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 the realm of weight training, costochondritis particularly impacts individuals following the 'chest day is everyday' mantra or those who rapidly escalate their upper body workouts. Engaging in excessive front-body muscle workouts without adequate attention to the back muscles, or performing back exercises improperly, can elevate the risk of developing costochondritis. Even exercises like push-ups, if not done with proper form and balance, can contribute to this condition.

What is costochondritis?

Costochondritis manifests in the area between your ribs at the front of your body and your sternum or chest bone. This region features cartilage, crucial for maintaining rib flexibility and securing them to the chest bone. In costochondritis, this cartilage or connective tissue becomes irritated or inflamed, typically affecting multiple ribs, notably ribs 2-5 (the region just below your collarbone to around nipple height).

While discomfort may subside within a few days, prolonged symptoms, especially when neglected, can extend for several months. This prolonged discomfort, particularly when attempting to overlook the symptoms, may result in significant muscle atrophy. This is particularly noteworthy for individuals engaged in weightlifting endeavors, especially those aiming to increase chest and arm muscle mass.

In more serious cases, the impact of costochondritis isn't confined to the chest area alone. Prolonged discomfort can lead to complications such as back pain, emphasizing the importance of addressing symptoms promptly to prevent extended discomfort and potential complications.

Costocondritis causes pain in the chest

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 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 want to emphasize the importance of seeking professional medical advice if you consistently experience chest pain during physical activity. Your health is paramount, and it's crucial to prioritize rest. Even everyday activities like push-ups should be approached with caution, and if you encounter persistent chest pain, taking a break is essential for your overall well-being. It's better to be safe and prioritize your health. 

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.

Costochondritis Physical Therapy?

Costochondritis can be influenced by various muscles attached to your upper chest, including the pectoralis major, pectoralis minor, scalene muscles, and latissimus dorsi. These muscles play a role in the upper ribs and shoulder blades, and incorporating costochondritis stretching routines is essential to alleviate pressure in the affected area. Individuals with this condition often exhibit over-rounded spines at the thoracic spine level.

In addressing costochondritis, targeted stretches, such as costochondritis stretching exercises, can provide relief by targeting the pectoralis major, pectoralis minor, scalene muscles, and latissimus dorsi. Additionally, the less recognized serratus anterior, along with the middle/lower trapezius, act as counterforces to the upper trapezius and pec minor.

For added relief, consider incorporating costochondritis tennis ball techniques during your stretching routines to target specific trigger points and promote further relaxation in the affected muscles.

Costochondritis Exercises

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.

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.

Healing 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!

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Physical therapy for costochondritis in Columbia MD.

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