costocondritis / tietzes syndrome

Two years ago was diagnosed with costocondritis by a medical doctor. I have been to two chiropractors during the last 18 months and even took printed pages of your web site for them to review. Is it possible to get detailed instructions from you that my chiropractor could use to do the type of adjustment that you refer to for tietzes?

The pain started as a sharp quick pain after a violent sneeze that would be sporadic and has gradually subdued to a dull pain / soreness on the left side at the fifth rib area- in the cartilage to the sternum area. Also sometimes have the same dull ache on the left side back that seems to be related to same location as the front- just below the shoulder blade.

The dull ache seems to come and go, some days OK and then other days can be quite painful and miserable.

Any help that you could give to me to relay to my chiropractor would be greatly appreciated. My chiro seems reluctant to call for help and this is my last option. Or if you could possibly recommend a DC that is knowledgeable in your techniques with the activator or other methods in the Augusta / Macon, Georgia area


UPDATE: I'm about to give a lecture on the treatment of TS to a chiropractic congress. The lecture notes will be available on this site, for chiropractors only, for .99c. Tell your chiro.

It's all about ego, I'm afraid. This is a difficult condition, and it took me 25 years to figure how to treat it. I shudder to think of the number of cases I either completely missed, or had no understanding of what was happening. Or aggravated, as a heavy manipulation in the middle of the back, posterior to anterior will aggravate the condition.

Suggest he come to the chiropractic convention in South Africa in September where I'll be lecturing on the subject!

Seriously, if he's open to learning about it, I'd be most happy to talk to him. Suggest he contact me at CONTACT and we can set up a Skype discussion. It's not rocket science, but some very specific things need to be done.

It's a horrid, nasty, very treatable condition. There's hope! The symtoms you describe are typical. If it's chronic I would recommend an X-ray of your midback.

Any indigestion?

Dr Barrie Lewis

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Apr 08, 2011
tietzes constochondritis
by: melissa gillen

Hi there,

I feel the same and I am at my wits end, my docs say there is nothing they can do for me and I can only do the most menial tasks.

This morning I wiped down the worktops and it started again and now I'm resigned to the couch again. I can't go on like this my kids are missing their old mum! I have stomach upsets, indigestion, I sort of have like hiccups a lot and want to yawn a lot and I need to hold it in.

Also I can't eat too much as it hurts when my stomach is full, so it's little and often. I'm thinking of going private and was told maybe an osteopath too , just want help to get my life back and be pain free, can't wash my hair now.

Hello Melissa,
Don't let this condition make you depressed. It's fixable, really, you have to find the right Chiropractor. I treat it almost every day.

It often also causes indigestion as the diaphragm is connected to the lower six ribs. Of course, if you are taking medication, that could be causing your tummy troubles too.

Ask your chiropractor to contact me. If he's too proud, go to another who wants to learn something new. Like I said, it took me 25 years to figure this one out.

Dr Barrie Lewis

Apr 08, 2011
tietzes constochondritis
by: melissa gillen

Hi there, I feel the same and i am at my wits end, my docs say there is nothing they can do for me and noeI can do the most menial tasks, this morning I wiped down the worktops and it started againa nd now I,m resigned to the couch again, I cant go on like this my kids are missing their old mum! I have stomach upsets, indigestion, I sort of have like hiccups a lot and want to yawn a lot and I need to hold it in, also I cant eat too much as it hurts when my stomach is full, so its little and often. I,m thinking of going private and was told maybe an osteopath too , just want help to get my life back and be pain free, cant wash my hair now :(

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Tietzes Syndrome

by Joe

I am an amateur boxer and was diagnosed with costochondritis in february of 2011. I rested 6 weeks like the doctor said and began training again with no ill affects at first. 2 weeks after my first fight back from the injury i began to feel pain again..the doctor suggested i rest again..i did and when i returned to exercise it again started hurting this time with swelling on my costochondral attachment.

I've lifted weights around it and did alot of back exercises, skipping out on chest work. eventually creating a muscle imbalance in my back being too strong for the chest. I've taken 2 months off of exercise but my ribs pop multiple times each day...the popping doesn't cause pain, and the swelling has gone...

I am giving it 8-12 weeks this time and if it does not heal i am considering taking HGH because i've heard it is an effective method to heal injuries. What do you think i should do...the pain is not too bad as long as im not exercising, after 1 month i still have daily popping sounds that are not painful, but i can feel pressure on my chest when layin on my belly or doing any kind of pushup. I appreciate any help.

Hello Joe,
I'd try as many things as you can before going on to HGH. Interfering with the body's hormone system can have very serious side effects.

You have typical Tietzes syndrome if the costo-sternal joint was swollen. You don't have a photo by any chance? I'd appreciate a copy.

