do, and reassure the patient that it’s not life-threatening, it’s just costochondritis, take these anti-inflammatories if needed, and it’ll settle down.

      This is quite understandable. The doctor’s focus, training and resources are all aimed at the major possibilities that could be causing the chest pain, and fair enough too.

      Unfortunately, costochondritis often doesn’t settle down, and can be a major source of pain, fear (it’s chest pain! Maybe the doc was wrong and it is heart!), and disability (can’t work, exercise, or even breathe in fully).

      Also, irritatingly, the medical understanding of costochondritis is that it’s pain and inflammation where the ribs hinge onto the breastbone (correct), and so treatment should be aimed at suppressing that (sounds reasonable but misses the point entirely which is why it usually doesn’t work).

      The reason the rib hinges on the breastbone are painful and irritated is because the joints at the other ends of the ribs where they hinge onto the spine are jammed. So the more delicate breastbone hinges have to do all the movement required for breathing all by themselves. So they get strained, irritated, then inflamed – and there’s your costochondritis.

      As a physio (in New Zealand, and we’re good at this stuff here), this is so easy to diagnose. I can feel whether the specific ribs are moving or not; I can do other movement tests to check for restriction; I can jiggle or manipulate the hinges and retest immediately afterwards to see whether the patient can now breathe in fully, or can rotate further – this is all basic manual physio as practised in NZ. It’s also not difficult.

      So I can tell whether stuck ribs are causing chest pain, nearly every time. But I can’t tell whether the heart is also causing chest pain, so I do want the patient to also see a doctor.

      Most doctors aren’t going to pick the stuck ribs. It’s not their area or focus, but mostly they’re just not thinking of costochondritis as a problem in those terms. It’s a tiny fraction of what they have to learn through medical school, whereas in physio we get get to concentrate almost entirely on musculoskeletal systems, problems and treatments. Of course we’ve got a better handle on this stuff. I lecture to the medical conferences in New Zealand on it. Of course costochondritis isn’t a mystery and of course it’s fixable.

      Lastly, (sorry about long reply!) physio practitioners vary, just like plumbers and hairdressers. NZ and Aussie physios tend to be good on this practical hands-on approach; it’s our particular area of expertise. I’m not saying all physios everywhere will have the same level of understanding, and very clearly most doctors don’t. You could ask any doctor or physio to have a look at my YouTube videos on costochondritis here and here – this is a perfectly reasonable request.

      Hope that helps!
      Cheers,
      Steve August

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      1. I HAVE BEEN EXPERIENCING THE PAIN AND SYMPTOMS FOR ONE YEAR, SEVERELY, THOUGHT I WAS HAVING A HEART ATTACK. HEART TESTS, OK….GASTROLOGIST RECOMMENDED STEROID SHOTS IN A SET OF 3, FOR THE LEFT AND RIGHT SIDE OF THE RIBS…SHOTS HELPED WITH THE PAIN FOR 3 DAYS MAXIMUM…I AM UNDER PAIN MANAGEMENT AND LIVE WITH A HEATING PAD!!!!! I WAS ALSO REFERRED TO A LUNG DOCTOR, HE PERFORMED OXYGEN TEST, PRESCRIBED 4 INHALERS, AND ADVISED ME THAT MAYBE I NEEDED A BREAST REDUCTION. CHEST XRAYS WERE OK…..I AM ALMOST OUT OF MY MIND WITH PAIN. MY PAIN MANAGEMENT RECOMMENDED ME TO SEE A DOCTOR THAT COULD EVALUATE ME AND ADVISED ME THAT IT COULD BE ENTRAPMENT OF THE LUNG THORACIC NERVES VS PAIN INDUCED BY WEIGHT OF BREASTS… I BELIEVE THAT THIS EVALUATION MAY INCLUDE BURNING OF THE NERVES ON THE RIGHT AND LEFT SIDE OF THE BREASTS!!! THIS PROCEDURE IS DONE WHILE YOU ARE AWAKE……WHEW!!! PLEASE ADVISE ME OF HOW I CAN RECEIVE HELP!!!!! TERRI WOODS

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        1. Sorry you are having these horrible symptoms (plus duelling opinions from the specialists you’ve seen so far!) Before you have surgery or an invasive nerve procedure, consult a physiotherapist (watch Steve’s video for more background). Best of luck to you, Teri. (PS Please don’t use ALL CAPS when you write; it’s hard to read).

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        2. I have been seeing doctor after doctor with many different diagnoses. I have unrelenting burning pain in ribs, back, stabbing at my heart. Costochondritis, shingles, possible pleurisy. So scared and frustrated. Been in bed for 2 months. On pain meds and steroids but still unsure what this is.
          Terri, Are you Carmen’s cousin?

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      2. My costochondritis has been chronic for over 15 years. I’m happy to look at your video. I appreciate your in-depth notes here. Tonight more of a question of, is this focal right-of-sternum pain today, cardiac? Cardiologist will be seen, but meanwhile… your video.

