Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.
Mohamad Hassan, PT, DPT, is a physical therapist at Premier Physical Therapy in Chicago.
If you have pain in one side of your chest wall, you may be suffering from a condition called costochondritis. This condition, often caused by irritation and inflammation of the cartilage that attaches your ribs to your breastbone, can make moving into certain positions painful. It may also cause pain when taking deep breaths.
If you have costochondritis, working with a physical therapist can be a good option to help ease the pain and inflammation and allow you to return to normal activity and function.
One of the tricky things about costochondritis is that the symptoms mimic other more serious conditions. Symptoms of costochondritis include:
If you have any of these symptoms, check in with your physician right away. They can assess your condition and make a diagnosis of costochondritis while ruling out more serious problems. Usually, costochondritis comes on after trauma, intense physical strain, or with arthritis. Sometimes it appears for no apparent reason.
When you first visit a physical therapist for costochondritis, they will conduct an initial evaluation. Questions will be asked about your chest pain and how it started. Be prepared to talk about how your symptoms are changing and how they behave. What makes your pain better or worse? And tell your therapist how your costochondritis pain is affecting your ability to perform functional tasks like breathing or rising from sitting.
Your therapist can get an idea of the severity of your costochondritis during the history-taking portion of the evaluation. More severe cases cause significant limitations in breathing and changing positions; mild cases may cause some pain, but functional mobility may not be affected to a great extent.
After your physical therapist takes your history, they will perform several tests and measures to get an idea of what impairments may be causing your costochondritis. Common tests and measures may include:
After your therapist performs an examination, they should have enough information to determine the root cause of your costochondritis and can start treatment. A plan of care will be discussed with you, and goals for rehab for your chest pain will be set.
Other conditions may manifest as chest pain or pain with breathing. These include:
These are all serious medical problems, so don't be surprised if your physician performs medical tests to rule out cardiac or pulmonary conditions. A chest X-ray may be done to assess your lungs and to look for a fractured rib. An electrocardiogram (ECG or EKG) may be done to assess your heart function and to rule out a heart attack.
Once serious medical pathology has been ruled out, your doctor will likely come to the conclusion that you are suffering from costochondritis, and a referral to a physical therapist may be made.
Physical therapy for costochondritis involves helping you manage your pain, decreasing inflammation, and improving the way you move to relieve pressure off inflamed rib cartilage. Most people with costochondritis benefit from working with an orthopedic physical therapist, an expert in the treatment of musculoskeletal conditions.
Different modalities and maneuvers may be used to improve the way you move. These may include:
Other treatments may be used to help decrease pain and inflammation. These may include heat to improve circulation and ice to decrease pain and swelling around inflamed tissues. Other treatments, such as ultrasound or electrical stimulation, are not used, as the cartilage involved is close to the heart. Performing these procedures near your cardiac structures is not recommended.
Active involvement in your therapy is key. Your therapist will likely prescribe exercises to help your ribs and thorax (chest) move better.
Exercises for costochondritis are designed to improve overall chest wall and rib mobility. This can help decrease pain and improve the way your ribs and thorax move. Postural exercises can relieve pressure off of inflamed cartilage.
Before starting any exercise program for costochondritis, check in with your doctor to ensure that exercise is safe for you to do.
The pectoral corner stretch is meant to improve flexibility of your pectoral, or chest, muscles. To perform the stretch, stand facing a corner about two feet away from the wall. Place both arms up, with your forearms resting against the wall on each side of the corner. Your hands, forearms, and elbows should be in contact with the wall.
Slowly lean into the corner, stretching the muscles in the front of your chest. Hold the stretch for 15 to 30 seconds, and then relax. Repeat the stretch three to five times.
You can stretch your pecs using a doorway opening, too. To perform this stretch, stand in a doorway, and place both elbows and forearms up against the doorjamb on either side of you. While keeping your elbows against the doorjamb, slowly lean forward, stretching the muscles in the front of your chest. Hold the stretch for 15 to 30 seconds, and repeat three to five times.
