by Eric Winder, D.C. 

Costochondritis, the most common source of chest pain, ranges from mild to severe. This condition causes 30% of all emergency room visits for chest pain which arises from irritation of the cartilage that joins your upper ribs to your sternum (breast bone).   

This pain can last just 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. While the conventional medical viewpoint asserts that, in most cases, the cause is unknown, many experts feel the cause lies in the mechanical motion of the rib cage. In my experience, this understanding is crucial to relieving the pain. 

Rib Problems Can Travel 

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

When we bend or twist our trunk, there has to 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 breast bone. This flexibility is also important just with the simple act of breathing which we do thousands of times every day. If the spinal rib joints are stiff or restricted, it forces more motion into the cartilage where ribs meet sternum. Over time, this can stress the cartilage and lead to chest pain. 

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

In cases like this, I typically find significant restrictions in the fibrous connective tissue called fascia which trigger 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 better motion to the spinal rib joints, taking stress off the rib cartilage in the front of the rib cage. This usually relieves 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 had persisted for two months. This pain had progressed to the point where could no longer swing a golf club or pick up her grandson.   

Taking a deep breath 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 of the 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 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 pain-free. 

Sally’s excellent response to treatment is not unusual. While there are several different treatment methods that 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, while at the same time gentle, which is important when dealing with extremely tender or sensitive joints.  

For those who suffer from the pain of costochondritis, I recommend consulting with a practitioner who understands the role of rib joint restriction and how to effectively treat it in order to relieve this aggravating problem. 

Eric Winder, D.C., uses gentle manual therapy and rehab techniques, without forceful manipulation, 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 located in Sarasota and Osprey.