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      3. I’ve had symptoms of costochondritis, on and off, for over a decade, but even in my late twenties, certain exercises would cause pain like an ice pick went thru my right chest to the back.

        I now have several diagnoses (53 years old), including fibromyalgia, chronic fatigue syndrome, arthralgia, degenerative disc disease, post Lyme and twice had RMSF that caused CFS and chronic joint pain, and now a rather generic diagnosis, “pain syndrome.”

        Most recently, I was diagnosed with Nutcracker syndrome that caused pelvic congestion syndrome. Wow right?! Sigh… I also have COPD. Lichen Sclerosus. Skin lupus. Arthritis. Bladder spasms. Blood in urine (Nutcracker), and of course, anxiety and depression.

        Alas. This costochondritis pain is getting the best of me!

        I saw a cardiologist, but failed to follow up with an echo test. Most doctors see my diagnosis of fibromyalgia and they are blind to all else, which leaves me with skepticism about them.

        I am supposed to have a Venogram and arteriogram to check level of compression on my renal vein from the Nutcracker. I am terrified of things in my veins and have been neglecting these tests, but the pain we are calling costochondritis is scaring me and disabling.

        I can’t do anything with my arms without causing the thoracic pain, front, back and sides. Mornings are scary. I can’t breathe in without knife like pleurectic pain. Thank goodness I have pain medication. I recently started PT but my level of confidence in the therapist is low.

        Pardon my long comment. I am concerned regarding possible costochronditis because although I have the symptoms, it’s my thoracic spine that feels like a mule kicked me. I hear you speak to the chest and ribs but right in the center of my spine is a spot; a rather small area, that starts burning and then comes the chest and rib pain. Now my neck, jaw, throat and ears are involved. Still, the thoracic spine seems to be the prevailing symptom. It burns and that spreads.

        A few years ago I took high dose of an antiviral drug. I was convinced I had shingles in my spine. I did get relief. I used to have outbreaks on my ribcage leaving me with post-herpetic pain.

        Too much…

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  4. I got diagnosed with costo 2 months ago, I had an xray done – but it was clear. I have been to four doctors and they haven’t sent me to get further tests such as EKG, blood work to rule out cardiac problems etc. They think I’m fabricating my pain and basically think I’m a hypochondriac – one doc said that the pain is all in my head. My symptoms are – hurts to touch lung/sharp pain, rib pain, shoulder pain, arm pain (tingling, heaviness and hurts to touch/put pressure on it), pain under the breast bone and both sides of sternum and spasms on the left side of chest and my chest feels achy when I breathe in and out. I’m constantly checking my pulse because I think I’m having a heart attack. I had chest pain back in May, it subsided and returned in June. It is now August and I feel weak, constantly in pain and a state of anxiety.

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    1. Hi Ellie – I’m not a physician so cannot comment on your specific experience, but I can say in general that a patient already diagnosed with condo is hardly a hypochondriac. The doc that initially diagnosed you must have offered a treatment plan. Two of the symptoms you mention are rarely if ever heart-related (hurts to touch and hurts breathing in and out) and do point instead to a muscular/joint issue. Try starting a symptom journal, tracking what you were doing/eating/feeling in the hours before to see if there’s any kind of pattern. And most importantly, stop checking your pulse repeatedly as that will simply worsen your anxiety and will NOT tell you anything about your heart health. Best of luck to you…

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    2. Hi Ellie, Amber, Ashly and Carolyn.

      I’m the New Zealand physio Carolyn’s mentioned in some of her replies to you. I’m just catching up with her blog and thought some comments might be useful. Of course, the absolute number one first response to chest pain is see a doctor to get it medically checked out in case it’s heart or something else dire. But you’ve all done that.

      Ellie – an X-ray is a still photo, so it can’t tell whether the hinges around the back where the ribs join onto your spine are moving or frozen solid. An MRI can’t tell that either – same reason. Jammed up rib hinges at the back cause most costo, because the more delicate rib hinges at the front have to then do all the work of breathing, so they strain, get irritated, then inflamed – and there’s your costo. That’s why the pain’s so specific, and also why it often hurts to breathe in fully. I sympathise with the anxiety – chest pain is scary stuff! But you can be anxious, and still sprain your ankle, or jam up your rib joints – it’s not ALL anxiety..

      Amber – I’ve often seen costo on young, breastfeeding mothers. All that bending forward over the baby can compress the rib hinges around the back enough that they jam, and the costo follows from that. Easy to fix – just free up the stuck hinges.

      Ashly – coughing doesn’t sound like much but it gives a surprisingly strong percussive impact on the rib hinges. It’s a common source of them freezing up, and the costo follows from that.

      For all three of you, your costo really sounds exactly like what I’ve been describing in a couple of YouTube videos – which makes it logical and readily fixable, not mysterious. If you’d like to have a look, the links are here and here. (I’m getting more technically adept with this stuff,Carolyn!)

      Cheers,
      Steve August.

