What is the treatment for costochondritis?

From the Guidelines

Treatment for costochondritis typically involves managing pain and inflammation until the condition resolves on its own, with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen being the first-line treatment to reduce inflammation and pain. The goal of treatment is to relieve symptoms, maintain or regain functional capacity, reduce inflammation, and prevent structural musculoskeletal damage 1.

Key Treatment Recommendations

• Provide patient education and lifestyle recommendations, and consider physiotherapy and dental examination 1
• Use NSAIDs/COXIBs in maximum tolerated and approved dosage in adults with active costochondritis, and evaluate treatment response at 2-4 weeks 1
• Consider short courses of oral prednisolone or intra-articular glucocorticoid injections as bridging options, but avoid long-term use of glucocorticoids 1
• For severe cases, a doctor might prescribe stronger pain medications or administer a local corticosteroid injection directly into the affected cartilage area

Important Considerations

• Rest and avoiding activities that worsen chest pain are essential, particularly movements that stretch or strain the chest wall
• Applying heat or ice to the affected area for 15-20 minutes several times daily can provide relief
• Gentle stretching exercises for the chest muscles may help once acute pain subsides
• Patients should seek immediate medical attention if chest pain is severe, accompanied by shortness of breath, fever, or spreads to the arm or jaw, as these could indicate a more serious condition like a heart attack rather than costochondritis 1

Treatment Response Evaluation

• Conduct a treatment response evaluation between treatment steps, primarily based on clinical measures, but integrate radiological and biochemical measures as appropriate 1
• Declare sufficient/insufficient response based on improvement, no change or worsening on relevant measures, with the individual patient context and predetermined treatment goals as reference 1

From the Research

Treatment Options for Costochondritis

The treatment for costochondritis typically aims to reduce inflammation and alleviate pain. Some of the treatment options include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation 2
• Local injection of anesthetic or steroid to reduce pain and inflammation 3
• Avoiding activities that produce chest muscle overuse 2
• Providing reassurance to the patient 2

Alternative Therapies

Some alternative therapies have also been found to be effective in treating costochondritis, including:

• Stretching exercises to improve pain and reduce inflammation 3
• Manipulative therapy, such as osteopathic manipulation techniques (OMT), to address rib dysfunction 4
• Instrument-assisted soft tissue mobilization (IASTM) and stretching to address myofascial pain generators 4
• Manual therapy and exercise directed at the cervicothoracic spine and ribcage 5

Physical Therapy

Physical therapy (PT) has also been found to be effective in treating costochondritis, particularly when using an impairment-based examination and treatment approach. This approach includes:

• Manual therapy to address impairments in the cervicothoracic spine and ribcage 5
• Therapeutic exercise to improve function and reduce pain 5
• Patient-specific functional scale (PSFS) and numerical pain rating scale (NPRS) to monitor progress and outcomes 5