Costochondritis

Overview

Costochondritis (say: KOS-toh-kon-DRY-tiss) is pain and swelling where the ribs join the breastbone. The breastbone is the flat bone in the middle of your chest. Strong, stretchy tissue called cartilage connects your ribs to it, and when that cartilage gets sore or inflamed, it causes chest pain. The pain can feel sharp or aching, and it often gets worse when you take a deep breath or press on the spot. The important thing to know is that costochondritis affects the chest wall, not the heart or lungs. It is not a heart attack, and it does not damage your heart.

Yes, costochondritis is a common cause of chest pain, especially in young adults and teenagers. It is one of the most frequent reasons people go to their doctor or an emergency department with chest pain.

It can affect anyone, but it is most common in people between about 20 and 40 years old, and it affects women more often than men. It also happens in children and teenagers, often after a cough or cold. In older adults, chest pain is more often caused by heart or lung problems, so it needs careful checking.

Symptoms

Common symptoms

• Sharp, aching or stabbing pain in the middle of your chest, often just to the left of your breastbone
• Pain that gets worse when you breathe in deeply, cough, sneeze or laugh
• Pain that gets worse when you twist, reach, lift or move your upper body
• Tenderness when you press on the sore spot on your chest
• Pain that may spread to one or both sides of your chest, or sometimes to your back or belly
• Feeling short of breath simply because taking a deep breath hurts
• Pain that eases when you breathe in a shallow way

Symptoms in children

• Children and teenagers can get costochondritis, often after a cough, cold or a growth spurt
• A child may point to one specific sore spot on their chest rather than describing a general ache
• They may avoid sports, deep breathing or rough play because it hurts
• Chest pain in a child should always be checked by a doctor, even though costochondritis is usually harmless

Symptoms in older adults

• Chest pain in older adults is more likely to come from the heart or lungs, so it needs prompt checking
• Costochondritis can still happen, often after a chest infection, a fall or strain
• Rib pain in older adults may also come from thin or fragile bones, so other causes are looked at first
• Any new chest pain in an older adult, especially with other health conditions, should be checked quickly

Causes

Main causes

• Often the exact cause is not known — this is very common
• A recent viral infection with a lot of coughing, which strains the chest wall
• Repeated strain on the upper body from sports, lifting, new exercise or heavy housework
• A direct knock or injury to the chest
• Poor posture or holding your body in one position for a long time, such as at a desk
• In some people, it is linked to inflammatory conditions such as certain types of arthritis or ankylosing spondylitis
• Rarely, an infection of the joint between the rib and breastbone

Risk factors

• Being a young adult or teenager
• Being female
• Having a recent cold, flu or chest infection with a lot of coughing
• Starting a new upper-body exercise or doing a lot of lifting
• Playing sports that use the arms and chest, such as rowing or swimming
• Sitting or standing with poor posture for long periods
• Having an inflammatory joint condition or arthritis
• A recent injury or fall onto the chest

When to see a doctor

See a doctor urgently if:

• You have chest pain for the first time — get it checked the same day, even if you think it is muscle pain
• The pain comes with shortness of breath, sweating, nausea, dizziness or a racing heartbeat — call your local emergency number straight away
• You have a fever along with chest pain
• The pain suddenly gets much worse, or you cannot breathe deeply because of it
• You have a heart or lung condition and get new chest pain

Book a routine appointment if:

• The pain keeps coming back or has lasted more than a few weeks
• The pain is affecting your sleep, work, exercise or daily life
• You are not sure what is causing the pain
• You want advice on pain relief or gentle exercises
• The pain is making you feel anxious or worried about your heart

Diagnosis

There is no single test for costochondritis. A doctor usually makes the diagnosis by talking to you about your pain and examining your chest. They will gently press along your breastbone and ribs to find the tender spot, listen to your heart and lungs, and check your breathing. A key clue is pain that is worse when you press on one specific spot. Your doctor will also ask questions to rule out other causes, especially heart or lung problems. If your pain fits the typical pattern and your examination is otherwise normal, you may not need any tests at all.

Tests that may be done

• A physical examination, including pressing on the chest wall to find tender areas
• Listening to your heart and lungs with a stethoscope
• An electrocardiogram (ECG) — a quick, painless recording of your heart's electrical signals — if there is any doubt about the heart
• A chest X-ray if a lung problem or injury is possible
• Blood tests if an infection or inflammatory condition is suspected
• Other heart tests, such as an ultrasound of the heart, only if your doctor thinks they are needed

What to expect at your appointment

The appointment is usually short and simple. Your doctor will ask when the pain started, what makes it better or worse, and whether you have had a recent cough, cold, injury or new exercise. They will gently press on your chest. You may be sent for an ECG or X-ray to be safe, especially if you are older or have other risk factors. Being told your heart is fine is often a big relief, and for many people that is the main thing they need from the visit.