Odd, boxers usually over exercise the pecs, not neglect them. That could well be the problem.

I find that a midback subluxation is the usual cause of Tietzes syndrome, though a heavy blow to the chest could as well. It's a disturbance of the whole rib, from the sternum to the joints with the spine.

A heavy manipulation, posterior to anterior, will aggravate. A chiropractic "anterior thoracic" adjustment is what will fix it, though the whole rib needs to be addressed.

Don't crack your ribs deliberately, it will become even more unstable. Those constant popping sounds may in fact be the cause of the problem. Have you had too-frequent manipulation of the rib?

Ice massage on the rib-sternal joint will help.

It's a difficult problem, Joe, one that responds well to a regimen I've worked out. I'm trying to summon the energy to put it onto the net for chiropractors who may be interested. Keep watching the Tietzes syndrome page, I'll get up soon.

Kind regards,

Dr Barrie Lewis

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Tietzes Syndrome

by Annie

I have a problem with my breastbone. I get a pain that radiates out short way from where the ribs join the breastbone on the right side but also sometimes goes through my body to the back. It is not severe but uncomfortable.

This usualy happens after I have been doing some exercise like digging the garden, it can also start from coughing and sneezing and I feel that a bone has gone out of place. With certain movements I can sometimes click the bone back.

Sometimes I get a secondary sensation usually only whilst walking. This feels like a tightening and pulsating in the same area. It doesn't last long if I slow down. I do not get breathless or feel light headed when it happens. I spend quite a bit of time at high altitude (above 3500 feet) and have experienced this sympton in more recent years, but I can also get it at low altitude too. It is much more likely to occur if I am stressed.

I have had an ecocardiogram done and the results were all OK. I am therefore assuming that this feeling a slight pressure around the same area is linked to the sternum problem ,and is part of Tietzes Syndrome, which I have only just learned about today.

The answer to do I suffer from indigestion and heart burn is 'Yes' - well used to, I am a daily user of Omeprazole - 10mg only. I don't like taking drugs but this has made a big difference to daily life.

Hello Annie,
You have the common, early sort of Tietze's syndrome. In the advanced kind the joint between the rib and the breastbone actually becomes swollen and very painful.

It's impossible to predict if your mild one will progress to the full blown Tietzes syndrome.

It's vital to get that rib adjusted, it's the cause of the pain, but do remember that a heavy manipulation in the middle of the back will aggravate the problem. Discuss it fully with your chiropractor. He /she has to coax the rib back into place, not use brute force and ignorance!

Alternating ice and heat (as in the shower or bath) on that joint will help.

I'm not familiar with Omeprazole. What often helps is not drinking any fluids with or after meals. Big cup of tea BEFORE breakfast, not after, nor for at least an hour.

Dr Barrie Lewis

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Diagnosed with Tietzes Syndrome - not quite sure...

by Kier
(Millville, NJ)

I have been diagnosed with Tietzes Syndrome after much in the way of testing..I could have sworn that my gall bladder was to blame, in that I exhibited the classic upper right quandrant pain.

As I write this, the pain on my upper right side is excruciating, it hurts to even just touch it or press on the area. I am a little doubtful though, about my Doctor's diagnosis. First, the pain is not quite on the rib where it meets the sternum, but just slightly off in the "field" or area near the rib.

Second, it feels numb to the touch, which sounds like a paradox in that there is so much pain, but it does have a deadness to it like when your leg falls asleep, just without the tingling. It also feels like there is heat being generated as well, but I've had my wife touch the area and she feels no difference in the surface temperature of my skin.

I just took an 800 mg Ibuprofen and after 20 minutes or so, the pain level of 10 drops to a more manageable 6 or so..I have had this condition before, about 4-5 years ago, then it went away. Presently, I have been dealing with this for about the last 6 months or so..I have had every gall bladder test to rule that out, as well as CT scans of the abdomen and thorax, with and without contrast and all have been negative, or basically revealed nothing..

I sure wish something would have been conclusive, this condition really is a bummer..I hope that this has been somewhat comforting to someone who is going thru this, I would have felt better if I found another person with the same symptoms who wrote them down..

Hallo Kier,
Ben je Nederlands?

I'll assume several generations ago, but the name has continued in the family.

Well, it certainly would be useful if YOU would write down all your symptoms, your story, and with your permission I would put it on the site, without your name of course.

Much of the details are already here, but some more would be useful. I can't quite make it out where the pain is - in your side, or near the breastbone? And which rib(s). Do you have any pain in the midback.

