Costochondritis
Inflammation where the upper ribs join the breastbone, causing sharp or aching chest pain that’s tender to press. It’s harmless and settles on its own, but new chest pain always deserves a proper check first.
Quick answer: Costochondritis is inflammation of the cartilage joining the ribs to the breastbone. It causes sharp, tender chest pain that’s worse with movement, deep breaths or pressing on the spot. It’s harmless and usually settles within weeks, sometimes months. Heat, rest from triggers and anti-inflammatory painkillers help. New chest pain still needs checking first.
How common. Very common. It accounts for roughly 6 to 13 in 100 GP visits for chest pain, and it’s one of the most common causes of chest pain in teenagers. In adults it peaks around age 40 to 50, slightly more often in women.
Causes. Often no clear cause. It can follow a bout of coughing, a viral infection, heavy lifting, a new exercise routine, repetitive arm movements or a knock to the chest.
Symptoms. Sharp, stabbing or aching pain at the front of the chest, usually beside the breastbone around the 2nd to 5th ribs, often over more than one rib and sometimes both sides. It’s worse with deep breaths, coughing, twisting, lifting your arms or lying on your front, and the spot is tender to press. The skin looks normal.
Tietze syndrome. A rarer cousin with visible, tender swelling over one rib joint, usually the 2nd or 3rd, more often in younger adults.
Look-alikes. The ones that matter: heart attack or angina, a blood clot in the lung, pericarditis, pneumonia or pleurisy, a broken rib, shingles before the rash appears, and reflux. Tenderness when pressed makes costochondritis likely, but it doesn’t rule out a heart problem on its own.
How it’s diagnosed. From your story and an examination: pressing on the rib joints reproduces the pain. No blood test or scan shows costochondritis. Your GP may do an ECG, blood tests or a chest X-ray to rule out other causes, depending on your age and risks.
The costochondritis ladder
No high-quality trials exist for any treatment. Most people improve with simple measures and time.
- Step 1 · Self-careHeat and rest from the triggersA heat pack or warm shower, and easing off the lifting, push-ups or arm-heavy work that sets it off.
- Works
- No trials; most cases settle with time
- Cost
- Free
- How long
- Days to weeks
- Watch for
- Don’t put heat packs straight on skin or fall asleep on one.
Your ribs are asking for a few weeks off push-ups.
- Step 2 · PharmacyAnti-inflammatory tablets or gel (ibuprofen, naproxen, diclofenac gel), or paracetamolRegularly for a week or two, then as needed.
- Works
- Standard practice; in one large observational study, 9 in 10 people’s pain had settled after 3 weeks of rest and anti-inflammatories
- Cost
- About $5–15 a pack
- How long
- 1–2 weeks at a time
- Watch for
- Anti-inflammatory tablets: stomach, kidney and blood pressure risks. Check with a pharmacist if you have other conditions.
Calm the joint, then let time do the rest.
- Step 3 · Allied healthPhysio-guided stretchingGentle chest and upper back stretches and posture work.
- Works
- One small study found modest pain relief in long-lasting costochondritis
- Cost
- About $80–120 a session; free once you know the stretches
- How long
- A few weeks
- Watch for
- Stretches should feel like a pull, not a stab.
Slow and steady. Nobody wins a chest-stretching contest.
- Step 4 · GP or specialistLocal anaesthetic or steroid injectionFor stubborn pain that hasn’t settled over months.
- Works
- Small studies only, mostly in Tietze syndrome
- Cost
- Medicare rebates; fees vary
- How long
- Single injection, sometimes repeated
- Watch for
- Skin thinning, infection, and rarely a punctured lung.
A last resort, not a first move.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Repeated scans and testsNo scan or blood test diagnoses costochondritis. Tests are for ruling out other causes; once that’s done, more of them won’t speed recovery.
What you can do
- Use heat and take regular anti-inflammatories or paracetamol for a week or two if safe for you.
- Pause the activities that bring it on, then build back gradually.
- Sleep on your back or the less sore side.
- Treat a lingering cough: coughing keeps the joints irritated.
- Gentle chest-opening stretches once the worst has passed.
See your GP if
- You have new chest pain and haven’t had it checked
- The pain isn’t easing after a few weeks
- There’s visible swelling, redness or heat over the ribs
- You have a fever, night sweats or unexplained weight loss
Call 000 (Australia) or your local emergency number for chest pain that feels heavy, tight or crushing, spreads to your arm, jaw, neck or back, or comes with breathlessness, sweating, nausea, fainting or coughing up blood. Don’t drive yourself. If you’re unsure, get checked: no one minds a false alarm.
Outlook. Most people improve within a few weeks, though it can grumble on for several months. It does no lasting damage, and it comes back in only a small number of people.
Common questions
How do I know if it’s costochondritis or my heart?
Costochondritis pain is usually sharp, in one spot beside the breastbone, worse with movement or breathing, and tender to press. Heart pain is more often a heavy or tight feeling that may spread to the arm or jaw, with breathlessness or sweating. But they can overlap, so get new chest pain checked.
How long does costochondritis last?
Most people improve within a few weeks. It can take several months to settle fully, and occasionally longer.
What triggers costochondritis?
Often nothing obvious. Common triggers are a bout of coughing, a viral infection, heavy lifting, a new workout, repetitive arm movements or a knock to the chest.
Can costochondritis make it hurt to breathe?
Yes. Deep breaths, coughing and sneezing stretch the rib joints and can make the pain worse. Real breathlessness isn’t caused by costochondritis and needs checking.
Can costochondritis be on the left side?
Yes. It can affect either side or both, often over several ribs. Because left-sided chest pain worries people most, get it checked first.
What helps costochondritis pain?
Heat, a break from the activities that trigger it, and regular anti-inflammatory painkillers or gel for a week or two if they’re safe for you. Gentle stretches help once it starts to settle.
Evidence and more information
- Mott et al, Am Fam Physician 2021: Costochondritis, rapid evidence review
- NHS: Costochondritis
- healthdirect: Costochondritis
maladywise.com/costochondritis/