Treatment

Costochondritis usually gets better on its own with time. The aim of treatment is to ease the pain while your chest wall heals, and to make sure nothing more serious is going on. Most people do not need strong medicines or any procedures. Your doctor will talk you through simple self-care steps and may suggest pain relief you can buy from a pharmacy. If the pain is not settling, they may refer you to a physiotherapist for gentle exercises and advice.

Self-care at home

• Rest the area — avoid heavy lifting, pushing, pulling and high-reach activities for a while
• Try a warm pack or a covered hot water bottle on the sore area for short periods, or a cool pack if that feels better
• Take your usual everyday activity gently — complete rest is not usually needed, but build up slowly
• Practise slow, relaxed breathing rather than very deep breaths that hurt
• Check your posture at your desk, in the car and on the sofa, and take regular breaks to move
• Once the sharp pain settles, gentle stretching of the chest and shoulders can help — a physiotherapist can show you how
• Ask your pharmacist which over-the-counter pain reliever is safe for you, especially if you take other medicines or have stomach, kidney or heart problems
• Sleep in a comfortable position, perhaps with an extra pillow, to reduce strain on your chest

Medical treatments

Treatment is kept simple. Your doctor may suggest a pain reliever or an anti-inflammatory medicine from the pharmacy, chosen to suit your health and other medicines — always follow the label or your pharmacist's advice. If the pain is severe, your doctor may prescribe a stronger pain medicine for a short time. Some people are offered a steroid injection into the sore joint by a specialist, but this is not common. A physiotherapist can teach gentle stretching and breathing exercises. Anything that made the pain worse — such as a new gym routine — should be paused and restarted slowly. Your doctor will also treat any underlying condition, such as an inflammatory arthritis, if one is found.

When is surgery considered?

Surgery is not used to treat costochondritis.

Living with this condition

Most people can carry on with normal life while the pain settles, but you may need to change how you do a few things for a few weeks. Avoid heavy lifting and repetitive reaching, take breaks during tasks that use your arms, and pace yourself. Some people find that shallow breathing is uncomfortable, so try relaxed breathing rather than holding your breath. Keep a simple note of what makes the pain better or worse — this helps you and your doctor see progress. The pain usually fades gradually rather than disappearing overnight, so give it time.

Lifestyle tips

• Build up activity slowly rather than going straight back to your old routine
• Warm up before exercise and cool down afterwards
• Set up your desk, chair and screen so you are not hunched forward
• Take a short moving break every 30 to 45 minutes when sitting
• Avoid carrying heavy bags on one shoulder
• Get regular sleep and try to keep stress in check, as tension can make chest wall pain feel worse
• Stay active in gentle ways, such as walking, while the pain settles

Diet and exercise

There is no special diet for costochondritis — eating a balanced, varied diet and staying well hydrated supports general healing. Exercise is helpful, but choose gentle movement while the pain is sharp. Walking, light cycling and gentle stretching are good options. Swimming and rowing use the chest and arms a lot, so ease back into them slowly. Stop any activity that causes sharp pain, and restart at a lower level. A physiotherapist can help you plan a safe return to sport.

Mental health and emotional wellbeing

Chest pain is scary, and many people worry that something is wrong with their heart. That worry can cause anxiety, poor sleep and a low mood, and anxiety can in turn make pain feel stronger. Being told your heart is fine often helps a lot. If you are still feeling anxious, or you find yourself checking your chest or searching symptoms often, talk to your doctor. Breathing exercises, relaxation, talking to someone you trust, and keeping gently active can all help. If low mood or anxiety is affecting your daily life, support is available — speak to your doctor or a local mental health service.

Prevention

There is no sure way to prevent costochondritis, because in many cases the cause is never found. But you can lower your chances of straining your chest wall. Warm up before exercise, build up new activities gradually, use good posture, take breaks from repetitive tasks, and treat a cough or chest infection sensibly by resting and staying hydrated. If you have an inflammatory joint condition, keeping it well controlled with your doctor's help is important.

Vaccines

There is no vaccine for costochondritis. Staying up to date with recommended vaccinations, such as flu and COVID-19 vaccines where offered, can reduce the chance of a chest infection with heavy coughing — one of the triggers for chest wall pain.

Screening programmes

There is no screening test for costochondritis. The important thing is to have any new chest pain checked once by a healthcare professional so that other causes can be ruled out.

Complications

If left untreated

• The pain may last longer or keep coming back if you keep straining the chest wall
• You may avoid exercise, deep breathing or certain movements, which can slow your recovery
• Ongoing pain can cause worry, poor sleep and low mood
• The main risk of ignoring chest pain is missing a more serious cause, such as a heart or lung problem — this is why new chest pain should always be checked
• Costochondritis itself does not damage the heart, lungs or bones

Long-term outlook

The outlook is good. Most people with costochondritis feel better within a few weeks, and nearly everyone improves within a few months. Some people have discomfort that comes and goes for a while, but it is not dangerous. With sensible rest, gentle activity and pain relief when needed, you should be able to get back to your normal life. If the pain is not settling, go back to your doctor — there is more they can offer.

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