The scapula squeeze can be done to improve posture and muscular control of your thorax. To perform this exercise, sit comfortably in a chair, and gently squeeze your shoulder blades together in the back. Pretend that you are trying to squeeze a pencil between your shoulder blades, and hold the position for three seconds. Slowly release, and return to the starting position. Repeat 10 to 15 times.
The scapula squeeze exercise can be more challenging with a resistance band. Loop the band around something stable, and hold each end. Bend your elbows back, as if rowing a boat, while pinching your scapulae together. Then slowly release, and repeat the exercise 10 to 15 times.
Another great way to open up your chest wall and stretch your pectorals and chest muscles is to use a stability ball. To do this stretch, lie on your back over a 65 centimeter stability ball. Hold both arms up in front of you, and then slowly open up your arms as if you were going to give someone a big hug. Relax your back as you open your arms, and allow your arms to move toward the floor, opening up your chest.
You should feel a slight pulling sensation in your chest when you do the exercise. Hold the stretch for 15 to 30 seconds, and then bring your arms back to the midline. Repeat three to five times.
If any exercise gives you lasting pain in your chest or ribs, stop it and check in with your physical therapist. Often, alterations can be made to make your exercises more comfortable.
One important component of any good physical therapy program is learning to prevent future problems with your condition. Prevention of costochondritis may include:
If you start to feel your symptoms of costochondritis creeping on again, performing your home exercise program for stretching, breathing, and postural exercises may help keep symptoms under control.
Costochondritis is a self-limiting condition. That means that symptoms and the pain typically subside without any treatment at all. Physical therapy, however, can be an effective management strategy to speed the process along and to ensure that you are moving correctly while your rib cartilage is healing.
Most people with costochondritis attend physical therapy for one to two sessions a week for four to six weeks. Your personal episode of care may be longer or shorter depending on the severity of your condition and any underlying medical conditions you may have.
If your symptoms persist for longer than six weeks, check back in with your doctor. A referral to an orthopedic specialist may be in order; occasionally, steroid injections are given to relieve inflammation in the costochondral joints. Keep in mind that the pain from costochondritis usually abates within a few weeks, but some severe cases last for up to one year.
If you have chest pain from costochondritis, you may benefit from working with a physical therapist. Your therapist can educate you about your condition and prescribe exercises to improve your mobility and decrease your pain. Most episodes of costochondritis are short-lived. Learning what to do, and when to do it, can help you recover quickly and return to your normal active lifestyle.
Most episodes of costochondritis last from four to six weeks, with some severe cases lasting up to one year. The condition is often self-limiting and goes away on its own, leaving no lasting functional impairments.
Costochondritis pain can be relieved with anti-inflammatory medication, heat, or ice. Sometimes severe cases require steroid injections for treatment, but this is rare. Most patients get adequate relief with ice, heat, medication, and gentle stretching and postural exercises.
The best treatment for chest pain from costochondritis is active in nature. Postural correction, breathing exercises, and stretches can help decrease your pain and improve your mobility. Over-the-counter pain medication or anti-inflammatory medicine may be useful. Heat or ice may also be used to decrease pain and inflammation.
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Patient information. Costochondritis: what you need to know. Am Fam Physician; 80(6):617-s1.
Mott T, Jones G, Roman K. Costochondritis: rapid evidence review. Am Fam Physician; 104(1):73-78.
Zaruba RA, Wilson E. Impairment Based Examination and Treatment of Costochondritis: A Case Series. Int J Sports Phys Ther; 12(3):458-467.
Berg AT, Stafne SN, Hiller A, Slørdahl SA, Aamot I-L. Physical therapy intervention in patients with non-cardiac chest pain following a recent cardiac event: A randomized controlled trial. SAGE Open Medicine. 2015;3:205031211558079. doi:10.1177/2050312115580799
Barranco-Trabi J, Mank V, Roberts J, Newman DP. Atypical costochondritis: complete resolution of symptoms after rib manipulation and soft tissue mobilization. Cureus. Published online April 8, 2021. doi:10.7759/cureus.14369
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