Costochondritis

What is Costochondritis?



Have you ever thought that there can be other reason for your chest pain?


Chest pain may not always relate to your heart!


Pain in your chest can be mechanical in nature. In the condition called Costochondritis, there is an inflammation of the areas where your upper ribs join with the cartilage that holds them to your breastbone. It can cause chest pain {1}.


What causes Costochondritis?


There can be various causes for the pain in the chest region (costochondral junctions).


Blow to chest which may lead to an inflammation.


Physical strain of any form like heavy lifting, strenuous exercise and vigorous coughing.


Costochondritis can be secondary to the conditions like osteoarthritis, rheumatoid arthritis or ankylosing spondylosis.


It can also be due to fungal or bacterial infections like tuberculosis.


Acute respiratory infection may also cause the inflammation at the costochondral junctions.


What are the Symptoms of Costochondritis?


A person may experience sharp pain in the chest typically in the center of the chest (costochondral junction), pain in the chest while taking deep breaths or while coughing.


There can be tenderness present at the area of costochondral junctions.


Pain may radiate to the arm and the shoulders.


Loss of normal spinal movement associated with the chest pain {2}.


How do we treat Costochondritis?


Oral Analgesics / Painkillers used to manage the increase in intensity of the symptoms.


Patient education and reassurance is the step to manage this condition. Avoid activities which aggravate the pain. (E.g. reducing the frequency or intensity of exercise or work activities). Trigger points or tension knots present at the chest region due to mechanical stress.



According to the researches use of Deep tissue release to manage the trigger points especially to the pectorals and to scapular muscles have proven effective to reduce the pain {3}.



The patient can also use Vapocoolant spray on the involved areas to manage the pain. Use heat/ cold pads and massage to help against the overloading of muscles and to lessen the pain {4}.


Activation of the scapular muscles to improve posture.


Functional training to improve the muscle function in simple activities like eg. Correct standing posture, sit to stand and walking up stairs all need be addressed to ensure correct technique and muscle recruitment. Exercises should be done in a pain free range.


To maintain the range of motion thoracic mobilizations can be given {5}.



Stretching exercises for Pectorals major and minor {6}.



Neuromuscular dry needling: Dry needling in the hands of properly trained providers may aid in diagnosis and treatment of focal chest wall syndromes according to the research conducted on a patient with costochondral pain {7}.


The course of costochondritis is variable. It often resolves within weeks to months. We as physiotherapist can diagnose the exact cause of the chest pain through detailed physical evaluation and detailed history of the patient. Costochondritis cases are most often seen in people older than age 40 and occur more often in women than in men.


References-


1] Schumann JA, Parente JJ. Costochondritis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.


2] Aspegren D; Conservative Treatment of a Female Collegiate Volleyball Player with Costochondritis ; Journal of Manipulative and Physiological Therapeutics.


3] Hudes K. Low-tech rehabilitation and management of a 64 year old male patient with acute idiopathic onset of costochondritis. J Can Chiropr Assoc. 2008;52(4):224-228.


4] Han J N et al.; Respiratory function of the rib cage muscles; European Respiratory Journal ISSN 0903 1993.


5] Han J N et al.; Respiratory function of the rib cage muscles; European Respiratory Journal ISSN 0903 1993.


6] Rovetta G, Sessarego P, Monteforte P. Stretching exercises for costochondritis pain. G Ital Med Lav Ergon. Apr-Jun 2009;31(2):169-71.


7] Westrick RB, Zylstra E, Issa T, Miller JM, Gerber JP. Evaluation and treatment of musculoskeletal chest wall pain in a military athlete. Int J Sports Phys Ther. 2012;7(3):323-332.





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