Mid & Upper Back

What It Is

Costochondritis is inflammation of the cartilage where the ribs join the breastbone (sternum); these junctions are called the costosternal or costochondral joints (NHS, 2026). It can cause sharp pain in the front or side of the chest. Pain from this condition can feel like a heart attack or other heart problems, and it can also be mistaken for acid reflux and indigestion. Some doctors call costochondritis costosternal syndrome or parasternal chondrodynia (Proulx and Zryd, 2009). It is sometimes confused with Tietze’s syndrome, but that is a separate, rarer condition that causes visible swelling (Proulx and Zryd, 2009; Rokicki, Rokicki and Rydel, 2018).

It is not always known what causes costochondritis, but it has been linked to an injury to the chest, repetitive upper body movements such as lifting, coughing a lot, and infection (NHS, 2026).

Costochondritis Anatomy

The chest is the part of the trunk between the abdomen and the neck. It holds the lungs and the heart, as well as the oesophagus (food pipe) and the large blood vessels connected to the heart. The chest wall is made of cartilage, bones, ligaments and muscles that hold the chest contents together. The rib cage consists of the ribs, the sternum and the vertebrae. The ribs are connected to the vertebrae at the back and, through cartilage, to the sternum at the front. The joints between the ribs, vertebrae and sternum let the bones move. Soft tissues, such as muscles, ligaments and nerves, also make up the chest wall.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Symptoms

How It Feels

Symptoms

Sharp pain in the front or side of the chest, over the breastbone and upper chest (NHS, 2026)
Pain that is worse when you move your upper body, lie down, breathe in deeply, or press on the middle of your chest or ribs (NHS, 2026)
Pain that can be worse with exercise or exertion (Proulx and Zryd, 2009)
No visible swelling over the painful area – swelling suggests Tietze’s syndrome instead (Proulx and Zryd, 2009)

It is important for a doctor to rule out more serious causes, such as heart problems, because costochondritis can feel like a heart attack (NHS, 2026). It is also not unusual to be investigated for reflux or digestive problems, which can cause similar symptoms.

Costochondritis usually gets better on its own over time. It can last from a few weeks to several months (NHS, 2026).
It usually settles within a year, although about a third of people still have some tenderness at one year (Proulx and Zryd, 2009).

Treatment

Self-Care & Treatment

How to Treat Costochondritis

There have been no clinical trials of treatments for costochondritis, but physical therapy has been used for chest wall pain caused by the muscles and joints (Proulx and Zryd, 2009). I can help ease muscle tension around your chest, keep your ribs and upper back moving, and guide you through gentle exercises. See the My Approach tab for how I work.

1. Medication

The NHS (2026) says painkillers that help with inflammation, such as ibuprofen, may be recommended to help with the pain. (This medicine information comes from the NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

2. Heat or Cold

Heat or ice may help ease the pain (Proulx and Zryd, 2009). For heat, you can use a warm compress or heating pad, which can be particularly helpful if muscles are overworked. For cold, wrap an ice pack (or a bag of frozen peas) in a tea towel and place it over the painful area for up to 20 minutes every 2 to 3 hours (NHS, 2024). Never put ice directly on the skin.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Injection: if you have very bad pain that does not get better over time, you may be offered a steroid injection to reduce inflammation or a local anaesthetic to ease the pain (NHS, 2026).

How I can help (see the My Approach tab)

Hands-on work for the chest, upper back and shoulder muscles

Gentle rib and upper back mobilisation

Breathing, posture and gentle exercise

Safe ways back to lifting and exercise

Tips

Costochondritis is more common in people over the age of 40 (Proulx and Zryd, 2009).
Avoid activities that trigger the pain, such as heavy lifting or strenuous exercise, until it settles (Proulx and Zryd, 2009). If physical exertion brings on tenderness and chest pain, ask me about safe ways to lift and exercise.
Coughing a lot, repetitive upper body movements and chest injuries have all been linked to costochondritis (NHS, 2026).
Maintain good posture at work. Keep upright and make sure your computer workstation is set up correctly, with the monitor at the right height, so you stay comfortable.
Take steps to relax regularly through the week. Try deep breathing exercises, watching a good film, or reading a book to unwind.
Make a gradual return to exercise, using slow stretching to avoid aggravating the area.

