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Costochondritis: stress on the chest



Most people will not be able to tell you anything about costochondritis. The name itself is obscure enough to keep most people from researching the condition!

In terms of the weight room, costochondritis effects the “chest day is everyday” type of lifter or the person who ramps up their upper body work outs too fast. If you spend too many days working on muscles in the front of your body, and not the back of your body (or do the back exercises improperly) you may also be at higher risk.


What is costochondritis?


Costochondritis happens in the area in between your ribs in the front of your body and your sternum or chest bone.  Here there is a cartilage that helps keep the ribs flexible and secures them to your chest bone. In costochondritis this cartilage, or connective tissue becomes irritated or inflamed. This usually happens to multiple ribs and usually ribs 2-5 (area just under your collar bone to around nipple height)

The discomfort can sometimes last for a few days, but in many cases can last for several months on end (especially when trying to ignore the symptoms). This can lead to serious atrophy in muscle, especially in the weight lifter trying to increase chest and arm muscle mass.

How does this condition happen?


Due to the fact that this condition is less common than knee, hip, or back injuries, there are not many high level studies looking into the cause of costochondritis. Many clinicians agree it happens when excessive and continuous forces are placed on the cartilage in the front of the chest. Outside of the gym, serious coughing spells, or labor intensive jobs involving use of those front chest muscles can cause this musculoskeletal disorder.


Is this Costochondritis, or am I having a heart attack?


When most people hear chest pain, the first thing that comes to mind is a heart attack. Pain on palpation or rubbing your fingers on the sides of your chest bone is a sign of costochondritis, but DOES NOT rule out a cardiac condition and even a tumors. Though rare, if you are over the age of 35, have heart or lung issues, smoke, have high cholesterol, high blood pressure, have type 2 diabetes, or are obese and just starting to work out, consult your primary care physician to rule out any heart issues.


I cannot stress this enough: if you are having chest pain consistently with activity, see a medical professional!  It's always better to be safe than sorry!


With actual costochondritis, slouching, or flexion can aggravate the symptoms. It mostly affects only one side of your chest bone, but at rare times can affect both. Rubbing over the affected rib or ribs even on the side and in the back, may be painful. There are other less known conditions that this could be, but a physical therapist will know how to rule these out and screen for more dangerous conditions.



I think I have costochondritis, what now?


Many muscles are attached to your upper chest that may contribute to costochondritis. Your pectoralis major, pectoralis minor, scalene muscles, and latissimus dorsi have play into the upper ribs and shoulder blades. These muscles need to be stretched to take pressure off of that irritated area. Many people with this condition also have over-rounded spines at the level of the ribs (thoracic spine). The less known serratus anterior, and middle/lower trapezius provide a counter pull to the upper trapezius and pec minor.

Arm movement with shoulder blade positioning

Exercises to do at home


Now you may be saying to yourself: “Great... you listed a lot of muscles and body areas there, but what can I do at home to deal with this condition so I can get back to lifting?” If you have a tennis ball, you have everything you need.  A pectoralis minor release can help relieve some of the tension from the muscle onto the ribs.

Massage of the pectoralis minor muscle

Investing in a foam roller can allow you to mobilize your thoracic spine or spine attached to your rib cage. Usually, extension or straightening of this area of your spine can relieve the pressure from your chest area. Serratus anterior strengthening exercises such as a “push-up plus” may be a decent place to start as well.


Knowledge of the activity that causes pain is very important for recover from this condition. Reducing the aggravating activity, along with these corrective exercises, will provide the fastest recovery. Taking 2 weeks off to get back to heavy chest work is better than taking several months at half strength.


Physical Therapy and Costochondritis


Physical therapists are movement experts. Part of an evaluation for costochondritis would be looking into the aggravating activity and breaking down the movement.  The goal is to decrease the stress on the chest, and improve strength in the muscles that counteract the chest muscles.


Manual therapy is one of the best treatment for this condition. A physical therapist can provide a more effective way at mobilizing the areas previously mentioned. Hands on trigger point releases, trigger point dry needling, contract-relax, instrument assisted soft tissue work, and joint manipulations help restore normal motion and relax tight muscles.


Once those muscles are relaxed, this is when specific exercises working on the “counter pull” muscles come into play. Your therapist will make sure those targeted muscles become better at their job and establish muscular balance.  This will decrease stress in your chest. The faster you rebalance your muscles, the faster you can get back to building muscle.


So please, trade some of these chest days for one of these back exercises or two.  Don't forget to loosen those chest muscles once in a while!


Happy Lifting!