Costochondritis Patient Information
Costochondritis is a self-limiting inflammation of the cartilage connecting your ribs to your breastbone that typically resolves within 6-8 weeks with appropriate pain management and activity modification. 1, 2
What Is Costochondritis?
Costochondritis is inflammation at the junction where your ribs meet the cartilage of your breastbone (sternum), most commonly affecting ribs 3-7. 1 This condition causes chest wall pain that can be alarming but is benign once serious causes like heart problems have been ruled out. 3 Your negative rib fracture imaging confirms there is no broken bone, which is reassuring. 1
Expected Recovery Timeline
- Most cases resolve within 6-8 weeks with proper treatment, though some patients experience symptoms for several months. 2, 3
- Pain typically improves significantly by 4 weeks with appropriate management. 2
- Complete functional recovery usually occurs within 8-12 weeks for straightforward cases. 2
- A small percentage of patients may have persistent symptoms requiring additional interventions. 3
Pain Management Strategy
First-Line Treatment
- Take acetaminophen (Tylenol) 650-1000mg every 6 hours regularly, not just when pain occurs—scheduled dosing works better than as-needed dosing. 4
- Oral acetaminophen is just as effective as IV formulations. 2, 4
Second-Line Treatment
- Add NSAIDs (ibuprofen 400-600mg or naproxen 500mg) if acetaminophen alone is insufficient, but discuss with your doctor first if you have kidney problems, stomach ulcers, or take blood thinners. 2, 4
- NSAIDs help reduce both pain and inflammation at the affected cartilage. 5
Additional Pain Relief
- Apply ice or cold compresses to the painful area for 15-20 minutes several times daily, especially in the first few weeks. 4
- Avoid activities that worsen your pain, particularly twisting motions and heavy lifting. 5
Breathing and Movement Exercises
- Perform gentle deep breathing exercises 3-4 times daily to prevent chest tightness and maintain lung function. 4
- Start gentle stretching exercises after the first 1-2 weeks when acute pain begins to subside—stretching of the chest wall muscles has been shown to significantly improve pain in costochondritis patients. 5
- Maintain good posture, as slouching can worsen chest wall pain. 6
Warning Signs Requiring Immediate Medical Attention
Seek emergency care if you develop any of these symptoms: 4
- Increasing shortness of breath or difficulty breathing
- Fever above 100.4°F (38°C)
- Chest pain that suddenly worsens or feels different from your rib pain
- Productive cough with yellow, green, or bloody sputum
- Dizziness, fainting, or confusion
Follow-Up Care
- Schedule a follow-up appointment within 1-2 weeks to reassess your pain and ensure proper healing. 4
- If pain persists beyond 4-6 weeks despite treatment, consider physical therapy referral for manual therapy techniques and targeted exercises. 4, 3, 6
- Physical therapy interventions including rib mobilization and soft tissue work have shown complete resolution of symptoms in cases of persistent costochondritis. 3, 6
Activity Modifications
- Avoid heavy lifting, pushing, or pulling activities for at least 2-4 weeks. 5
- Gradually return to normal activities as pain allows, but stop if pain worsens. 2
- Athletes should not return to contact sports until pain has completely resolved and full range of motion is restored. 7
Common Pitfalls to Avoid
- Do not undertake pain—inadequate pain control leads to shallow breathing, muscle guarding, and prolonged recovery. 4
- Do not rely solely on rest—gentle movement and breathing exercises are essential for recovery. 5, 6
- Do not ignore worsening symptoms—while costochondritis is benign, new or different chest pain requires immediate evaluation. 4, 3
Why Your X-ray Was Negative
Chest X-rays miss up to 50% of rib fractures, but more importantly, costochondritis involves cartilage inflammation that doesn't show up on standard X-rays. 1, 4 The treatment approach remains the same regardless, focusing on pain control and functional recovery. 1