What are the recommended treatments for costochondritis (inflammation of the cartilage that connects the ribs to the breastbone) during pregnancy?

Management of Costochondritis During Pregnancy

For pregnant women with costochondritis, acetaminophen is the first-line treatment for pain relief, followed by conservative non-pharmacological approaches including heat therapy, gentle stretching, and physical therapy with manual therapy techniques. 1

First-Line Treatment Options

Pharmacological Management

• Acetaminophen: Safe during all trimesters of pregnancy 1
  • Recommended dosage: 500-1000mg every 6 hours as needed, not exceeding 4000mg in 24 hours
  • Can be used throughout pregnancy with minimal risk to the fetus

Non-Pharmacological Management

1. Heat therapy:

   • Warm compresses applied to the affected area for 15-20 minutes, 3-4 times daily
   • Provides pain relief without medication exposure

2. Rest and activity modification:

   • Avoid activities that exacerbate pain
   • Modify sleeping position using supportive pillows
   • Gradual return to normal activities as symptoms improve

3. Physical therapy interventions 2:

   • Manual therapy directed at the cervicothoracic spine and ribcage
   • Gentle mobilization of the costovertebral and costochondral joints
   • Soft tissue mobilization of intercostal muscles and pectoral muscles
   • Evidence shows significant improvement with PT (mean pain reduction of 5.1 points on NPRS) 2

Second-Line Treatment Options

If symptoms persist despite first-line treatments, consider:

1. Physical therapy referral if not already initiated:

   • Instrument-assisted soft tissue mobilization
   • Rib manipulation techniques
   • Therapeutic exercises targeting posture and thoracic mobility 3

2. Supportive garments:

   • Maternity support bands that don't restrict breathing but provide stability

Treatments to Avoid During Pregnancy

• NSAIDs (ibuprofen, naproxen): Should be avoided, particularly in the first and third trimesters 4

  • Associated with increased risk of miscarriage in first trimester
  • Risk of premature closure of the ductus arteriosus in third trimester

• Corticosteroid injections: While sometimes used for severe costochondritis in non-pregnant patients, these should be avoided or used with extreme caution during pregnancy

• Muscle relaxants: Most are not well-studied in pregnancy and should be avoided unless benefits clearly outweigh risks

Monitoring and Follow-up

• Follow-up every 2-4 weeks to assess symptom progression
• If symptoms worsen or new concerning symptoms develop (fever, localized swelling, redness), urgent evaluation is needed to rule out infectious costochondritis 5
• Most cases of costochondritis are self-limiting and resolve within several weeks to months 6

Special Considerations

• Ensure proper diagnosis by ruling out cardiac and pulmonary causes of chest pain
• Costochondritis is diagnosed clinically by reproducible tenderness over the costochondral or costosternal joints
• Pregnancy itself can exacerbate costochondritis due to postural changes and increased chest wall strain
• Symptoms typically improve postpartum as biomechanical stresses normalize

When to Consider Specialist Referral

• Persistent symptoms despite 4 weeks of conservative management
• Signs of infection (fever, progressive swelling, purulent discharge)
• Severe pain limiting activities of daily living or affecting sleep quality

By following this treatment approach, most pregnant women with costochondritis can achieve significant symptom relief while minimizing risks to both mother and fetus.