Costochondritis: Symptoms, Causes, and Treatment

one of the most common causes of chest wall pain that is not related to the heart. It produces sharp, localised pain that gets worse when you breathe deeply, press on the area, or lift something heavy. It is not dangerous, and in most cases it settles on its own.

We know that word “chest pain” is frightening. If your pain came on suddenly and comes with shortness of breath, sweating, nausea, or pain spreading into your arm or jaw, stop reading and call 000. That is not something to sit on.

At ME Physio we assess costochondritis by looking at the whole chest wall system: rib joint mobility, thoracic spine stiffness, breathing pattern, and shoulder mechanics. In our clinical experience, the people whose pain keeps coming back are almost always the ones whose underlying load pattern was never changed, not the ones whose cartilage failed to heal. That is the difference between waiting out a flare and actually preventing the next one.

Key Insights

• Costochondritis affects the costochondral joints, where ribs 2 to 7 meet the sternum. Pain is usually on the left side, which is why it is so often mistaken for a cardiac problem.
• The single most useful clue is reproducibility. If pressing on the cartilage recreates your exact pain, a cardiac cause is far less likely.
• Most cases settle within 3 to 6 weeks. Some take a few months, particularly if the aggravating activity continues.
• It is self-limiting, not something physiotherapy “cures”. What we can change is your pain levels, your movement, and how likely it is to return.
• Recurring costochondritis is usually a load problem, not a healing problem. Posture, breathing mechanics, and training habits matter more than rest alone.

What Is Costochondritis?

Costochondritis is inflammation of the costochondral joints, the small cartilage connections between your ribs and your breastbone (sternum). When that cartilage becomes irritated, the area becomes tender and painful, especially with movement and breathing.

It is a benign condition. That means it does not damage your heart, your lungs, or your ribs, and it does not develop into anything more serious. It is genuinely uncomfortable, sometimes enough to interrupt sleep and exercise, but it is not harmful.

Costochondritis is sometimes confused with Tietze’s syndrome. The two are related but not the same: Tietze’s syndrome is rarer and produces visible swelling over the joint, while costochondritis usually does not.

How Do You Know If It Is Costochondritis?

The pain is typically sharp or aching, sits close to the breastbone, and can be pressed on. It most often affects the cartilage of ribs 2 to 7, and it commonly appears on the left side of the chest.

Pain usually gets worse with:

• Deep breathing or coughing. The rib cage expands, which loads the inflamed joint directly.
• Physical activity, particularly pushing, pressing, or overhead movements.
• Lying on the affected side, which compresses the tender area.
• Lifting or sudden twisting, which loads the chest wall quickly and without warning.

Intensity varies a lot. Some people describe a background ache they can work around. Others find it hard to take a full breath. It also tends to come in episodes, flaring during stressful periods or after a heavier week of training, then quietening down again.

Is It Costochondritis or Something Serious?

This is the question most people arrive with, so let us deal with it directly.

Condition	Where the pain sits	Does pressing reproduce it?	Other signs
Costochondritis	Sharp, localised, next to the breastbone	Yes, reliably	Worse with deep breaths, no swelling
Tietze’s syndrome	Same area, often one joint	Yes	Visible, palpable swelling over the joint
Intercostal muscle strain	Between the ribs, along the side	Yes, over the muscle not the joint	Follows a twist, cough, or lift
Cardiac pain	Central, heavy, pressing, spreads out	No	Shortness of breath, sweating, nausea, arm or jaw pain
Respiratory cause	Deep, diffuse, worse on breathing	Usually not	Fever, cough, breathlessness

Reproducibility is the key. Cardiac pain does not switch on when you press your chest with a finger. Costochondritis usually does.

Call 000 immediately if chest pain comes with shortness of breath, sweating, nausea, light-headedness, or pain radiating into the arm, shoulder, neck, or jaw. If you are unsure, get assessed. Nobody will think you overreacted.

What Causes Costochondritis?