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      1. Thanks once again Steve. I sure would feel a lot better about recommending physiotherapy as you New Zealanders are routinely doing IF I knew that physios throughout North America were as familiar with/experienced in treating costochondritis as you and your colleagues are in NZ…. Please keep me posted if you hear of Canadian or American physios who are!

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      2. Hi, my biggest confusion is the different locations costochondritis affects. Ive seen a few videos and has got me to understand more, but i keep searching and there are very few explanations of where else you can feel the pain. All the videos i have seen are comparison to just chest pain where the sternum is. Though i have pain in my ribs that are on my side radiating to back and side of my breast or under them.

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      3. Hi Steve, I understand. I’ve watched your videos explaining costo and they’re very informative… I’m going to ask my physiotherapist on Tuesday. Is it possible to get arm weakness/tingling with costochondritis?

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        1. Hi Ellie. I just spotted your question. Sure – you can get arm symptoms, especially tingling, in association with costochondritis.

          It’s called T4 syndrome. The sympathetic trunk (big nerve bundle) sits around the fourth thoracic vertebra (T4) – about the middle of the upper back. If that patch of moving joints is gummed up/adhesed, the nerve bundle can be tweaked, and send symptoms off down the arm. Usually, these are tingling, dull ache, maybe a bit of mottling down the arm. (Not usually loss of strength though – muscle power is controlled by motor nerve wiring to the arm which comes out of the spine more at the neck level.)

          How it ties in with costochondritis is that jammed up rib and spinal joints at the T4 level can cause the inflammation and pain at the other ends of the ribs where they hinge onto the breastbone – called costochondritis. If the sympathetic nerve trunk next to the hinges at the back is also tweaked, that can send the tingles off down the arm. So you can fairly frequently get both problems from the same gummed up hinge origin. The answer, of course, is to free up the stuck hinges causing both problems.

          Hope that fits – you can get arm weakness/tingles from a neck problem also, of course; and also with a heart problem – but you’ll have been checked out for that. Cheers, Steve August.

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          1. Aloha,
            I haven’t been diagnosed with costochondritis yet but have been suffering with all the burning, stabbing pain in sternum, heart constantly now for 2 months. Haven’t been able to leave far from my bed. I also have reflex sympathetic dystrophy in feet but this is new. Had chest x-ray and ultrasound and blood test. All normal. Doc says not costo since he can push with not much pain. Next move is neurologist. Does this sound like costochondritis to you?
            Aloha,
            Corazon

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  5. Hi – going on for 5 months now, I’ve been having pain in my chest that tends to move around. At first it started with my breasts so I thought either my bra was tight or it was just cyclical. But after a while, I started getting anxiety attacks because my sternum would really hurt so I’ve already gotten two x-rays and one ultra sound and all came out clear.

    I have a 17 month old daughter so I use to do a lot of lifting and exercises, but now I haven’t picked up my daughter in a few months because the doctor first said it was inflammation in my ribs and chest. They gave me antibiotics which didn’t seem to work and I’m starting to get real depressed. My pain lately tends to feel a tad better if I do absolutely nothing but one little exertion that I do, I’m in terrible pain the next day. I don’t know what’s going on with me.

    Every now and then it gets so severe it feels like it’s the ring underneath my breasts especially my RIGHT breast. And at the moment it’s my ribs and breast radiating to my right arm and back of shoulder. I keep worrying so I tend to press down where I feel tender because it kind of helps me feel at ease to know it could be costochondritis.

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    1. Hello Amber – that’s heartbreaking to think that you haven’t been able to pick up your daughter for a few months. My grandbaby is about the same age and I can’t imagine how sad I’d feel not to be physically able to scoop her up in my arms. I’m not a physician so cannot comment specifically on your symptoms, but I can say generally that it does sound like your doctor is leaning towards an inflammation diagnosis like costochondritis. Please read Steve August’s comments below and watch his video to learn more about how physiotherapy might help. Best of luck to you…

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  6. I was diagnosed with costo a little over 3 months ago due to severe coughing from bronchitis. Although it’s not as severe as it was, I still have touch & go pains all through my sternum, above both breasts & lower left ribs & upper back most days. In the beginning, it was most certainly tender to the touch under my left breast but now isn’t. A lot of what I read said that tenderness to the touch is a constant thing with costo so that has me worried and thinking about going in for more tests. I’ve had an EKG, chest X-ray & blood work all came back normal. I’ve been anxiety-ridden the last 9 weeks & feel I’m kind of getting a handle on things, but that tad bit is concerning me.

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    1. Hi Ashly,
      I’m not a physician so cannot comment specifically on your symptoms, but I can say that in general, the onset of serious costo symptoms coincides with something like your severe coughing episodes. You can of course, reach out to your physician for further tests, but I’m guessing that docs seem to pay more attention when we say pain is getting worse, not when we’re worried that it’s getting better. Re-read the comment by physiotherapist Steve August and watch his video to see if it might apply to your case. Best of luck to you…

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      1. I’m hoping getting better is the case, I just wasn’t sure if since the tenderness to the touch is gone but continued chest pain is there it could still be costo! Thank you for the reply!!