Treatment

My Approach

Costochondritis usually settles on its own, but it can be sore and worrying while it does. My aim is to ease the tension around your chest and upper back, keep your ribs and spine moving, and help you get back to lifting, exercise and work without stirring it up.

Chest pain always needs a doctor to rule out heart and other serious causes first. If you haven't been checked, please see your family doctor or nurse practitioner before we start.

I start by assessing how your upper back, ribs and shoulders move, how you breathe, and which movements bring the pain on.

Hands-On Treatment

Massage and trigger point work for the upper back, neck and shoulders
Work on the chest wall muscles (between the ribs and in front of the shoulder), only with your informed consent and a written consent form, and never on breast tissue
Gentle mobilisation of the ribs and upper back, with no quick thrusts, and no firm pressure on the sore rib joints themselves
Warm applications in the clinic, and I'll show you how to use heat or ice at home

Movement and Breathing

Gentle range-of-motion exercises for the upper back and ribs, staying within comfort
Breathing and relaxation work to ease tension in the chest and diaphragm
Gradual strengthening for the upper back and shoulders as it settles

Daily Life and Training

Cutting back the lifting and exercise that bring on pain, rather than stopping everything
Desk and workstation set-up so you stay comfortable
For gym-goers, adjusting pressing, pulling and breathing technique, then building load back up step by step

If your chest pain changes, spreads to your arm, neck or jaw, or comes with breathlessness, call 911 (see When to get emergency help).

What to Expect

Typical Course

Typical course: Most people come once or twice a week at first, then weekly, then less often as you manage more on your own, with a reassessment at about 4 to 6 weeks. Costochondritis usually eases over a few weeks to several months and settles within a year for most people, though some tenderness can linger.

What I Focus On

Assessment

Chest & Upper Back Release

Rib Mobility

Breathing & Relaxation

Gradual Return to Lifting

Please read

When to See a Doctor First

When to get emergency help

Call 911 or go to the emergency room at your nearest hospital if you have (NHS, 2026)

chest pain that started suddenly, or spreads to your arm, neck or jaw, or your chest feels tight – this could be a heart attack
chest pain with difficulty breathing, a fast heartbeat, or coughing up blood – this could be a blood clot in the lung
sudden chest or back pain that feels like something tearing inside, with shortness of breath, or problems with walking, vision or speaking

Do not drive yourself to hospital. Always get medical advice for unexplained chest pain that doesn't go away (NHS, 2026).

Sources

References

NHS (2026) Costochondritis. Available at: https://www.nhs.uk/conditions/costochondritis/ (Accessed: 7 October 2026).
Proulx, A.M. and Zryd, T.W. (2009) 'Costochondritis: diagnosis and treatment', American Family Physician, 80(6), pp. 617–620.
Rokicki, W., Rokicki, M. and Rydel, M. (2018) 'What do we know about Tietze's syndrome?', Kardiochirurgia i Torakochirurgia Polska, 15(3), pp. 180–182. doi: 10.5114/kitp.2018.78443
NHS (2024) Sprains and strains. Available at: https://www.nhs.uk/conditions/sprains-and-strains/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooCostochondritis

What It Is

Costochondritis Anatomy

How It Feels

Symptoms

Self-Care & Treatment

How to Treat Costochondritis

1. Medication

2. Heat or Cold

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Movement and Breathing

Daily Life and Training

Typical Course

When to See a Doctor First

When to get emergency help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooCostochondritis

What It Is

Costochondritis Anatomy

How It Feels

Symptoms

Self-Care & Treatment

How to Treat Costochondritis

1. Medication

2. Heat or Cold

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Movement and Breathing

Daily Life and Training

Typical Course

When to See a Doctor First

When to get emergency help

References

Related Conditions

Tietze's Syndrome

Cervical Kyphosis

Cervicothoracic Joint (CT) Dysfunction

Costovertebral Joint Disorders

Book a session