Costochondritis

What you get told is that costo or Tietze’s is a mysterious inflammation of the joints where your ribs hinge onto your breastbone - it has no known cause, it’ll settle down in a few weeks, and take these anti-inflammatory medications.

There is almost no medical research evidence supporting any of those statements.  For instance, no-one has ever (2018) done a clinical trial to see if anti-inflammatories or steroid shots into the rib joints actually help costo.  If you’re reading this, it’s probably because the standard medical approaches haven’t fixed you.

Neither have the vast array of non-medical suggestions - turmeric, Vitamin D, CBD oil, omega-3, etc.  Certainly, if you take or inject enough medications they’ll dampen any pain, and if your body is healthier because of the non-medical supplements, then it’ll handle inflammation and pain better.

But all these treatments don’t help much, or don’t work at all; and anyway don’t last. There’s a very clear reason - none of them, medical and non-medical, treat the CAUSE of the costo pain, so they all miss the point.

This is easy to follow.  Think of your ribs like bucket handles, hinged at the front (onto the breastbone) and at the back (onto your backbone).  The ribs lift up and down as you breathe, and also move as you twist and move around. 

Now, if the posterior rib joints (where the ribs hinge onto your spine) are frozen solid and not moving, then the more delicate joints where the ribs hinge onto your breastbone HAVE to work excessively, just to let you breathe.

So they 'give', strain, get irritated, then get inflamed - and there’s your costochondritis.  If they’re inflamed enough to produce obvious swelling then it’s called Tietze’s Syndrome.  And they never get a rest, as long as you keep breathing.

That's why you get the sharp stabbing pains and clicking with costo - as the rib joints on your breastbone 'give' with movement.  These are NOT symptoms you get from inflammation, which is silent and constant.

This explanation is the only, repeat only, one which makes sense of why you get such specific pain just at the rib joints on the breastbone and nowhere else in the body. It’s supported by medical research, e.g. a recent (2017) US paper by Zaruba and Wilson. 

It explains why you often get breathless with costo - you can't inhale fully if your rib joints can't move.  It fits with the known anatomy and physiology.  It's sensible - and it makes treatment logical, effective and quick.

Instead of going on a mystical quest for the magic bullet which will somehow disappear this mysterious inflammation that nobody understands, all you have to do is free up the frozen rib machinery around the back, and the straining rib joints on the breastbone can settle down.

This is pretty common, and there are various reasons - impact on the rib cage, much coughing (which is a surprisingly strong percussive impact on the rib joints) and straining or twisting - especially from dips in the gym.  The rib joints commonly get quietly tight with asthma, ankylosing spondylitis and scoliosis.  

Chest surgery like a thoracotomy or sternal split puts a MASSIVE strain on the rib joints as the ribs are cranked apart to allow the surgery, and they will commonly scar and freeze afterwards.  Scoliosis surgery straightens and fuses the spine, and can leave immobile rib joints in its wake.  (These are not fused, and can be freed up).

There seems to be much more costo recently, with people hunching over laptops, tablets and smartphones.  As the hunching spinal joints tighten and freeze, so too do the rib joints - setting off the costo pain around the front when they get tight enough.  See our iHUNCH page for a good explanation and how we sort it out.

Almost everyone with costo has some pain around the back and/or side as well.  This is why - it’s from the tight or immobile rib joints round the back.  It's not an unusual extra - it's the basis of most costo.  It's just that everyone focuses on the worse, scarier pain round the front.

This isn't conclusive (no single test for costo is) but is a good indicator that you have this locking rib problem at the back driving your costo pain on your chest.  It works best if your chest pain is mostly one-sided.

Sit squarely on a desk, table or bench.  Get someone to take hold of your shoulders and rotate your torso to both sides.  Normal range would be about 90˚, with your shoulders coming into line with your thighs.

If your rib (and spinal) joints are jammed on one side, causing the costo pain on that side, then you won’t rotate so far towards that painful side.  If so, then what you’ve got is NOT a mysterious inflammation which nobody understands, but a straightforward musculoskeletal locking joint problem which is not difficult to sort out.  (This joint locking will not show on X-ray, CAT or MRI scans - these are essentially still photos, and cannot show whether the joints can move or are frozen solid.)

This is perfectly logical - you free up the tight rib machinery around your back and sides which is causing the overuse strain and pain of the rib joints on your breastbone.  This is quite quick and not difficult - it's basic New Zealand manual physiotherapy.  It's MUCH easier than trying to heal a "mysterious inflammation" that nobody understands.

How to do it is explained in our YouTube video ‘How to fix (most) costochondritis and Tietze’s Syndrome chest pain; Part (2)’. 

As well as freeing up the posterior rib hinges, you may need some massage and stretches for the tight muscles - and a Backpod.

The essential core of fixing most costo and Tietze’s is freeing up the tight and frozen posterior rib hinges.  As far as we can tell, there isn’t anything other than the Backpod that will do this effectively - for clear technical reasons.  Foam rollers are the next best thing, but their long cylindrical shape spreads the load so you can’t get much stretch pressure onto the rib joints.  Swiss balls are too wide and rolled towels are too squashy.  All balls and rollers are unstable, so your muscles can’t relax when you’re on them - this limits the stretch.

The Backpod's stable peaked form, shape, size and construction are exactly designed from 30 years of physiotherapy expertise to give the best possible stretch for tight rib (and thoracic spinal) joints.  You can bang stuck joints free with manipulation, but they don’t stay free unless you also stretch the tough, tight collagen material around them - hence the Backpod.

For one young woman’s report on using the Backpod, see Samantha Wayne’s YouTube video (2018) ‘Costochondritis / The Backpod’.  After a year of debilitating costochondritis, she was pain-free in three weeks on the Backpod, and back in the gym after that.

This is the usual response with costo and Tietze’s - feeling obviously better in the first week, and 90% better in three weeks.  That’s the timing you’d expect with freeing up a frozen joint problem - it’s in the real world.

Of course it can vary, but freeing up tight joints essentially isn’t difficult - MUCH easier than searching for a non-existent magic potion to somehow disappear a "mysterious inflammation" of no known cause.  Regardless of what you've been told, the mysterious inflammation idea is not evidence based - we've gone back over the published medical research and looked.

DO follow the instructions in the detailed user guide - this comes as a booklet with the Backpod, or download or view it here.  Lying back on the Backpod uses your own upper body weight to quietly stretch tight and frozen spinal and rib joints. 

With costochondritis, make sure you also use the Backpod positioned slightly to the side of the spine over the curve of the ribs, to quietly stretch free the tightened rib joints. 

Using it positioned under the midline of the spine will stretch a tightened upper back hunch, and you’ll probably need to do this too.  Usually 10 minutes once a day, changing position every minute or so, is all that’s needed for an effective stretch.  For a video on how to use the Backpod, click here.

If this sounds simple - it is.  All you're doing is using your upper body weight focused over the Backpod to effectively stretch tight rib and spinal joints.  It's like stretching tight hamstrings - if you do that for 10 minutes daily for a few weeks, sure they'll get freer.