Chest wall pain

Also called: Costochondritis; Tietze syndrome

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Sharp pain in the front of the chest, tender to press, worse with deep breaths and twisting. It is the cartilage joints where the ribs meet the breastbone - and the first job is always to be confident it is not the heart.

How common: A common cause of non-cardiac chest pain, especially in the under-40s

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What it is

Costochondritis is inflammation or mechanical irritation of the joints where the rib cartilages meet the breastbone. It produces sharp, localised chest pain that is reproducibly tender to press, worse with deep breathing, coughing and twisting.

The single most important thing about it is what it is not. Chest pain has causes that kill people, and no page can distinguish them from a distance. Reproducible tenderness on pressing is reassuring but not definitive - pain with exertion, breathlessness, sweating, nausea or pain spreading to the arm or jaw needs emergency assessment regardless of how tender the chest wall is.

What it feels like

Sharp or aching pain at the front of the chest, usually to one side of the breastbone
Clearly tender when you press on the spot
Worse with deep breaths, coughing, sneezing and twisting
Worse lying on that side and with pushing movements
Lasting days to weeks, and often following a cough, a lift or a new workout

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Repetitive or unaccustomed loading: A new pressing programme, heavy lifting, or a burst of DIY loads the chest wall joints in a way they are not used to. It is one of the most common precipitants.
Coughing: A prolonged cough repeatedly loads the rib cartilage joints. Costochondritis following a chest infection is a very common sequence.
Direct trauma: A blow to the chest or a seatbelt injury irritates the joints directly.
Poor thoracic mobility: A stiff mid-back means the ribs and their joints absorb more movement. A rigid thoracic spine makes chest wall pain more likely and more persistent.
Shallow, upper-chest breathing: Habitual chest breathing moves the upper rib joints thousands of times a day without the diaphragm sharing the work.
Stress and muscular tension: Tension in the chest and intercostal muscles adds load to the joints and lowers the threshold at which they are painful.
Rib joint problems at the back: Irritation of the joints where the ribs meet the spine refers pain around to the front. The problem at the front may be the referral rather than the source.
Tietze syndrome: A less common variant with visible swelling of one cartilage, usually the second or third rib, rather than tenderness alone. Same principles, different appearance.
Inflammatory arthritis: Ankylosing spondylitis and other inflammatory conditions affect these joints and produce chest wall pain with reduced chest expansion.
Anxiety making it worse: Chest pain is frightening, and anxiety produces fast shallow breathing that loads the same joints. The loop is common and understandable.

Who tends to get it

Anyone who has had a prolonged cough or chest infection
People starting or increasing pressing and lifting work
Anyone with a stiff thoracic spine
People with habitual upper-chest breathing
Anyone with an inflammatory arthritis

What makes it worse, and what settles it

Makes it worse

Continuing heavy pressing and lifting through it
A persistent cough left untreated
Shallow, fast upper-chest breathing
Twisting and reaching movements during the acute phase
Assuming any chest pain must be muscular, which is the dangerous error

Settles it

Getting the chest pain properly assessed first, which is the priority rather than an afterthought
Thoracic mobility work, gently and within comfort
Diaphragmatic breathing retraining to take load off the upper rib joints
Reducing pressing and heavy lifting temporarily
Massage of the chest and intercostal muscles for symptomatic relief

What actually helps

The short version: Inflammation or mechanical irritation of the costochondral junctions, often after coughing, lifting or a new push workout

Strength work: Back: Traps: Lower; Back: Rhomboids - once cardiac causes are excluded

Stretching: Chest; Trunk; Spine - thoracic rotation

Massage: Chest; Back: Upper Back; intercostal work

Also worth doing: Reduce heavy pressing while symptomatic

What the evidence says: Self-limiting in most cases. Stretching and manual therapy help. The safety gate matters more than the routine here.

The names above are the Targets qFIT tracks — the Muscle Guide explains what each one does, and Quick Add switches on the Exercises you already have.

No ready-made routine for this one yet

249 of the 267 problems here have a routine already built, and this is not one of them — usually because the work that helps is covered by a general routine rather than needing its own. What actually helps above names the muscles and the work involved, which is enough to put it together yourself.

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Get it checked if…

CHEST PAIN MUST HAVE CARDIAC AND PULMONARY CAUSES EXCLUDED FIRST. Crushing pain, breathlessness, sweating, radiation to the jaw or arm - emergency

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Costochondritis usually settles over a few weeks to a few months and is self-limiting, and it can recur with the same triggers. The advice on this page assumes the diagnosis has been made by someone who examined you. Chest pain that comes with exertion, breathlessness, sweating, nausea, palpitations, or that spreads to the arm, neck or jaw is a medical emergency and should be treated as cardiac until proven otherwise, however tender the chest wall is.

Prevalence basis: Emergency department chest pain series

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.

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