Treatment for costochondritis

Treatment for costochondritis is largely unproven and frankly ineffective. I as a chiropractor struggled with the condition for twenty five years before coming up with a protocol that is still not researched, but yes, it does work. It quite likely won't cure you, but if you're satisfied with a sixty odd percent lessening of pain, then I recommend it.

The condition can also affect the sternoclavicular joint with similar pain, but often then with associated pain and tingling down the arm that does not follow a dermatomal pattern. It is in effect a variation of thoracic outlet syndrome.

If there is actually a palpable lump over the joint then it's known as Tietze's syndrome.

The causes of costochondritis may be trauma, for example a fall on the fist when skating. A severe bout of coughing or sneezing can set it off, usually associated with a sharp pain in the shoulder blade area; a tight chest ensues and there may well be shortness of breath.

Lifting heavy boxes above the head is another cause.

Because the pain is often located over the heart, or under the breast, there is often considerable anxiety associated with the condition. Since it follows the rib, there is often discomfort in the armpit, or lower, depending on which joint is affected.

Rarely an infection such as TB or a tumor can cause it, but that's really not common. I've never seen that in chiropractic practice in 35 years.

As the diaphragm is also attached to the underside of the ribs, pain after eating and stomach upsets are common complaints.

There are reports of costochondritis and Tietze's syndrome after breast surgery.

Costosternal cartilage.

Thus it's good when making an appointment with your chiropractor for treatment for costochondritis to be able to answer questions about when the pain began and if it's getting worse and whether any lung, heart or breast conditions need to be considered.

Have you recently been coughing a lot, and do deep breaths cause pain? Are there any other medical conditions that might have a bearing on your  costochondritis symptoms? Shortness of breath in particular needs to be considered.

Treatment for costochondritis

Treatment for costochondritis with chiropractic certainly helps reduces the pain but may not cure the condition.

To my knowledge there's no scientifically proven treatment for costochondritis. It's a condition that both medicine and chiropractic struggle with. It took me 25 years to come to terms with it, and work out a protocol that is reasonably effective. Patients gain substantial relief, but few are cured.

First it needs to be acknowledged that a vigorous manipulation in the middle of the back will probably aggravate the condition and, in fact, overly enthusiastic chiropractic treatment is one of the causes of osteochondritis.

The effective treatment for costochondritis involves a gentle anterior thoracic chiropractic adjustment, and soft tissue treatment along the course of the intercostal nerve and the rib at the costochondral junction.

Since the condition may also affect the clavicular sternal joint, mobilisation of the collarbone and the AC may be important.

Alternating ice and heat treatment in the shower should be done daily. An ice block, directly on the costochondritis pain spots, followed by hot water is ideal.

Then using a little cream, massaging between the ribs at the junction with the sternum is particularly relieving.

It does not need to be emphasised, but clearly taking a friend or partner along for treatment of costochondritis makes sense. Treatment encroaches on the breast, making both doctor and patient anxious. Alternatively ask if a secretary can be present. Sexual advances by a chiropractor certainly does occasionally occur.

Costochondritis and stress casefile

Mrs M, a fifty year old woman, has had a particularly stressful life. Forced to go out to work because her husband failed repeatedly in business, she became the breadwinner whilst he stayed at home for long periods.

An old injury to the mid thoracic spine whilst joyriding as a teenager appears to be the primary cause of her costochondritis. Whether the compressed and elongated bone is the result of a spinal fracture thirty years ago, or a mild dose of Scheuermann's disease, remains conjecture and a matter of opinion.

Certainly she has shoulder blade and armpit pain radiating to and from the spine to the breastbone; and stomach upsets and pain after eating.

Fortunately there was no obvious soft tissue swelling over the costochondral joints. Nevertheless, gentle mobilisation of the mid thoracic spine caused immediate severe pain in and around the breastbone. There was the extreme rigidity that is the hallmark of Scheuermann's disease.


Xrays reveal a mildly compressed, or Scheurermann's type vertebrae, fortunately without Schmorl's nodes, or severe endplate erosions.

She had never heard of Tietzes syndrome and confessed to deep seated fears over her heart. Her blood pressure was seriously raised at the first consultation at 185/105.

Upper cervical pain was in fact the presenting complaint, but every chiropractor knows to tread warily when manipulation of the neck is the otherwise treatment of choice in the hypertensive patient.

Fortunately she responded very quickly to gentle activator treatment of her neck, and an anterior thoracic adjustment.

After only three treatments she stated that the pain in her neck and breastbone was 70 percent reduced. A repeat of the previous treatments plus stiff neck exercises was the protocol then followed.

A consultation with her GP, gave a tentative diagnosis of white coat high blood pressure, but I was not happy about giving an upper cervical adjustment.

Update: The good news is that the treatment for this lady's costochondritis has been very successful. Tenderness remains to touch, but she has no frank pain in the chest any longer. Also her neck is 80% better despite the very conservative gentle treatment. The bad news is that her blood pressure is as high as ever. Life threatening high.

Tietzes syndrome

Tietzes syndrome is a grade IV costochondritis, or -osis.

All of these symptoms, accompanied by a swollen tender lump over the costochondral junction is pathognomonic of Tietze's syndrome.

In fact in my book, Tieze's syndrome is but a grade IV ostochondrosis. Mostly this is a non inflammatory condition, hence the osis, instead of itis, which is why it doesn't respond to anti inflammatory drugs.

This Tietze's syndrome casefile may give some further insights.

Wholism @ treatment for costochondritis

Patients are usually offended and angry if a doctor broaches the subject of their weight. They have tried every diet in the book, and simply cannot lose weight.

I address the subject of weight and smoking, once only, but very clearly, and then hold my tongue; we are ultimately responsible for our own health.

The woman above was at least 50 pounds overweight, hence her alarming blood pressure of 185/105 on three different drugs to control it. It's life threatening. I recommended instead of following any diet that she learn about the meaning of the term "glycemic index, or GI" of starches, and avoid high GI foods. White rice and white bread are the chief culprits.

A summer salad.

Useful links @ treatment for costochondritis

› Costochondritis

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.

Interesting questions from readers