by Eric Winder, D.C.  

Costochondritis hurts. It’s the most common source of chest pain and causes 30 percent of all emergency room visits for chest pain. It arises from inflammation or irritation of the cartilage that joins the upper ribs to the sternum (breastbone).    

This pain sometimes lasts a few weeks before disappearing, but it can also persist for a year or longer, while causing problems like loss of sleep, limited physical activities and even pain from taking a deep breath. The conventional medical viewpoint holds that, in most cases, the cause is unknown. However, many experts feel the root cause lies in the mechanical motion of the rib cage. In my experience, looking for restrictions in normal motion of the rib cage is crucial to relieving this pain.    

Rib Problems Can Travel  

The upper ribs all attach to the back of the body at the spine, then curve around to the front of the chest. The last inch or two of rib, as it approaches the breastbone, is flexible cartilage instead of bone. This cartilage attaches the rib to the sternum bone in the center of the chest.  

When we bend or twist our trunks, there must be some flexibility at both the joints where the rib is attached to the spine, as well as at the cartilage where the rib joins the breastbone. This flexibility is integral to the simple act of breathing which we do thousands of times each day. If the spinal rib joints are stiff or restricted, it forces more motion into the cartilage where the ribs meet sternum. Over time, this can stress the cartilage and lead to chest pain.  

What causes the spinal rib joints to stiffen? Coughs, physical trauma and scoliosis are known triggers for costochondritis, and these can also cause rib joint stiffness. I find that, in many cases, patients with costochondritis cannot recall experiencing any of the above issues recently, but upon examination, they do have restricted movement of the rib joints.    

Stiffness in the rib joints is typically caused by restrictions in the fibrous connective tissue called fascia. This triggers muscle imbalance and joint tension, resulting in stiff rib joints. These fascia restrictions are usually in the muscles and joints of the rib cage, shoulder girdle and neck. Releasing these restrictions can restore motion to the spinal rib joints, taking stress off the rib cartilage in the front of the rib cage. This usuallyrelieves the chest pain.    

Getting Back in the Swing  

A patient I will refer to as Sally came to our office wanting treatment for costochondritis pain that she had been experiencing for two months. This pain had progressed to the point where could not swing a golf club or pick up her grandson.  

Taking deep breaths caused sharp pain. She also experienced intense pain between her shoulder blades which is not unusual with costochondritis. An examination revealed restrictions of the fascia in several muscles that attach to her left shoulder blade, as well as at the base of the skull and along the edges of two of her ribs.  

Of course, there was also restricted motion of the rib joints on the left side of the spine.  After her first treatment with fascia release therapy, she was able to take a deep breath with only mild discomfort. After three of these gentle treatments, she was able to play nine holes of golf with only mild aggravation, and that calmed down within an hour of finishing the round. With just a few more treatments after that, she had normal rib joint motion, her fascia restrictions were gone, and she was entirely pain-free.  

Sally’s excellent response to treatment is not unusual. While several different treatment methods can help to restore the range of motion and relieve the pain of costochondritis, my preferred method is fascia release therapy. I find releasing the fascia to be effective and gentle, which is important when dealing with extremely tender or sensitive joints. I also prefer fascia release because it addresses the root of the problem. For those who suffer from costochondritis, I recommend consulting with a practitioner who understands the role of rib joint restriction and how to effectively treat it to relieve this painful condition.   

Eric Winder, D.C., uses gentle manual therapy and rehab techniques to help patients with a wide range of pain and injury problems. For more information, call 941-957-8390 or visit Gentlebay.com. Dr. Winder’s offices are in Sarasota and Osprey.