Costochondritis is irritation of the cartilage that joins the upper ribs to the breastbone. It causes sharp, aching or pressure-like pain at the front of the chest, usually beside the breastbone and often on the left. The pain is typically worse with deep breaths, coughing, twisting or pressing on the spot. It is a common cause of chest wall pain and often settles within a few weeks to a few months. New chest pain still needs a medical check first.
It most often involves the second to fifth ribs, usually several joints at once, with no visible swelling. Swelling over one tender joint points to a related condition, Tietze syndrome.
First: chest pain that needs emergency care
Being sore to press does not rule out a heart or lung problem, and the two can happen together. Costochondritis is a diagnosis a doctor makes after the heart and lungs have been considered. Call your local emergency number now, and do not drive yourself, if chest pain comes with any of these:
- Pressure, tightness or heaviness: in the chest, especially spreading to the arm, jaw, neck or back.
- Breathlessness, sweating or nausea: or feeling lightheaded or faint.
- Sudden sharp pain on breathing: with breathlessness, a fast heartbeat or coughing blood.
- Pain on exertion: chest pain that comes on with activity and eases with rest.
Key takeaways
- What it is: irritation of the cartilage joints between the upper ribs and the breastbone.
- Typical symptoms: sharp or aching pain at the front of the chest, tender to press, worse with deep breaths, coughing, twisting or arm movement.
- Heart and lungs first: new chest pain needs a medical check, because tenderness alone does not rule out a heart or lung cause.
- Typical course: often settles within a few weeks to a few months; some cases last longer.
- What helps: easing off what aggravates it, gentle movement, heat, and pain relief your doctor or pharmacist advises.
Where are you right now?
- New chest pain, not yet checked: start with the emergency signs above. If none fit, see a doctor today so the heart and lungs can be considered.
- Diagnosed and weeks in, still sore: go to “Week by week” and “If it isn’t going to plan”.
- After an injection: a steroid injection is sometimes used for pain that persists. Follow your doctor’s advice on activity afterward.
- Getting back to exercise or work: the “When can I…” table gives typical ranges. Pushing exercises are often the last to feel comfortable.
Week by week
- Weeks 1 to 2: pain is often sharpest. Deep breaths, coughing and pushing can all catch. Ease off what provokes it, keep walking, and try heat for 15 to 20 minutes at a time.
- Weeks 2 to 6: many people notice gradual easing. Gentle movement that opens the chest and turns the upper back is added within comfort.
- Weeks 6 to 12: most cases have eased a good deal. Push-ups, heavier lifting and overhead work are reintroduced gradually.
- Beyond 3 months: some people have pain on and off for months, and flares after a cough or a heavy week of upper body work are common. Pain that is not settling needs a medical review.
Tender to press does not mean safe to ignore. Get it checked, then give it time.
Where else this could be coming from
- The heart: heart pain is more often a pressure or tightness, may spread to the arm, jaw or left shoulder, and tends to come with exertion. See left shoulder pain: heart or shoulder.
- The lungs: pleurisy, pneumonia or a blood clot in the lung can cause sharp pain on breathing, usually with fever, breathlessness or a fast heartbeat. The signs are set out in upper back pain when breathing.
- Rib joints at the back: an irritated joint where a rib meets the spine can send pain around to the front of the chest. See rib joint pain in the upper back.
- Upper back stiffness: a stiff, rounded upper back moves less with each breath and reach, which can leave the rib joints at the front and back more irritable.
- Nerve or shingles: burning or shooting pain in a band around the chest. Shingles adds a rash within a few days. A pinched nerve in the upper back can feel similar.
- Muscle strain, rib fracture or reflux: a chest muscle strain after pushing, a rib injury after a fall, or burning behind the breastbone linked to meals.
Is this normal?
- The pain moves around or affects both sides: common. Several joints are often involved, and the sorest one can change.
- A hug or lying on my front hurts: common. Pressure on the front of the chest loads the irritated joints.
- It flared again after a cold: common. Coughing moves the ribs hard and often.
- I keep worrying it is my heart: understandable. If the pain changes, comes on with activity, or comes with any emergency sign above, get checked again.
If it isn’t going to plan
It is week five. Your doctor checked your heart and told you it is the chest wall, but the spot beside your breastbone still catches when you lift the laundry basket. You press it several times a day to see whether it is still there. The thought in your head is that if you rest your upper body completely, it will finally settle.
Complete rest tends to stiffen the chest and upper back, so the rib joints move less and take more strain with each breath and reach. Pressing the spot keeps it sensitive. Costochondritis usually settles with steady, gentle movement of the chest and upper back, a gradual return to pushing and lifting, and time.
If the pain is not clearly easing after about 6 weeks, or keeps flaring, go back to your doctor or see a physical therapist. Questions worth asking:
- Have the heart and lungs been considered for this pain?
- Is this costochondritis, Tietze syndrome, a rib joint at the back, or something else?
- Which movements should I build up, and which should I ease off for now?
When can I…
| Activity | Typical range |
|---|---|
| Sleep on that side | Usually possible from the start; lying on your front is often the last position to feel comfortable |
| Drive | Usually no restriction once the heart and lungs have been checked |
| Reach overhead | Usually possible; it may pull at the front of the chest for a few weeks |
| Lift | Light loads usually fine; heavy lifting, pushing and pulling often built back over 2 to 6 weeks |
| Desk work | Usually continues, with a change of position every 30 to 45 minutes |
| Manual work or sport | Often continues, with push-ups, bench press and heavy pushing reduced for several weeks |
If you have had surgery, your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Heart signs: chest pressure, tightness or heaviness, especially spreading to the arm, jaw, neck or back.
- With other symptoms: chest pain with breathlessness, sweating, nausea, lightheadedness or fainting.
- Possible clot: sudden sharp pain on breathing with breathlessness, a fast heartbeat or coughing blood.
- Chest injury: severe chest pain after a car accident, a fall or a heavy blow.
See a doctor today if
- New chest pain: chest pain that has not been checked yet, even if it is mild and sore to press.
- Fever: chest pain with fever, chills or a cough with phlegm.
- A hot, red, swollen joint: beside the breastbone, especially after chest surgery or with fever.
Get it checked soon if
- Not easing: the pain is not clearly easing after about 6 weeks.
- Visible swelling: a swollen, tender spot where a rib meets the breastbone.
- Burning linked to meals: pain behind the breastbone after eating or when lying down.
- Wider health: unexplained weight loss, night sweats, or a history of cancer.
More on this area: upper and mid back conditions.
Have new chest pain checked first; once the heart and lungs are clear, costochondritis usually settles with time and steady movement.
Written by Louise Yow, Neck & Shoulder Physio.