Costochondritis is pain and tenderness where the ribs join the breastbone, usually on the front of the chest. It is a common and usually harmless cause of chest pain that often settles within weeks. Because chest pain can come from the heart or lungs, it should always be medically assessed before it is treated as costochondritis.
Also known as costosternal syndrome, anterior chest wall syndrome, chest wall pain, Tietze syndrome (a related condition)
Symptoms
- Sharp, aching or pressure-like pain at the front of the chest, often beside the breastbone
- Tenderness when pressing on the rib joints, often several of the 2nd to 5th ribs
- Pain that is worse with deep breaths, coughing, sneezing or stretching the arms
- Usually no swelling, redness or warmth (swelling suggests the related Tietze syndrome)
- In some people, a feeling of tightness or difficulty taking a full breath
Causes and risk factors
- Often no clear cause is found
- Repeated or unaccustomed upper body exercise, lifting or rowing
- Strong or prolonged coughing, for example after a chest infection
- Minor strain or knock to the chest wall
- Sometimes linked with inflammatory arthritis or widespread pain conditions
What the evidence says helps
- Medical assessment comes first. Tenderness on the chest wall does not rule out a heart problem, so most adults with new chest pain need checks such as an ECG before costochondritis is diagnosed.12
- For most people, costochondritis is self-limiting. In one large observational study, around 9 in 10 people were pain-free after about three weeks of relative rest and anti-inflammatory medication, and recurrence was uncommon.1
- There are no high-quality trials of treatment. Usual care is reassurance, simple pain relief where safe (for example paracetamol or anti-inflammatory gels or tablets), local heat and easing off activities that aggravate the pain.12
- A guided stretching programme has been reported to reduce pain slightly in people whose symptoms had lasted over a year.14
- For recent chest wall pain that is musculoskeletal, a package of hands-on care, exercise and advice gave similar pain reduction to a single education session, but people were more likely to report feeling meaningfully better.5
- Some people still have chest pain a year later, so ongoing or recurring symptoms are worth reviewing.3
Things you can try at home
- Make sure new chest pain has been checked by a doctor before managing it yourself
- Ease off push-ups, heavy lifting or other activities that clearly flare the pain, then build back gradually
- Try a warm compress on the sore area for 15–20 minutes
- Ask a pharmacist whether simple pain relief or an anti-inflammatory gel is suitable for you
- Keep gently moving your shoulders and upper back so the area does not stiffen
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Call 999 for chest pain that feels heavy, tight or crushing, or spreads to the arm, jaw, neck or back
- Call 999 if chest pain comes with breathlessness, sweating, feeling sick, dizziness or fainting
- Call 999 for sudden chest pain with breathlessness or coughing up blood, especially after recent surgery, a long journey or with a swollen calf
- Call NHS 111 or see a GP urgently for chest pain with fever, or a red, hot, swollen area over the ribs
- See a GP urgently if chest pain comes with unexplained weight loss, night sweats or a history of cancer
- See a GP if pain lasts more than a few weeks or keeps returning
How Apollo can help
We only see chest wall pain once a heart or lung cause has been ruled out, and we will ask about this at the start. Our osteopaths assess the ribs, upper back and shoulders, explain what is likely going on, and may offer gentle hands-on care, mobility and stretching exercises, and advice on pacing training or work. If anything in your history or examination concerns us, we will direct you to your GP, NHS 111 or 999.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
How do I know if my chest pain is costochondritis or my heart?
You cannot reliably tell the difference yourself. Even when the chest wall is tender, a heart problem can still be present, so new chest pain should always be checked by a doctor. Call 999 if the pain is heavy or tight, spreads to your arm or jaw, or comes with breathlessness or sweating.
How long does costochondritis last?
Most cases settle within a few weeks. A minority of people have pain that lasts months or comes back. If it persists, a review of your ribs, upper back and activity levels can help.
Can I exercise with costochondritis?
Gentle activity such as walking is usually fine. It is sensible to reduce exercises that clearly bring on the pain, such as push-ups or heavy pressing, and then reintroduce them gradually as symptoms ease.
References
- Mott T, Jones G, Roman K (2021). Costochondritis: rapid evidence review. American Family Physician. View source
- Proulx AM, et al. (2009). Costochondritis: diagnosis and treatment. American Family Physician. View source
- Disla E, et al. (1994). Costochondritis: a prospective analysis in an emergency department setting. Archives of Internal Medicine. View source
- Waggoner R, et al. (2024). Costochondritis. Pediatrics in Review. View source
- Southerst D, et al. (2015). The effectiveness of noninvasive interventions for musculoskeletal thoracic spine and chest wall pain: a systematic review by the OPTIMa collaboration. Journal of Manipulative and Physiological Therapeutics. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
