Costochondritis
Rib joint assessment can help determine whether chest pain behaves like a musculoskeletal chest wall problem.
Costochondritis causes pain and tenderness around the joints where the ribs meet the breastbone. Symptoms often change with breathing, coughing, upper-body movement or pressure over the chest wall. However, chest pain can also have serious causes, so new or unexplained chest pain should not be assumed to be costochondritis.
What Is Costochondritis?
Costochondritis is pain and irritation around the junctions where the ribs connect with the breastbone. These areas include the costochondral and costosternal joints. They move slightly as the rib cage expands during breathing and as the upper body twists, reaches and lifts.
There is no single clinical test or scan that proves costochondritis in every case. Diagnosis usually depends on the symptom pattern, examination findings and exclusion of other important causes of chest pain.
A health professional may need to consider cardiac, respiratory, gastrointestinal, inflammatory, traumatic and other musculoskeletal causes before deciding that costochondritis is the likely source.
What Are the Symptoms of Costochondritis?
Costochondritis commonly causes localised pain around one or more rib joints at the front of the chest. The pain may feel sharp, aching, burning or pressure-like. Some people also feel discomfort around the side of the rib cage or towards the upper back.
Chest wall tenderness
One or more areas near the breastbone may feel sore when touched or pressed.
Breathing and coughing
Deep breathing, coughing, sneezing or laughing may increase chest wall pain.
Upper-body movement
Reaching, lifting, pushing, pulling or rolling in bed may reproduce symptoms.
Rib or upper-back stiffness
Some people notice stiffness through the ribs or thoracic spine alongside their chest pain.
Activity sensitivity
Gym work, rowing, swimming, throwing or repetitive upper-body activity may aggravate symptoms.
Variable symptoms
Pain can fluctuate as breathing, posture, coughing and physical load change.
Chest wall tenderness provides useful information, but tenderness alone does not prove that pain is harmless or musculoskeletal. Serious conditions can sometimes produce overlapping symptoms.
For other upper-back, rib and chest wall conditions, see the thoracic pain conditions guide.
What Else Can Feel Like Costochondritis?
Several conditions can produce pain around the chest, ribs or upper back. Assessment is particularly important when symptoms are new, unusual, severe or do not follow a clear musculoskeletal pattern.
Heart and lung conditions
Heart and lung problems can cause chest pain that overlaps with musculoskeletal symptoms. Pain quality alone cannot reliably identify the cause. Seek urgent medical care when chest pain has concerning features or is accompanied by breathlessness, fainting, sweating, nausea or other systemic symptoms.
Our chest pain – spine issue or heart attack guide explains important warning signs and when urgent care is appropriate.
Thoracic facet or rib joint pain
Pain arising from the thoracic spine or rib joints may be felt around the chest wall and can change with twisting, bending, breathing or sustained postures. Read more about thoracic facet joint pain.
Rib stress injury
A rib stress fracture can cause focal rib pain, particularly after repeated loading from sport, rowing or other repetitive activity. Pain may also increase with deep breathing or coughing.
Muscle strain
Muscles between and around the ribs can become painful after forceful movement, coughing or sport. A side strain more commonly affects the lateral or lower rib region.
What Causes Costochondritis?
Costochondritis does not always have one obvious cause. Symptoms may develop after increased chest wall loading, repetitive upper-body activity, persistent coughing or direct trauma.
Possible triggers or contributing factors include:
- a sudden increase in gym or upper-body training
- rowing, throwing, swimming or repeated pushing activities
- forceful or persistent coughing
- sporting contact, a seatbelt injury or another direct impact
- repetitive lifting or physically demanding work
- reduced thoracic or rib mobility
- prolonged postures that repeatedly aggravate symptoms
Posture can influence how load is distributed through the thoracic spine and rib cage, but there is rarely one universally “correct” posture that prevents costochondritis. Changing position regularly and improving tolerance to required activities is usually more useful than trying to hold one rigid position.
For practical advice, see our information about posture and physiotherapy and posture exercises.
How Is Costochondritis Assessed?
Assessment starts by determining whether the symptoms behave like a musculoskeletal chest wall problem and whether medical review is required first.
Your physiotherapist may ask about:
- where the pain started and how it has changed
- breathing, coughing and other symptom triggers
- recent illness, trauma or changes in physical activity
- work, sport, gym and lifting demands
- medical history and other associated symptoms
A physical assessment may then examine:
- tenderness around the ribs and chest wall
- thoracic spine and rib movement
- shoulder and neck movement where relevant
- breathing mechanics
- movements or loads that reproduce the person’s familiar symptoms
Reproducing familiar pain during a chest wall examination can support a musculoskeletal explanation, but no single finding should be used in isolation to rule out other causes.
Imaging is not always required for a typical musculoskeletal presentation. A doctor may recommend investigations when symptoms follow trauma, are severe or persistent, have atypical features or raise concern about another condition.
Rib movement, breathing and thoracic mobility may form part of a chest wall assessment.
How Is Costochondritis Treated?
Management depends on the likely source of symptoms, their irritability and the activities you need to return to. Once serious causes of chest pain have been appropriately excluded, physiotherapy may help reduce aggravation and gradually restore comfortable movement and activity.
