A few months back I presented two of the more common causes of upper back or rib pain on breathing. Because of its intimate relation to the heart and lungs, pain on inspiration is a cause for concern, especially when coupled with other symptoms like fever, cough, or shortness of breath. But in the absence of these more concerning symptoms, “knocked out” ribs or spasmed intercostal muscles are two of the more typical presentations I see for painful breathing. A third condition can also cause pain on inspiration and that is costochondritis.
Costochondritis is an inflammation of the costal cartilage which attaches the ribs to the sternum (breastbone). It can be extremely painful, making the sufferer wince to the touch. It appears to be most common in women, and I can attest that most clients I’ve seen with this condition have been female. However, I have also seen it in men. Further, because the cartilage is in the front of the chest, the pain can mimic cardiac symptoms. This can be scary for women and men alike. If there is an associated rib subluxation or muscle spasm of the rib muscle or any muscle in the upper back, then the pain can be maddening indeed.
From a clinical standpoint, what are interesting are the many potential causes of costochondritis. I have mostly seen cases that were due to physical strain from either repeated lifting or pushing, like on movie sets. One hands-on television producer client of mine had a bad case that was likely lit-off by the manual labor she was doing daily. Another client came in with moderate case he developed from bench pressing at the gym. He would let the barbell sort-of bounce off his chest. The repeated impact, along with his other chest workout activities ultimately led to chest pain particularly on breathing. So costochondritis, then, can be caused by trauma. Even severe coughing can lead to a bout of costochondritis.
Arthritis can also cause costochondritis. For instance, both rheumatoid arthritis (RA) and ankylosing spondylitis (AS), two forms of autoimmune arthritis, can lead to inflamed costal cartilage. People who suffer from these conditions are more prone to costochondritis; thus any case which arises in the absence of insult or injury (like it just appeared) may warrant an evaluation for an autoimmune disorder.
Costochondritis can also be caused by infections and cancer. Tuberculosis, syphilis and the fungus, Aspergillus can lead to infection of the costochondral joints and cartilage. Tumors can also cause the affliction. Breast, lung and thyroid cancer can all metastasize to the chest wall including the costal cartilage.
Treatment for costochondritis, of course, depends on its cause. Cancer, autoimmune conditions, and infection need medical care. Obviously, getting the proper care requires the proper diagnosis. You can help yourself in this regard by getting a medical check, if you have any of the symptoms outlined here or in the previous article on the subject. Costochondritis caused by physical strain or injury can be helped enormously by icing the painful area (cryotherapy). Ultrasound is also an excellent treatment for costochondritis. Finally, once the area is cooled down a bit, light stretches and exercises can help, which can eventually lead to more advanced movements.
Pain on breathing is not pleasant and it can be scary if felt at the chest. If you are experiencing any associated symptoms as I outlined before, or if they fail to subside with treatment, then I really advise you to get checked by your medical doctor. But if your pain is due to a musculoskeletal condition, chiropractic and physiotherapy can help enormously. If you are suffering from upper back, rib, or breastbone pain and you are in the Beverly Hills, Los Angeles, or West Hollywood areas, then please contact me for an evaluation.