Have you ever experienced a sharp stabbing pain in your chest that got worse when you took a deep breath? Or a “stitch” in your ribs? You may have experienced a condition called costochondritis. Although this may sound like a mouthful—the word is easy to decipher when it is broken down to its two root words and suffix. “Costo” refers to rib, and “chondro” refers to cartilage. The suffix “itis” refers to an inflammation process. So, we have an inflammation of the rib and cartilage area of the chest.
Costochondritis is a harmless but painful condition that is often diagnosed when other more serious conditions, such as heart attack and pleurisy, are ruled out.
Symptoms of costochondritis usually include sharp pain near the area where the rib joins cartilage near the sternum or breastbone. Coughing, taking a deep breath, excessive twisting or strain to the rib cage may cause pain to worsen. The painful area is usually very tender to touch.
The cause of costochondritis is often idiopathic, meaning unknown. Sometimes it can happen after trauma, such as a car accident in which the steering wheel impacts the sternum or the seat belt cuts across the chest. In other cases, the condition may start after a bad cold that is accompanied by excessive coughing. Still in other situations, a person may have some back spasms or midback pain and then develop rib pain.
The mechanics of rib function can shed some light on costochondritis. First, let’s start with some anatomy. Both men and women have 12 pair of ribs. The top 7 pairs attach in back to the spine in an interesting way. Each rib forms a joint with two vertebrae. The rib then bows around the side of the body and forms a junction with cartilage that then joins the rib to the breastbone. If you run your fingers down the center of your sternum, starting just below the space between your collarbones, you can get an idea how much of your chest is protected by the rib cage.
Now slide your fingertips about an inch to either side of the center of the sternum and run your fingers down vertically. You will feel bumps and indentations as you travel down the junctions between rib, cartilage and the edge of the sternum. When you get to the bottom of the sternum the ribs form upside down. It is at this point that the 8th, 9th and 10th ribs attach not to the sternum but instead to cartilage. These ribs are therefore more flexible and can more easily become problematic. The last 2 ribs (11th and 12th) still are attached to the spine like the other 10 pairs, but they don’t attach to the front at all. They are therefore called floating ribs.
In clinical practice, it isn’t unusual to find restrictions around these floating ribs as the source of side stitches in running. One possible explanation is that the rotation of the trunk involved in running can irritate the muscle and fascia around the ribs if they are restricted from moving freely, causing pain.
Between each rib are 3 layers of muscles that form a weave. They control rib movement as you breathe in and out. Costochondritis appears to be related to dysfunction in the normal movement of the rib that causes it to be less mobile. This is why deep breathing or other activities that cause the ribs to move may be painful. Often, this imbalance can be seen in the mirror in that the rib cage looks different when comparing left and right sides. Although many people have asymmetrical rib cages, not all have rib pain. Typically, rib pain will occur if the imbalance is a recent event.
To treat costochondritis, traditional physical therapists use ultrasound and heat to reduce the inflammation. This procedure does have some success. To speed recovery, however, a manual physical therapist trained in the specialized area of ribs can normalize rib function and mobility and reduce pain by using gentle hands-on techniques. Remember that because all ribs are attached to the thoracic spine in back, any problem with this midback area can lead to compensations in the rib cage. It is important to know that this sometimes chronic condition in many cases can be successfully treated.