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    2. Hi Ashly. I’m just supporting Carolyn’s comment. Coughing doesn’t sound like much but it has a surprisingly strong percussive impact on the rib machinery – muscles and joints. I’ve seen fractured ribs from coughing, and not just in elderly patients, either. So it’s certainly strong enough that repeated impact on the rib joints around the back can leave them glued stuck because of adhesive fibrosis (part of a repair process). Once they’re jammed, the joints at the front have to work overtime just to let you breathe – so they get sore and often inflamed. Easy enough to sort out if it doesn’t settle fast and completely.
      Cheers, Steve August, physio.

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      1. Thanks Steve – I can personally attest to the immense power of a cough! Last month, I was knocked out for about 10 days by a brutal chest cold accompanied by SEVERE and protracted coughing episodes. I woke up one morning after the first week of this and could not believe how every muscle in my upper back, shoulders, sides and abdomen ached horribly. I could hardly move. It took me a while to finally figure it out: must have been due to those crazy coughing attacks, day after day after day. But luckily no chest pain! 🙂

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        1. Thanks guys I really feel for everybody that has dealt with this for so long.. I hope everybody finds a way to get through the pain! Mine started in just the left side & arm which is why I started getting to anxiety ridden but it’s spread to my right side, upper back & neck pain here and there.. Normal? I always find myself thinking it’s more then costo but try to keep myself calm about it all.. Thanks again reading, it has really helped me feel less crazy!

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  7. I’ve had a lot of different pains for about 7 months now. I get throbbing pains in what feels like my veins, dull pain under by breastbone, stomach pain and feel like I have a fever a lot of the time. I’ve seen several doctors who said it’s costochondritis but they are not sure. I’m 17 and feel like they don’t really care as I am young and healthy. 7 months ago I had a really unusual headache and I also had work that day as well as walking 4 miles. That night I was laying in my bed and my heart starts to beat really fast so I go to the hospital and they said it was a panic attack (first one I’ve ever had). The next day I feel like my chest is in agony and for the past 7 months I have experienced multiple pains around my chest. I have been unable to keep fit and have missed a lot of school. The tests I have had so far – Chest x-ray, blood tests x3 (both came back fine). Still waiting to see the cardiologist.

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    1. Hello Rohan – I’m not a physician so of course cannot comment specifically on your symptoms, but I can say that it would be highly unusual at your age to have a heart-related condition. I’m not saying you don’t, just that it would be rare. If it IS costochondritis, ask for a referral to a physiotherapist who is familiar with costo (and see Steve August’s comments/video below about his work treating costochondritis patients in New Zealand). Best of luck to you…

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      1. Thanks Carolyn – I know there are probably different causes for costochondritis: inflammatory, mechanical. I often hear therapists say it’s associated with ribs that are fixated at their connection with the spine. I believe having a significant bend in the spine at this level would possibly predispose exacerbate or maybe even cause the condition. As an engineer, it’s difficult to believe that scoliosis wouldn’t at least cause extra stress at the costachondral junction.

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        1. It makes sense to me, too, Peter. Watch the video (in the post) with New Zealand physiotherapist Steve August talking about the non-drug, non-invasive physiotherapy methods that he and other NZ physios have been using to treat the costovertebral rib joints for 30+ years.

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    2. Hi Peter and Carolyn. Yes, absolutely there’s a link between scoliosis and costochondritis. You’ve summed it up as an engineer and I’d see it in exactly the same way as a physio. I’ve seen it plenty of times in patients, and of course it makes structural sense. You’re not alone – see the comment from Thomas Ward only five days ago and my reply on my YouTube video ‘How to fix (most) costochondritis and Tietze’s Syndrome chest pain‘ Part (2)

      The twist in the thoracic spine with scoliosis distorts the whole rib cage, to some extent. It has to, if you think about it. The hinges where the ribs join onto the vertebrae of your backbone (a.k.a. the costovertebral (CV) joints), and also the hinges where the other ends of the ribs join onto your breastbone (a.k.a. the sternocostal joints) have to move somewhat asymmetrically to still have your chest facing reasonably forward, even though the the spine is twisted towards one side.

      Of course this puts abnormal loading on the rib and spinal joints on one side – a bit like leaning back in your chair and getting the whole load onto the back two legs. So unsurprisingly, if you have scoliosis then the CV joints are predisposed to locking. (I’m not sure of the mechanism – either simple compression, or irritation leading to inflammation leading to adhesive fibrosis gluing and then freezing the movement – but I’ve seen the results more than often enough to note it as a pattern.)

      My view as a New Zealand physio is that once the CV rib joints at the back have locked, then the SC joints at the breastbone have to do all the rib cage joint movement just to let you breathe, so they get irritated, then inflamed, then it’s called costochondritis.