Early symptom management
Early treatment may involve temporarily reducing movements or loads that repeatedly provoke symptoms while keeping comfortable general movement going.
Depending on the assessment, management may include:
- advice about temporarily modifying painful activities
- gentle rib or thoracic movement where appropriate
- strategies for comfortable sleep, desk work, driving and lifting
- heat or cold if the person finds it useful for short-term symptom relief
- gradual restoration of normal breathing and upper-body movement
Rib and thoracic movement
Some people develop protective stiffness around the rib cage or thoracic spine. Appropriate mobility exercises may help restore comfortable movement without repeatedly provoking the irritated area.
Breathing and movement confidence
Pain can lead to guarded breathing or reluctance to move the upper body. Graded breathing and movement exercises can help restore normal movement while symptoms settle.
Strength and return to activity
As symptoms improve, rehabilitation may progress towards the loads required for work, gym, sport and everyday activities.
This may include:
- shoulder blade and upper-back strengthening
- trunk and thoracic strengthening
- graded pushing, pulling and lifting
- progressive return to gym exercises
- sport-specific loading where relevant
Treatment varies between people. Physiotherapy should not be presented as a guaranteed cure, and persistent or changing chest pain may require further medical review.
Why Does Load Management Matter?
Chest wall symptoms often become more irritable when activity increases faster than the tissues can tolerate. Complete rest is not always necessary. Instead, the aim is usually to reduce clear aggravating loads temporarily while maintaining comfortable movement and then rebuilding activity gradually.
A Simple Activity Guide
Comfortable movement
Continue gentle movement that feels manageable and does not cause a significant or lasting flare.
Painful activity
Consider reducing the load, range, speed, repetitions or duration before stopping activity completely.
Unusual symptoms
Seek appropriate medical review if symptoms change, become severe or no longer behave like a typical musculoskeletal problem.
Our exercise load management guide explains how physical activity can be progressed in manageable steps.
How Long Does Costochondritis Last?
Recovery varies. Some episodes improve within several weeks, while others remain sensitive for longer. Duration can be influenced by the underlying trigger, repeated aggravation, persistent coughing and the physical demands placed on the chest wall.
A gradual improvement in pain, breathing comfort and activity tolerance is generally more useful than expecting recovery to follow an exact timetable.
When symptoms persist, return repeatedly or change significantly, reassessment can help determine whether the diagnosis or management plan needs to change.
Related PhysioWorks Articles
Frequently Asked Questions
How long does costochondritis usually last?
Some episodes improve within several weeks, while others take longer. Recovery varies with the underlying trigger, repeated aggravation, coughing and the physical demands placed on the chest wall.
Can physiotherapy help costochondritis?
Physiotherapy may help when serious causes of chest pain have been appropriately excluded and symptoms behave like a musculoskeletal chest wall problem. Management may include assessment of rib and thoracic movement, activity modification, mobility exercises, breathing strategies and gradual strengthening.
What is the difference between costochondritis and Tietze syndrome?
Both can cause pain around the rib joints near the breastbone. Tietze syndrome is less common and characteristically includes localised swelling around an affected costochondral joint, whereas obvious swelling is not typical of costochondritis.
Can exercise make costochondritis worse?
Yes. Exercises such as push-ups, bench press, dips, rowing or other repeated upper-body loading may aggravate an irritable chest wall. This does not necessarily mean all exercise must stop. Reducing the aggravating load and returning gradually is often more practical.
Is costochondritis dangerous?
Costochondritis itself is generally a musculoskeletal chest wall condition. However, chest pain can also result from serious heart, lung and other medical conditions. New, severe, unusual or unexplained chest pain should receive appropriate medical assessment.
Do you need a scan for costochondritis?
Not always. Costochondritis is commonly assessed from the clinical history and examination rather than confirmed by one scan. Imaging or other investigations may be considered after trauma or when symptoms are severe, persistent, atypical or suggest another condition.
When should you see a physiotherapist?
Physiotherapy may be appropriate after urgent or important medical causes have been excluded when chest wall pain persists, repeatedly returns or limits comfortable movement, work, exercise or sport.
Choose your clinic and appointment pathway
Select a PhysioWorks clinic to continue to live booking, an appointment request or reception assistance.
References
- Schumann JA, Sood T, Parente JJ. Costochondritis. StatPearls. Updated 2024.
- Mott T, Jones G, Roman K. Costochondritis: Rapid Evidence Review. American Family Physician. 2021;104(1):73-78.
- Healthdirect Australia. Chest pain. Healthdirect Australia.
- Mayo Clinic Staff. Costochondritis: Diagnosis and treatment. Mayo Clinic.
- Mandrekar S, Venkatesan P, Nagaraja R. Prevalence of Musculoskeletal Chest Pain in the Emergency Department: A Systematic Review and Meta-analysis. Scandinavian Journal of Pain. 2021;21(3):434-444. doi:10.1515/sjpain-2020-0168.
- Stowell JT, Walker CM, Chung JH, et al. ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. Journal of the American College of Radiology. 2021;18(11S):S394-S405.
