Costochondritis

You can't reliably tell on your own, and a physiotherapist shouldn't be the first to try.

Doctors treat costochondritis as a diagnosis of exclusion. It's what remains once the serious causes of chest pain have been ruled out: a heart attack, a blood clot in the lung (pulmonary embolism), a tear in the body's main artery (aortic dissection), pneumonia, and a collapsed lung (pneumothorax) ³.

Your GP will examine you and may order an ECG (a heart tracing), a chest X-ray or blood tests to rule those out ¹. An ECG and chest X-ray should be considered for any adult with chest pain. In costochondritis, both come back normal ³. Your pulse and blood pressure should be normal too. A fast heart rate or low blood pressure points towards something else ³.

One common belief needs correcting. Pain you can reproduce by pressing on your chest does not rule out your heart. Heart-related chest pain can occasionally be reproduced by pressure too ³. That's why tenderness helps a doctor build the picture but can't settle the question for you.

Once the serious causes are off the table, other chest-wall problems can still look similar. A pulled chest muscle and an intercostal strain each have their own page. Working out which one you have is part of a proper assessment.

No scan shows costochondritis. Once the serious causes have been dealt with, the diagnosis comes from your story and a hands-on examination, and more imaging isn't recommended just to confirm it ³.

Your doctor will ask what brings the pain on and what makes it worse. Then they'll press gently on the joints where your ribs meet the breastbone to see whether that reproduces it, and check whether movement does too ¹. Often the sore spot is where one or two ribs join the breastbone ³. They'll look at the skin and the joints around the breastbone as well. Warmth, redness, swelling or a rash don't belong to costochondritis and point to something else ³.

We see people once a doctor has ruled out the serious causes, usually because the pain is lingering longer than expected, keeps coming back, or is getting in the way of work, sleep or training.

Here's what the evidence does and doesn't show. In that case series, eight people who'd had costochondritis for an average of 6.3 months had about five sessions. Their pain and function improved, and all eight returned to their usual activities ⁴. But there was no comparison group, so natural recovery can't be ruled out. The authors say physiotherapy "may facilitate" recovery ⁴, and we'd put it the same way: a reasonable option for costochondritis treatment when pain persists, not a guaranteed fix.

Once a doctor has ruled out the serious causes of chest pain ³, costochondritis that lingers follows The Well Motion Recovery Path™. You move up a phase when your chest tolerates more, not when a date arrives.

• Reset: from your first visit, after medical clearance. Heat, and easing off the movements that trigger the pain ^1,3. Expect deep breaths, coughing and lying down to stay sore for a while ^1,2. We move you on once breathing and everyday movement no longer set the pain off.
• Rebuild: for pain that has not settled. Manual therapy to the upper back and ribcage ⁴, with stretching and gentle, low-impact exercise ^1,3. Expect uneven progress, because coughing and sneezing can stir the pain up again ³. We move you on when you can stretch and exercise without a flare the next day.
• Return: back to lifting, training, a physical job or sleeping comfortably. Heavy lifting and repetitive upper-body movement are recognised triggers ^1,2, so we build those loads back in steps. You leave with a home stretching routine and the warning signs that need a doctor ³.

How long it usually takes. Over 90% of people improve within three to four weeks ³, and some cases last several months ². For pain that persists, no study gives a reliable timeframe for physiotherapy. The only evidence is one small case series with no comparison group ⁴, so we will not put a number on it.

Costochondritis rarely comes back ¹, and no trial has tested how to prevent it. So this list works from its recognised triggers:

• Lifting and repetitive upper-body work. Heavy lifting and repetitive upper-body movements are recognised triggers and the activities to cut back ¹. When you return to the gym or a physical job, build back up in steps instead of going straight to your old weights.
• A cough that won't quit. Heavy coughing is a recognised trigger ¹, and coughing and sneezing can stir the pain up again ³. Get a lingering cough or chest infection treated ¹.
• Gentle, regular exercise. Low-impact exercise that works the chest muscles without straining them is the one active step recommended to lower the chance of a repeat ³.
• Know when a flare-up isn't one. Worsening chest pain, shortness of breath, dizziness, fainting, or swelling or a rash on the chest need a doctor, not another week of waiting ³.