      Not all scoliosis leads to costochondritis, and you can also have costochondritis from a normal non-twisted spine, but there’s definitely a tendency for the two to overlap. My view on both (mild) scoliosis and costochondritis is that if you get the spinal and rib hinges moving okay, then you don’t get pain or restriction from either of them.
      Cheers,
      Steve August

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  9. I am in heart failure but my pulmonary DR thinks I have this; my chest pain has had me in the hospital for years they’d discharge say nothing was wrong with my heart, look at me like I was lying. I had high BP so I went to a cardiologist, had an echo done and was told I have heart failure. My cardiologist doesn’t see any connection of pain with my heart either – ekgs ecgs all ok, blood work fine. I do have a tissue mass in my mediastinum so I think the pain is coming from this, how can I tell the difference? I had pain in my arm they still told me it had nothing to do with my heart, could it be the mediastinal mass?

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    1. I’m not a physician so of course cannot comment specifically on your case, but I can tell you generally that a mediastinal mass can cause chest pain. If you’ve been diagnosed with this mass, what treatment plan do your doctors have in place for you to treat it? Ask for a second opinion – best of luck to you.

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  10. Costochondritis is often a result of a vitamin D deficiency. I had bouts with costo every spring for several years. It would always happen just as the weather would be on the verge of becoming nice enough to get outside again after a long winter. The costo would last anywhere from a few days to several weeks. Eventually I realized that it would go away after I started to get exposure to sun and my vitamin D level would rise.

    Incidentally, the first time I had a costo attack, I went to the ER for chest pains, certain that I was having a heart attack. I had just about every test done, including EKG and a dye injection CT scan. The doctors never diagnosed anything, but simply sent me away telling me it wasn’t anything to worry about.

    These days I have to be extremely careful about my vitamin D levels since I don’t spend as much time outside. If my levels drop at any point I could have a costo episode. Fortunately, I’ve learned to not panic when I feel a tight chest. I might have to take some ibuprofen for a few days while I build my D level back up. But I can carry on with my normal routine without much difficulty.

    Also, since costo is essentially an inflammation problem, curcumin, garlic and other anti-inflammation supplements can be of help. Just be aware that they also tend to thin your blood.

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    1. Brett, if your theory is correct (a vitamin D deficiency due to lack of sunshine was the cause of your springtime attacks of costochondritis), why wouldn’t your costo symptoms kick in during the winter instead of in early spring?

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      1. Your vitamin D reserve should be somewhat high at the beginning of winter since it is stored in body fat and the liver throughout summer and fall. But the sunlight in the northern states where I live isn’t strong enough to maintain or replenish levels much at all throughout winter. Vitamin D levels gradually drop and are at its lowest point at the end of winter, regardless of how dark the days are in between. At least in my area. I would say that my costo episodes happened at ‘the end of winter’ rather than ‘the beginning of spring’. A small distinction, but probably easier to understand that way.

        It’s a bit like gas in your car. You fill up your tank and drive for quite a while as your gas gauge drops and you’re fine. But once you hit a certain threshold your gas low warning light comes on. Even filling up a gallon or two here and there won’t help beyond a certain point. Costo is sort of my low vitamin D light.

        I can’t speak for other people (and I’m not a doctor), but I know for a fact that there is a direct relationship between my costo episodes and vitamin D since I can eliminate all my costo symptoms by increasing D supplements.

        One thing to note… your body uses up magnesium when converting D supplements to a useable form. So you should take magnesium along with vitamin D or you might end up with other equally unpleasant symptoms if your magnesium levels drop too much (as I’ve learned).

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        1. Hi Brett and Carolyn.

          This is a really interesting discussion. Since I put up my two YouTube videos giving my New Zealand manual physio view of costochondritis and got swept into the “What causes costo?” arena, I’ve been trying to resolve obviously clear and accurate reports like yours, Brett, with my own knowledge and experience of fixing costo by freeing up the stuck rib joint machinery at the back (which causes the overuse pain and inflammation at the other ends of the ribs where they hinge onto the breastbone). I can do this!

          Essentially, I think the stuck rib origin I’ve described CAUSES the localised breastbone/rib joint inflammation of costo for obvious mechanical reasons. However Vitamin D (and probably Omega 3 also) help your body to fight and suppress inflammation generally, so they can take the pain away if the joint locking isn’t too bad. It’s similar to taking anti-inflammatory medications or turmeric for it – they’ll suppress the inflammation if it isn’t too bad. But in most cases, and probably almost all chronic cases, none of these meds or supplements will actually FIX the costo. That’s why it keeps coming back when you stop taking the stuff.

          (To be completely accurate, if the costo is recent and not too bad, and you take away the pain by Vitamin D or whatever – a good thing !- then your own unguarded movements have got enough leverage to pull free the bit of posterior rib joint restriction that’s causing the chest pain.

          So you could say the costo is fixed then. But this is NOT the case when things are tighter, as they will be in chronic cases – that’s WHY they’re chronic. A thoroughly jammed up rib hinge cannot be freed up just by doing exercises – it’s a matter of leverage. You HAVE to use an external force. Without that, they’ll tend to just stay jammed. Hence costo lasting many, many months and years.)