Tietzes classically affects ribs 1-5, more on the left, but also right. From what you describe, it sounds to me like you have a lower rib problem, in which case not a classical Tietzes. The root of your problem is almost certainly in the low thoracic spine. Lie on your tum and ask "she who must be obeyed" to press in that area on the right. Is it sore?

Does it give you any indigestion? Heartburn? Often affects the diaphragm.

This is a very treatable syndrome, but I have to say that it's taken me thirty years to perfect it. I can't guarantee that every chiropractor can help you, but it's worth a try, because no one else probably can.

Be pleased the scans are negative. Gallbladder, liver and pancreas do refer to that area.

I hope this contributes. Separately I'll send you our latest newsletter than has some info on the subject.

Met vriendelijke groenten!

Dr Barrie Lewis

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Tietzes syndrome and bulging discs

by Kathy
(clifton park ny)

Tietzes syndrome of the SC joint.

Tietzes syndrome of the SC joint.

I have bulding discs from c2 to c7 and Tietze syndrome,my pain meds help my back ,but do not touch my rib cage,i have beeen disabled for 7 yrs

the pain doctor keeps giving me anti inflamatory drugs and oxcdone/325 that helps my back,no one knows how to treat this syndrome,

when it first occacured the dotors thought I was crazy,the hospitals too,

I got labled as a drug seeker,and know one knows how to treat it,nothing helps either,I was on antiscokics ,seizie meds,got injections nothing works,unless I am on strong pain meds ,and nobdy wants to give them to me,

I do not know what to do ,it is depressing and not even my family understand it. Please help.

Hello Kathy,
Be comforted, yours is not an unusual tale, and it reflects on the ignorance of all the doctors who have treated you, not on you.

One thing they have now got right. Meds do not help, and if they read their own research they would know that. And I'm afraid when doctors don't know what to do (and that includes chiropractic doctors) they often blame the patient. It's all YOUR fault!

So, stop taking those toxic meds, they won't fix it.

Anyway, now for the positive. Tietze's syndrome is very treatable. Do you have a painful swollen nodule where the rib meets the breastbone, or is it just sore?

You've already said you have pain in the middle of the back, that's where it's all coming from, but the treatment is very specific and the wrong chiropractic treatment will only increase your pain.

I know! It's taken me 25 years to work out how to treat this little monster that's plaguing you, and I often in my ignorance made it worse in the first 25 years.

Do you have any pain in your collarbone or your arm?

Can you be patient for another couple weeks? I've just given a lecture at our chiropractic convention on the treatment of Tietzes syndrome, and it will be on the web once I've got my life in order. Come back to Chiropractic-Help in a few weeks.

Meantime, shed the guilt, you're not the one to blame, and start icing the joint. Take an ice cube to the shower or bath, and put alternating ice and heat on your breastbone where it hurts.

Dr Barrie Lewis

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Hi there can you please advise me I have had pain for nearly 2 years in the rib, sternum, breast region sometimes radiating to my mid back, right under the shoulder blade.

Also I have had pain in my arm, with tingling in my fingers.

I can't lie in certain ways, I definitely can't lie on my front and twisting is a no-no.

I can't lift things for any length of time.

It's seriously affecting my life that I'm so down every day and I have 3 gorgeous girls who are not seeing the best of their mum and I am suffering.

I'm ok if I don't move but I can't go on every day like this, my daughters have health problems and severe skin conditions and I think years of doing their skin routine has over worked my muscles but I've had scans xrays blood tests and nothing is showing up I would just love a diagnosis of something and a promise it wil get better as I can't face life like this every day.

Please can you help

I,m in Scotland UK

Any advise is welcome as I have the pain clinic at the hospital soon and no one knows what to do with me. They are saying I,m a hypochondriac so I just shut up and persevere now.

I trained as a holistic therapist and qualified just before this happened and that dream is in tatters now and affecting family income.

If you can find anything then I would be so grateful,

Yours sincerely

Hello Melissa,

Regretably I can't do anything to help you, but there is sure to be someone nearby to help you out. You have what seems to be a classic case of Tietze's syndrome.

I take it you have seen the page on Tietzes at C-H, hence this letter.

Is it also giving you indigestion? The diaphragm attaches to those the lower six ribs and so upset tum is often a biproduct of the problem.

Tietze's syndrome is a dysfunction of the whole rib, hence you are getting pain all the way from the midback where the rib begins, all along its course to the breastbone.

One big NO-NO. Never let anyone manipulate you hard in the midback. That will aggravate the condition. Talk to your local Chiropractor about that, as it took me 20 years to work that out. S/he may not know it either. You need help, Melissa, see your local DC.

What you can do for yourself is:

* Fill a polystyrene cup with water and put it in the deep freeze. When frozen tear away a little of the polystyrene so that the ice is proud. Take it to the shower or bath. First give yourself an ice massage over the offending rib-breastbone joint. When very cold, go in the hot water. Repeat a few times. Do it at least once a day, preferably more often.

