Costochondritis: Rib Pain

Costochondritis causes pain in the front of the ribs. The name refers to inflammation of the cartilage between a rib and the breastbone (sternum).

Chest pain can indicate a respiratory or cardiovascular emergency and should first be investigated by a doctor. Please go to A&E if your breathing is affected, or there are signs of a serious problem.

Features of Costochondritis

This condition most often affects the upper 5 ribs. Pain at the joint where the rib meets the sternum causes either a sharp or dull pain, which may be worse on taking a deep breath. Typically, the area over the joint will be tender.

The onset of symptoms can be sudden or gradual, and may be aggravated by some arm and upper body movements. Often it seems to begin for no apparent reason, but it might follow intense exercise or an illness that causes a lot of coughing.

Prognosis for Costochondritis

Fortunately, the condition is considered self limiting. The NHS expects it to resolve on its own within a few months.

As it can be associated with RA or fibromyalgia, it may recur or be more persistent. If your symptoms come and go a lot over the course of your recovery, or it takes more than a few months to resolve, it’s time to look at other factors.

Other conditions can present similarly, so these should also be ruled out if symptoms are not improving as expected:

• Tietze’s Syndrome is similar, but a separate disease. The key distinguishing feature is swelling and heat at the painful point. Blood tests will show raised inflammatory markers.
• Slipping Rib Syndrome: the pain here is further down the chest, as the ribs with a less direct connection to the sternum are affected. They become hypermobile, and the ends can catch and irritate a nerve.

Managing Costochondritis

The root cause of the pain in costochondritis is inflammation. You can speak to your GP or pharmacist about anti-inflammatory medications that are appropriate for you, or try a cool compress over the painful area. Because these joints are close to the skin, you might find that you can make a big difference with a bag of frozen peas. Make sure you don’t leave it in place for more than 10 minutes at a time, and don’t apply the bag directly to skin- use a tea towel or keep a layer of clothing in between.

Your osteopath can support you through your episodes of costochondritis by ensuring the rest of the body is working well. Inflammation in the joint at the front of a rib might change the way the joint at the back works. This could cause mid-back pain and stiffness, potentially with secondary effects elsewhere.

As slouching and some exercises can make symptoms worse, we can also work with you to alter these behaviours. Gentle exercises to strengthen the upper back and make it more comfortable to sit up straight can be helpful. If your pain is aggravated by exercises that you do in the gym or as part of a sport, we can look to alter form, intensity, or frequency to reduce the irritation on the joints in question.

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