          Finally, a reality check. It just doesn’t make sense that a very specific pain only where your ribs join onto your breastbone and nowhere else in your body is actually caused by low levels of Vitamin D in the body generally. My New Zealand explanation of the rib hinges at the back being jammed is the only one that accounts for such a specific pain. But absolutely, Vitamin D is highly useful in helping your body deal with the pain and inflammation – I reckon while you’re sorting out the frozen machinery round the back which is driving it. The best treatment is probably combining both approaches.

          My New Zealand manual physio view of costo and how to fix it is on two YouTube videos. Links are: https://www.youtube.com/watch?v=uvJbQFDeyO and https://www.youtube.com/watch?v=r7ve6nNVdWc

          Cheers,
          Steve August

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          1. Thanks for this, Steve, especially your reality check (“…doesn’t make sense that a very specific pain only where your ribs join onto your breastbone and nowhere else in your body is actually caused by low levels of Vitamin D in the body generally”) You’re so right.

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  11. Pingback: Good Info Car Accident Laws

  12. I think I have this condition. I have chronic fatigue fibromyalgia syndrome. I’ve had this sore aching chest pain on and off for years. I was supposed to have heart tests years ago, but I got scared, and depressed, so I left hospital without the procedures done. Now, I feel I must have the heart tests performed.
    I like your blog. Very helpful information! Thanks!

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  13. I’ve been having this type of pain for 2 and a half years. It started about 4 months after my mom put my family on a strict gluten-free diet. The odd thing is, that I only have chest pain when I’m on my period, or when I’m using hormonal contraceptives.

    I’ve seen a gynecologist about this (as well as some other issues) and been to the ED a few times, but my x-rays and physical exams have all been clear. A few doctors have suggested that I could have endometrial tissue in the area, but that’s apparently rare, and should be resolved by the hormonal contraceptive use. My gynecologist is extremely hesitant to do any kind of surgery because I’m 19. I also want to discontinue the contraceptive use because of the severe mood effects, but I’m going to hail mary with an IUD in a few months, so that I can say I’ve exhausted all options.

    I had an ECG before I went to the children’s hospital the first time two and a half years ago, which showed ST segment abnormalities, but further ECGs were clear. I also went for an echo (which was clear), but never a stress test. I never received a formal diagnosis at the hospital or at urgent care, I was simply told to “keep coming back” until someone could figure it out, but my parents refused to take me, I’m not able to get their on my own, and I really don’t think I should be going to the hospital for something that’s non-life threatening that could be tested and taken care of non-urgently.

    I’m autistic, and I’m also looking into possible rheumatoid issues (family history) and neurological issues related to a potential TBI 6 years ago with my GP, and I’m also seeing a chiropractor about some of the same issues.

    Do you know of any differentials/tests/treatment options that I could discuss with my GP, gynecologist, or doctor of another specialty that may be of help? Thank you for having taken the time to read all of this, and for your response.

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    1. Hi Madeleine – I’m not a physician so cannot advise you on your specific case. I can say that, generally, it would be unusual that new chest pain would be associated with adopting a gluten-free diet (in fact, likely just the opposite). There are not, to my knowledge, specific diagnostic tests that would confirm a costochondritis diagnosis. So much of medicine is just trying to rule out what the problem ISN’T – ruling out one possibility after another to solve the mystery. In your case, it sounds like you have a medical history that’s varied and complex – so it’s much more challenging for your physicians to connect the dots. Try keeping a symptom journal to show your doctor (e.g. what were you doing/eating/feeling in the hours leading up to a pain episode). You may be surprised by some of the patterns or clues that come up. Best of luck to you…

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  15. It really breaks my heart 💔 to read about all of this pain so many of you are suffering from. I suffered with this pain on and off since I was about 10 years old. But beginning in the summer of 2009 I was in pain everyday. I had every exam and blood work done that you can imagine. I had steroid injections, I was hospitalized for almost 3 weeks to control the pain that only dilaudid could control.

    My pain management dr referred me to a surgeon that told me he believed that removing my xyphoid would take care of my pain. At this point I didn’t care what he removed. All I wanted was to rest from the pain. In April of 2010 I had it removed. When I woke up from surgery I couldn’t believe that excruciating pain was gone. THANK GOD!! I was obviously in some pain due to the surgery but I could tell the difference. I recovered quickly. I had the surgery on a Thursday and I was back at work the following Tuesday.

    I pray every one of you finds a Dr who will take you seriously and that every one of you finds relief SOON!!!!
    *hugs to all of you *

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    1. That’s an amazing story, Silvia! The 2009 medical textbook General Thoracic Surgery does recommend surgery like yours for appropriate costo patients, calling the xyphoid a “partially cartilaginous structure that may promote bilateral spread of the infection”. But each case seems to be uniquely puzzling; glad that your remedy worked for you after all those inexcusable years of pain.