* Take a little massage oil or cream and gently run your index and middle finger, straddling the painful rib(s), starting at the breastbone and moving as far under the breast as you can reach.

* Lying on your side, ask hubby to use some cream to rub all along the rib from your back towards sternum, under the armpit, under the breast (no hanky panky now!). Take him with you, by the way, the treatment goes all around the breast (mostly you can pull the breast tissue out the way with your own hand which gives you a modicum of privacy.

But that rib needs a very specific and careful Chiropractic adjustment to fix this condition.

Thought: It took me me 25 years to work out the treatment of this condition. If your chiro is floundering, suggest he skype me. I'm very happy to go thru the protocol with her/him.

There's hope, Melissa. Really there is. This is something I treat on a daily basis, it's really quite common, just you have a particularly bad, and now chronic dose of it. If all else fails, I'll be in Ludlow in June, tho not sure what the laws of the land are. I'm not registered in the UK. Otherwise you could come to Dordrecht in the Netherlands for a week or two in July or August where I'll be doing a locum, nice holiday in Holland! But first your local DC.

Oh, btw, don't believe that bs about being a hypochondriac. That's we doctors do when don't know what else to do: blame the patient: IT MUST BE YOUR FAULT! This is a very real condition, just Medicine is not so good at handling musculo-skeletal conditions.

Oh, by the way, it's well known that a progressive and inadequately treated Tietzes syndrome begins to affect the neck and arms.

Let me know how you get on.

Dr Barrie Lewis


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Mar 31, 2019
by: Paul scotland

Did you ever get anyone to help you in Scotland , I am having the exact same symptoms? Hope you did!!!

Jul 10, 2016
Chest pain
by: Anonymous

I'm a 59 yr old female that had total thyroidectomy in Dec 2015. Trying to get Levothyroxine regulated has been a challenge. Have started going to a Functional Medicine Chiropractor. He specializes in helping people with thyroid and adrenal issues. I did a 30 day elimination diet and started on numerous supplements. Also have been told I have a fatty liver approx 1 1/2yrs ago by Internist.

On June 20, 2016 went to ER with chest pain. Had EKG & Chest xray and lab that determined it was not heart attack. Have continued to have episodes of chest pain off and on the past 3 wks. Earlier today had episode where could hardly breath with terrible pain between breasts. Have had pain under left breast and in left side of back by shoulder blade and in center of back.

Hands are tingling. Pain off and on in the left arm. Scheduled for stress test with neuro dept tomorrow at hospital. See internist next morning. I had never seen a chiropactor before the past 6 wks. Had never had an adjustment before. Went in to get help with thyroid. Neck and back have bothered me for a long time much more in past couple years. My husband suggested I get an adjustment since I was going to him anyway so I have had several.

Now esp if after tom stress test is normal wondering if I have costochondritis? I'm just at a loss and have been in so much pain off and on. More on past few weeks. Now taking Motrin regularly and using heating pads. Does help but isn't going away. Any help or suggestions would be so greatly appreciated.
Thank you.

One of the rules with chest pain, if it involves the rib-sternum joint is to absolutely avoid any heavy posterior to anterior manipulations in the midback.

The anterior thoracic treatment is the best option. Talk to your chiropractor.

Use an iceblock directly over the painful area in the shower, alternating cold and hot, ending with cold.

Lying on your side, ask you husband to gently massage along the painful rib, from the spine, under the breast as far as possible, and to the sternum.

With the painful rib between two fingers you can gently massage away from sternum towards the breast yourself.

No heavy PA manipulations, remember. Sorry for the late reply; I've been on two weeks leave.

Dr Barrie Lewis

Nov 04, 2012
adjustment for tietzes
by: Anonymous

I would love to know more about the adjustment so I can have it done here in the usa. I have been having trouble since I started wrking out. I stopped and the problem seems to be getting worse with bad weather. My armpit feels swolle when it comes on and my sternum "clicks" when i sneeze. I feel that click under my arm,, it seems. Tks! Lisa

Hello Linda,
Turning a lecture I gave to the national chiro association into a pdf file is one of things on the to-do list, fraid I can't promise when.

Whilst it took me 25 years to figure how to treat Tietzes, I'm sure there must other chiros, probably many, who could successfully treat you. Just ask before you make the appt. If they've never heard of Tietzes, move on.

A quick rule of thumb: a heavy post to ant manipulation will aggravate the condition, whereas an "anterior thoracic" is a large part of the successful treatment of Tietzes.

Get your doc to check out that swollen armpit.

Dr Barrie Lewis

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