Costochondritis is usually a load and irritation problem rather than a disease process. Common contributors include:

• Repetitive strain. Heavy lifting, repeated pushing or pressing, and long hours in a slumped desk position all load the costochondral joints.
• Direct trauma. A fall, a knock to the chest, a seatbelt in a minor collision. It does not need to be dramatic.
• Training overload. Sudden increases in bench press, push-ups, dips, or rowing volume are frequent triggers, especially after time off.
• Persistent coughing. Bronchitis, pneumonia, or a stubborn cold can inflame the chest wall through sheer repetition.
• Underlying inflammatory conditions, including arthritis, ankylosing spondylitis, and fibromyalgia.
• Pregnancy, where postural change and increased chest wall load raise the risk, particularly in the third trimester.
• Stress and anxiety. These raise muscle tension around the rib cage and change breathing patterns, which increases load on the joints and turns up pain sensitivity.

In our assessments, one factor shows up more than any other: a stiff thoracic spine. When the mid-back does not rotate or extend well, the rib joints at the front absorb movement they were never meant to handle. That is why thoracic mobility work often helps chest wall pain more than anything aimed at the chest itself.

How Is Costochondritis Diagnosed?

There is no single test that confirms costochondritis. Diagnosis is clinical, which means it is based on your history and a hands-on examination.

A thorough assessment usually involves:

• Palpation of the costochondral joints to see whether your pain can be reproduced. This is the most informative part of the exam.
• A symptom and medical history review, including what triggered it, what makes it worse, and whether there are any cardiac or respiratory risk factors.
• An ECG or blood tests, if there is any reason to rule out a cardiac cause first.
• Imaging (X-ray, ultrasound, or CT), only when the picture is unclear. Costochondritis itself does not usually show on a standard X-ray, so imaging is there to exclude rib fracture, pneumonia, or other causes.

The point of the process is as much about ruling things out as ruling things in. Once serious causes are excluded, treatment can start properly.

How Is Costochondritis Treated?

Treatment has two jobs: settle the current flare, then change what caused it.

What helps in the first two weeks?

• Relative rest, not bed rest. Stop the specific movements that spike your pain (pressing, heavy lifting, lying on that side) while keeping gentle general movement going.
• Ice, then heat. Ice for 15 to 20 minutes every 2 to 3 hours during the sore, acute phase. Once the sharpness eases, heat helps release the surrounding muscle tension.
• Anti-inflammatories. Over-the-counter options like ibuprofen or naproxen can help. Check with your pharmacist or GP first, particularly if you are pregnant or on other medication.
• Breathing retraining. Shallow, guarded breathing is a natural response to chest pain, but it stiffens the rib cage. Slow diaphragmatic breathing, five minutes twice a day, keeps the chest wall moving.

What exercises actually help?

Start gently, and stop short of any movement that reproduces sharp pain.

• Doorway chest stretch. Forearm on the frame, elbow at shoulder height, step through slowly. Hold 30 seconds, twice each side.
• Cross-body shoulder stretch. Eases the chest and shoulder muscles pulling on the front of the rib cage.
• Seated thoracic rotation. Restores mid-back movement so the rib joints stop taking the load. Pairs well with stiff mid-back exercises.
• Postural strengthening. Scapular retraction and upper back work to pull you out of the slumped position. See our postural exercise guide.
• Diaphragmatic breathing. Hand on the belly, breathe low and slow, let the ribs expand sideways rather than lifting the shoulders.

Where does physiotherapy fit in?

We will be honest here: costochondritis heals on its own timeline, and no treatment forces cartilage to settle faster. What physiotherapy does is reduce pain along the way and fix the reason it started.

Our team uses hands-on manual therapy to free up stiff rib and thoracic joints, soft tissue work to release the chest and mid-back muscles pulling on the area, breathing and postural retraining, and a graded return-to-activity plan so your first week back at the gym does not undo the last month. For people whose pain is tied to posture and desk work, Pilates for ME builds the postural endurance that stops the pattern repeating.

For stubborn cases, a corticosteroid injection may be considered by your doctor. And where anxiety is feeding the pain cycle, addressing that side of it (relaxation techniques, breathing work, or counselling) is not optional extra. It is part of the treatment.

How Long Does Costochondritis Last?