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    2. Silvia,
      I really need to know to know more details of your surgery PLEASE I have had my Costochondritis since 16 and I am now 50 and have tried everything. I am at my wits end. Can you tell me what kind of surgeon it was, his name, where he is located, what is the kind of doctor you went to to find this surgeon please give me as much information as you can PLEASE I’m begging you.
      Thank You So Much,
      Donna Soderlund

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      1. Hello Donna — If Silvia has subscribed to these comments, she may respond to your questions, but if not, she won’t. Meanwhile, here is some basic info: the kind of surgery that Silvia had is called a xyphoidectomy, which just means removing a part of the breastbone. A thoracic surgeon (a surgeon who operates on organs located in the chest) is the kind of surgeon who would typically perform this procedure. Please view Steve August’s videos (Links are: https://www.youtube.com/watch?v=uvJbQFDeyO and https://www.youtube.com/watch?v=r7ve6nNVdWc) before pursuing any kind of surgery. I’m not a physician but I have heard from readers who did have this surgery for costochondritis but still have chronic pain post-op. Every patient is different.

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  16. I’ve RA, OA and Fibromyalgia. I have had several bouts of Costochrondritis over 30+ year period. I have controlled HBP, otherwise my good and bad cholesterol, and other blood work are excellent. My rheumatologist believes the pain I experienced is definitely associated with this very painful condition. I cannot take oral NSAIDS, but have had good luck with Voltaren Gel.

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    1. Hello Rebecca – thank goodness you seem to be finding relief with the Voltaren. While you’re here, check out Steve August’s video on physiotherapy to treat costochondritis, as mentioned in this article. Best of luck to you…

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  17. I was recently diagnosed with costochondritis, though I’ve been in varying degrees of pain for 4 years. I have had every workup possible except cardiac (aside from echos) x-ray, MRI, full body scan, endoscopy, colonoscopy, abdominal ultrasounds and my blood work is always prefect (aside from elevated amylase – that’s why they did the abdominal ultrasound.

    I have had constant pressure and dull ache under my left lower rib and in December I had an episode of severe pain while I was doing leg presses. Since then I stopped working out completely. My back is now in constant pain because I stopped working out – it’s the only thing that helped me with back pain. It was suggested that I have a steroid shot in the ribs, but I HATE steroids and even more so because I’m not quite convinced that it is costochondritis.

    Is it possible for costochondritis to last this long? I’m contemplating doing the steroid injections just to rule out costochondritis, but even if I do rule it out I have no clue where else to turn. I’ve seen countless physicians and some told me they have no clue, some said I should wait until something else happens that might help give them an idea and some said I should just live with it.

    I’m 52 years old and have always been in excellent health and I’m also not overweight. Any idea at all what I should do next? I have also not been able to sleep on my back since the onset of this problem and I do get chest pains but only at night usually around 3am. Many times the chest pains wake me up but I was just given anxiety medication for that, which I don’t take. I’ve been taking tumeric/curcumin/coconut oil paste for the past 2 weeks thinking that if it is an inflammatory process I might be able to affect it somewhat but nothing changed – some days the pain is better some day it’s not. I still cannot pinpoint a particular reason why that is! I’m getting depressed at the thought of having to live with this forever!

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    1. Hello Lucia – four years is a very long time to be in pain before a diagnosis! Sometimes there is no sudden specific event or reason that pain can start, and sometimes there is. I’m going to suggest that you revisit Steve August’s link (and his video) about how physiotherapists in New Zealand are approaching costochondritis and see if this makes sense to you. It’s very different from our North American views. Best of luck to you…

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  18. I was just diagnosed with costo today. I hurt my lower back last month and was in my second week of physical therapy for it and last night I was doing my stretches and heard and felt something pop in my chest. I thought a rib moved or something, but it’s the most painful thing ever. I can’t even breathe or sit or lay down or anything without pain… They did an x-ray and I guess my ribs are fine, but that’s what the doctor diagnosed me with. I was crying earlier because it hurt so badly. I can’t handle this!

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    1. This sounds awful, Amanda. What treatment did the doctor who diagnosed you recommend? As Kelly Young (who has had several bouts of this condition) recommends in this article, many costochondritis patients find relief with ice or heat and anti-inflammatory medications; in her own experience, “the inflammation subsides to a more manageable level in a few days” if it is costo. I hope this will also be true for you!

      You are in very early days yet, but make an appointment to see your family physician as soon as possible for further recommendations. You might also ask your physiotherapist too (watch Steve August’s video for more about how physiotherapy can also help). Good luck to you…

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    2. Hi Carolyn and Amanda.

      Amanda, what you’ve just described would fit squarely into the explanation of costochondritis I’ve put on a couple of YouTube videos on CC which Carolyn has kindly referred to and linked.

      That sharp pop and the feeling that the rib moved is a classic mechanical pain presentation – not an inflammatory one. The rib joint(s) around the back where they hinge onto your spine will be jammed – maybe from whatever you did to hurt your low back, especially if it was a fall. Then when you stretched, the frozen rib hinge(s) round the back couldn’t move, so the rib joints around the front where the ribs hinge onto the breastbone had to try and do all that movement. They’re more delicate, and one of them strained and ‘gave’ – hence the pop and the very sharp instant pain.

