Q&A: Chest Pain from Costochondritis
- How To TBI
- Feb 6, 2022
- 7 min read
Updated: Sep 30, 2022
A special thank you to Diane for her original question, Dave for sharing additional info & to Trudy for her follow-up dialogue.
Q.
"Does anyones elses sternum hurt like you got punched in the chest ?"
~Diane
"Yes! It started off as a tight chest - like a big rubber band around my chest for months. Then it became isolated pain in sternum, and parts of back and chest. I've had heart, lungs and gastro checked out and still no clear idea what it is. Best guess at this point is costochondritis. Thankfully it's much better than it was but I just "celebrated" 9 months since first symptom. Seems any bit of progress just takes so very long. But now I can sometimes go a whole day without pain (in that particular location - there always seems to be some pain somewhere). I hope you get some relief!"
~Dave
" I get the belt tightening thing too. Can you do anything for Costochondritis?"
~Trudy
NOTE: If you are experiencing active chest pain, go immediately to see your PCP, cardiologist, urgent care, or 911 emergency services/hospital setting for a correct current acute diagnosis & treatment interventions, especially if you are born genetically female.
Signs of heart attack are not often recognized/often missed/often overlooked in women in emergent settings.
Signs of heart attack in women are often NOT the same as the "classic signs" exhibited by men who are having a heart attack.
Chest pain, among other symptoms, can be signs of a blood clot, be it a:
-DVT (deep vein thrombosis),
-pulmonary embolism (clot in lungs),
-heart attack/myocardial infarction (clot in heart)
-stroke (clot in brain),
or sign of transient or sustained heart failure.
The only way to be sure is to go see your Dr. and get a complete cardiac workup, incuding EKG, cardiac enzymes labs & D.Dimer bloodwork tests.
Even if you think you know what's going on, or have experienced similar pain before, if you're unsure &/or something seems different &/or you are in active pain, stop what you're doing and seek out emergency care immediately.
Every second counts; don't wait to seek out emergency medical care.
A.
With that said, the word "costochondritis" comes from the Latin:
-"costo" meaning rib bone
-"chon" meaning cartilage
-"itis" suffix meaning inflammation.
Pain, where the cartilage meets the 2nd or 3rd rib, is called Tietze Syndrome.
Pain, where the cartilage meets the 4th, 5th or 6th rib, is called Costochondritis.
I really like the PT content from Bob & Brad.
Even though the pain is in the front of your chest on &/or around your sternum, it's actually originating from the (lack of movement) around the thoracic area of your back.
It's exacerbated by the attempts at chest wall movement & expansion/contraction of your ribcage at the area on your back as you inhale & exhale, where the ribs connect with the vertebrae of your spinal cord.
This is what they recommend from the PT Steve August who created the Backpod.
He also said you could try using a softball in a pillowcase as an alternative, although it may roll.
This is links to published peer-reviewed medical research:
This is a video presentation of that medical research:
This is a longer version of the user guide & background info for PTs, & other clinicians:
& this is the original video I saw a few years ago which was eye-opening about the bucket handle shape
it talks about in a healthy person with no adhesions, the ribs in your ribcage move up and down during breathing freely, like the way a bucket handle moves up and down freely when you go to lift it & then let go of the handle.
But when you develop an adhesion on your back, it's like pinning down one side of a bucket handle, and then the movement on the other side of the handle (your front) has to work excessively harder and is more restricted, which is where you get the inflammation on the front of your chest.
the video demo is easier to understand than my trying to type out the explanation here: https://www.youtube.com/watch?v=W9PWTLOQf3w
as i'm sure many covid survivors here know, your lungs are closer to your back than your front (which is why prone positions tend to help because it allows your lungs to expand more readily). especially if you experienced respiratory symptoms during the active phase of covid with difficulty breathing, you likely also had restricted movement with your lungs & thoracic upper/mid-back area, & adhesions may have developed.
breaking up those adhesions & restoring movement there should hopefully help at getting at the root cause.
Talk to your Dr., first. & then then your PT. anti-inflammatories may help in the short-term, but to try to fix longer term, you have to address the root cause where your back is.
hope that helps.
good luck.
---
"thank you!! I’ll check these out. Interesting theory about it originating in the back."
~Trudy
absolutely. it was eye-opening & very helpful for me, so when I saw this thread, wanted to make sure others knew, too.
i think in general, the impression i got previously & still seems to be the case was that costochondritis didn't seem to be like something that was widely understood, especially in terms of root cause & treatment, even before covid, and now it's amplified given everyone with covid.
if it ends up working for you as well, be sure to let others know!