Most cases resolve within 3 to 6 weeks with sensible management. Some run for a few months, and cases past three months are considered chronic, though these are less common.

Three things influence how long yours takes:

• How inflamed it was to begin with. A significant flare takes longer than a mild niggle.
• How consistently you modify activity. This is the one you control. Pushing through repeatedly is the most common reason recovery stalls.
• Underlying conditions. Fibromyalgia, inflammatory arthritis, or ongoing high stress all extend the timeline.

It is also very normal for costochondritis to come and go: better with rest, sore again when you return to the activity that caused it. That pattern is not a sign something is wrong. It is a sign the load has not been addressed yet.

Costochondritis During Pregnancy

Costochondritis is relatively common during pregnancy, especially in the third trimester. Postural changes, increased breast weight, hormonal effects on cartilage, and a rib cage that has to expand around a growing baby all add up to more load on the costochondral joints.

It is benign and usually resolves after delivery. Management focuses on pregnancy-safe options: paracetamol rather than NSAIDs (confirm with your GP or midwife), a properly fitted supportive bra, side-lying with pillow support, gentle postural work, and physiotherapy. Hydro for ME is often a good fit during pregnancy, since the water supports your body weight while you keep moving comfortably.

Frequently Asked Questions

Is costochondritis dangerous?

No. Costochondritis is benign and self-limiting, and it does not damage the heart, lungs, or ribs. That said, any new, severe, or unexplained chest pain should be assessed by a doctor to rule out cardiac and respiratory causes first.

Can costochondritis be cured?

Costochondritis resolves on its own, so “cure” is not quite the right frame. It can absolutely be managed well, and with the right changes to posture, training load, and breathing mechanics, the chance of it returning drops significantly. It can recur if the original strain pattern comes back.

How do I know it is not my heart?

The most reliable clue is reproducibility. If pressing directly on the cartilage beside your breastbone recreates your exact pain, costochondritis is far more likely. Cardiac pain is usually central, heavy, spreads to the arm, neck, or jaw, and comes with shortness of breath or sweating. When in doubt, treat it as an emergency and call 000.

When should I see a doctor or physiotherapist?

See someone if pain lasts beyond two weeks, worsens despite rest and home care, follows a significant injury, or if you cannot reproduce it by pressing on the chest wall. If pain comes with breathlessness, sweating, or arm and jaw pain, seek emergency care immediately.

What activities should I avoid with costochondritis?

During a flare, avoid heavy lifting, bench press and dips, push-ups, repetitive overhead or pushing movements, and sleeping on the affected side. Walking, gentle cycling, and light lower body work are usually fine and worth keeping.

Can I still exercise with costochondritis?

Yes, with modification. Keep moving, avoid anything that reproduces sharp chest pain, and rebuild chest and pushing exercises gradually once the pain has settled. A physiotherapist can map out how fast to progress so you are not guessing.

Does stress make costochondritis worse?

It can. Stress raises muscle tension through the chest and shoulders, shifts you toward shallow upper-chest breathing, and lowers your pain threshold. Managing stress is a legitimate part of treatment, not a side note.

Can costochondritis affect both sides?

Yes, though it is more common on one side and more common on the left. Pain across both sides can also point to a broader inflammatory condition, which is worth investigating with your GP.

Getting Help With Chest Wall Pain

Costochondritis is uncomfortable and unsettling, but it is manageable and it does resolve. The part worth getting right is the reason it started, because that is what decides whether you see it again in six months.

If chest wall pain is affecting your sleep, your training, or your work, our team at ME Physio can assess your rib joints, thoracic spine, breathing, and posture, then build a plan tailored to what we find. We will also be straight with you about what physiotherapy can and cannot change.

Book an appointment online or call us on (03) 9571 6888.

References

• https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chest-pain: Better Health Channel, Victorian State Government. Chest pain.
• https://www.healthdirect.gov.au/chest-pain: Healthdirect Australia (Australian Government). Chest pain.
• https://www.heartfoundation.org.au/heart-health-education/heart-attack-warning-signs: Heart Foundation Australia. Heart attack warning signs.
• https://www.health.gov.au/: Australian Government Department of Health, Disability and Ageing. General health guidance.