      Don’t panic, it’s easy to sort out.The key is, logically, to free up the stuck rib hinges around the back. Have a look at two YouTube videos ‘How to fix (most) costochondritis and Tietze’s Syndrome chest pain’ – Part 1 and Part 2. Ask your physio to view them also. This is a perfectly reasonable request – I’m a physio myself (in New Zealand).

      Carolyn, this is a perfect example of how I think most CC turns chronic and inflamed. Imagine if Amanda’s costovertebral rib hinges at the back don’t get freed up. I’m not being alarmist, just accurate – my own ones stayed stuck for seven years, after my climbing fall. Then the continuing extra strain on the sternocostal rib hinges around the front (which are now trying to do ALL the work of breathing and movement) means they get continually strained and irritated, and then inflamed.

      Cheeringly, Amanda’s ribs haven’t been jammed for very long, so should be easy to free up. Not too difficult even if it has been years – just takes longer.
      Best wishes,
      Steve August

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  19. I was diagnosed in Oct 2015 with Costochondritis and it’s been a living hell ever since. I first started experiencing the pain after smoking. My chest tightened up and I had a “full” feeling over my chest and throat. I rarely hear people describe it going up their throat but that’s where I feel it most and it frightens me. They ran so many tests on me as my brother passed away 5 years earlier from a pulmonary embolism and wanted to rule it out.

    I can’t stop worrying that maybe they got it wrong. Does anyone feel that way? Feeling an odd feeling in their throat and perhaps this is anxiety but I have to remind myself how to swallow while breathing. The Aleve medication helps but so much…. I don’t experience the soreness at all…it’s just an “My chest is too full, too tight, and it hurts and scares me”.

    Am I alone in this feeling regarding costochondritis?

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    1. Hi Shanelle – I’m not a physician so can’t comment specifically on your case, but I’d advise you to seek a second opinion focused on your throat pain if you are still experiencing it as a “living hell”. As you know, smoking irritates the throat, causing it to become dry, red and inflamed, so if you’re still smoking, that could also be contributing to your symptoms.

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      1. Oh I quit smoking immediately after being diagnosed. The pain comes and goes but I do have to admit with other replies left here it is a scary feeling to feel your chest tighten up so much and only being prescriped generic aleve or naproxen. Wish there was more information on this diagnosis on the web. Everywhere it states the same thing as if it’s no big deal!

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        1. Shanelle, I am experiencing the exact symptoms. For several weeks I have seen more than six doctors and even went to the ER. I was told it was costochondritis but I also have a subluxation on my sternoclavicular joint. I have radiating pain to my throat under chin. This is a condition not treated by many doctors. You have to find someone who knows and will listen! I am still looking and having relentless pain. Good luck!

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      2. I’ve had costo problems; I’ve had the pain that also traveled up to my throat. My rheumetologist diagnosed me with costo but he also suggested the possibility of anxiety as a result of fear that naturally occurs. I also see a cardiac doctor (I have atrial fibrillation, yet my heart and valves are in good condition). I have an irregular heartbeat at times. But when I’m in pain that lasts longer than 15 minutes, I usually go to the ER primarily to rule out angina which also can cause chest pain. As a side point: if chest pain is relieved by NSAIDS (ibuprofen, etc.) it’s probably not cardiac problems. (EDITOR’S NOTE: see FDA warning in my response below) Go to your doctor and request a work up to rule out cardiac problems; it will alleviate much of the anxiety issues. Remember: knowledge is power!

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        1. Just a cautionary reminder here for my readers: last summer, the FDA strengthened its prior consumer warning that NSAIDS pain medications (nonsteroidal anti-inflammatory drugs) like brand-name Motrin, Advil, Aleve, Celebrex, Voltaren (or generic ibuprofen, naproxen, celecoxib, or diclofenac) increase the risk of having a heart attack or stroke, and may also elevate blood pressure or cause heart failure. The risk is greatest for people who already have heart disease, according to this Harvard bulletin.

          Aspirin is also an NSAID, but apparently does not pose a risk of heart attack or stroke, and is not covered by this new warning.

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    2. I also get tightness and pain crawling up my neck and throat. It continues up my face and feels like all my teeth are being pulled out. It’s terrible, sometimes I pray that I could just die, the pain is so bad. The attacks usually last 1-2 hours and repeat 3 or 4 times over the next few days. Afterwards my face hurts for days.

      I have never smoked.

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  20. I’m 24 and have had this recurring chest pain for over 7 years now. It lasts for a minimum of a month if I’m lucky and the ERS says this is what it is. Now it is spreading to my neck and back and my chest is breaking out which it never does, and personally it’s starting to freak me out.

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    1. Hi Susan – I’m not a physician so cannot comment on your specific case, and I’m not sure if you mean you’ve been diagnosed with costochondritis or not. If you have, you should have some type of treatment plan in place. Seek a second medical opinion, or conversely consider a physiotherapy consultation. Seven years is a long time to withstand distressing symptoms!

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