---
"I’m seeing an osteopath, just started acupuncture and she also wants me to do myofascial massage therapy. She said my fascia is restricted and surrounding my heart."
~Trudy
yay! I love acupuncture.
I was nervous to try it initially, but have found it very helpful, especially for nausea & migraine.
I feel a buzzing feeling with it, especially if I close my eyes, and the best way I can describe it is a faster way to get to a meditative state than going through a 20 minute meditation, which I also like. I can feel the pulsations.
So glad that you found someone near you.
Also, myofascial release will change your life.
When seeking out a PT, I recommend searching for one who focuses on manual therapy, meaning that they do actual physical manipulations of your underlying musculature with their hands.
Not all PTs do this --- some practices focus more on only giving instructions for an at-home exercise program & never actually do physical manipulation.
All things being equal (including your co-pay, if you have one...amount of worth may be a judgment call on your part if you have cost-sharing co-insurance where the OOP (out-of-pocket) cost varies based as a percentage (%) on the base contracted billable charge, instead of a flat-rate co-pay), unless you have a compelling reason otherwise, I would strongly recommend seeking out a PT practice that actually has a manual therapy component.
The word "manual" comes from the Latin word "manus" which means "hand."
Specifically, finding a PT who is certified and specializes in Graston Technique may be of particular help.
Graston Technique uses specific tools by certified PT professionals to help them go deeper & better manipulate underlying musculature & better break up adhesions, especially when excessive guarding from pain is present.
Those who are certified in this technique with these specific manual tools know how to safely "scrape" along the skin, which, while often painful & causing acute inflammation, is specifically designed not to bruise & further damage underlying musculature & cartilage while breaking up adhesions.
In my personal experience, Graston Technique is painful while the certified PT is performing it, and hurts & swells a bit for at least a day or so after (YMMV), but the increased range of motion at follow-up is incredible, sustainable, & empirically measurable on palpation by the practitioner.
I would equate Graston Technique to a more intense version of myofascial release that leverages tools as part of the intervention to aid the certified PT with the manipulations of the underlying musculature, as opposed to them only using their hands.
For particularly difficult or long-standing cases with excessive guarding, it can take more than a few sessions, often not back-to-back because you need to give your body time to recover.
When you're at the start of your PT journey, if you have the opportunity, I would add that to the questions to ask when trying to initially screen PT practices when trying to figure out where to seek out care before starting.
If you've already started PT, it's probably worth it to continue on with your existing practitioner & practice since you've already gone through and paid for the evaluation & in particular, if you're noticing progress.
If you later relapse or your PT has reached their personal limit in terms of their own personal expertise & knowledge, I would recommend keeping an eye out for a PT skilled and certified in Graston Technique for your next course of PT.
According to the Graston Technique website,
"Graston is the leading soft-tissue therapy that is used by 2/3 of NFL, NBA and MLB teams."
Image Courtesy of Graston Technique website: https://grastontechnique.com/
Pulled: February 6, 2022
You can locate Graston Technique providers here:
My PT recommended a massage therapist whose work they had seen with other patients, and the range of motion difference is completely noticeable.
If you have an FSA or an HSA account and a Dr.'s Rx, you can pay for that with pre-tax dollars, as well.
For those who may have difficulty affording, I recommend "community-based acupuncture" where the acupuncture is done in a shared large room with other patients, instead of in an individual room, and I also recommend massage therapy schools where the LMTs in training are working on gaining enough hours for the licenses.
It's not the same as seeing an established provider, but everyone has to start somewhere, and the price for those services can be less expensive, which is really helpful.
Some insurances may also provide coverage, but it depends & is worth calling your health insurance provider to see if you have coverage for either type of holistic & allied health service.
If you're seeing a physiatrist (a spinal back Dr.) &/or an orthopedic Dr. &/or some PTs, some offer "dry needling" which is sort of like acupuncture (same needles), but inserted I think slightly deeper into adhesions and sometimes they also pass electrical current in to stimulate the underlying musculature at a deeper level.
Sometimes dry needling may or may not be covered by health insurance with a given provider; that's something to inquire about, as well.
Same for electrical stim (like a TENS unit). However, those may be contraindicated in those who are cancer patients/survivors, and those with peripheral neuropathies who may not be able to detect if stim levels are too high.
Definitely worth discussing with your provider to see whether or not any of these are interventions which may be applicable & helpful from a therapeutic standpoint.
---
"those are great suggestions. I used to go to a cosmetology school for my haircuts and color. Same idea."
~Trudy
Thank you! Appreciate it lots :-)
Comments