Massage therapy · Kitchener–WaterlooTietze's Syndrome
Mid & Upper Back
What It Is
Tietze’s syndrome is a rare condition in which the cartilage where one of the upper ribs meets the breastbone (sternum) becomes inflamed, causing pain and noticeable swelling (Cleveland Clinic, 2025). The swelling usually affects just one joint on one side, most often at the second or third rib (Proulx and Zryd, 2009; Rokicki, Rokicki and Rydel, 2018). Chest pain from this condition can feel like a heart attack or other heart problems. Pain is felt at the front and top of the chest and may spread to the arm, shoulder and neck (Cleveland Clinic, 2025).
Tietze’s syndrome is often confused with costochondritis, but they are different conditions. Costochondritis is more common, usually affects several rib joints, mainly affects people over 40, and does not cause swelling (Proulx and Zryd, 2009).
Doctors aren't sure what causes Tietze’s syndrome. It may follow an injury to the upper rib cage, such as a car accident, fall or sports injury, or repeated minor strain on the rib cage, such as frequent violent coughing (Cleveland Clinic, 2025).
Tietze’s Syndrome 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 tips, to the sternum at the front (Cleveland Clinic, 2025). 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
Treatment
Self-Care & Treatment
How to Treat Tietze’s Syndrome
Treatments you may want to discuss with your family doctor or nurse practitioner
Tips
- Tietze’s syndrome mainly affects younger people, usually under the age of 40 (Proulx and Zryd, 2009).
- Avoid any activities that trigger the pain. If physical exertion brings on tenderness and chest pain, ask me about safe ways to lift and exercise (see the My Approach tab).
- Frequent, violent coughing and repeated strain on the chest have been linked to Tietze’s syndrome. Some people need treatment to stop coughing, sneezing or vomiting before the chest can heal (Cleveland Clinic, 2025).
- 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
Tietze's syndrome usually settles with time, rest and warmth, but the pain can leave you holding your chest stiffly, breathing shallowly and tensing the muscles around it. My aim is to ease that tension, keep your ribs and spine moving while the joint calms down, and help you get back to full activity without stirring it up again.
Chest pain always needs a doctor to rule out more serious causes first, so if yours hasn't been checked, please see your family doctor or nurse practitioner before we start. I then assess your posture, how your ribs, mid-back, neck and shoulders move, how you breathe, and which movements bring the pain on.
While It's Sore
- No direct pressure on the swollen joint, and shorter, gentler sessions while it's flared up
- Easing the neck, shoulders, upper back and the muscles around the ribcage that tighten up to guard it
- Warm applications in the clinic, comfortably warm rather than hot, and how to use warmth safely at home
- Breathing practice to keep your ribs moving gently, and relaxation to help you unwind
As It Settles
What to Expect
Typical Course
What I Focus On
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
- Cleveland Clinic (2025) Tietze syndrome. Available at: https://my.clevelandclinic.org/health/diseases/23565-tietze-syndrome (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 (2026) Costochondritis. Available at: https://www.nhs.uk/conditions/costochondritis/ (Accessed: 7 October 2026).