Costochondritis is a scary and confusing (but not life-threatening) condition with pain where your ribs join onto your breastbone.
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. 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.
Backpod® inventor, Steve August had a history of costochondritis himself:
“I had costo for seven years myself after a climbing fall onto my rib cage – with all the sharp stabbing chest pain, the breathing difficulties and the fear I was having a heart attack that comes with it. I fixed it after coming through physio school in New Zealand, and haven’t had even a twinge in decades. I can do anything physical – it’s completely fixed.”
Important – any acute chest pain should always be seen first (and urgently) by a doctor or Accident and Emergency Department in case it’s your heart.
Tietze’s Syndrome and Slipping Ribs
Tietze’s Syndrome is costochondritis with enough inflammation to cause obvious swelling at the rib joints on your breastbone – it’s not a whole different entity.
Slipping ribs are the same sort of thing where the pain and clicking is further out to the sides at the costochondral junctions, where the bony curves of the ribs change to cartilage. You treat it just like costo, with the core of fixing it being freeing up the stuck rib joints around the back. The swelling has often hardened into a tethering scarring, and this may need extra massage and stretches for the pectoralis muscles on your chest. As well, working a topical anti-inflammatory gel such as Voltaren (diclofenac) or CBD oil such as Penetrex into the hardened swelling twice daily should break it down slowly.
These are much less common than costo or Tietze’s, but occur for the same reason. When the joints where the ribs hinge onto your spine cannot move, other parts of the rib cage to move more to let you breathe. This extra ‘give’ can take place at the sides of the ribs, where the ribs change from bone to cartilage at the costochondral junctions.
Treatment is the same logical approach as for costochondritis – free up the frozen rib joints around the back which are driving the problem.