Costochondritis is one of the benign medical conditions, although the symptoms can be scary, and many people with this condition visit the emergency room. Costochondritis symptoms can mimic a heart attack and can be frightening. One study found that up to 45% of emergency room and urgent care visits for chest pain are due to musculoskeletal issues like costochondritis.

Costochondritis is chest pain caused by inflammation of the joints where your ribs attach to your breastbone (sternum). It’s not a heart problem. It’s not a lung problem. It’s not dangerous, yet it feels scary.

Costochondritis is a common cause of chest pain, usually affecting adults between 40 and 50 years old, and it’s slightly more common in women. While chest pain is often caused by musculoskeletal issues or other chest wall problems, doctors always need to consider other potential causes first, including heart problems, mental health issues, lung conditions, digestive issues, and less common causes.

Costochondritis vs. Heart Attack: How to tell the difference

With costochondritis, the pain is often sharp, aching, tight, or pressing. It is usually felt along the breastbone and gets worse when you take a deep breath, cough, or sneeze. Many people notice it increases with certain movements, such as reaching overhead, twisting, or rolling over in bed.

Heart attack pain, on the other hand, is typically described as a deep, heavy pressure or squeezing sensation. It does not change when you press on the chest or move your arms. It is often triggered by physical exertion, such as walking uphill or climbing stairs, rather than by specific movements. Other symptoms, such as shortness of breath, nausea, sweating, dizziness, or a general feeling of unwellness, might be present.

A useful tip: If your chest pain can be reproduced by pressing on a sore spot or moving your arm a certain way, it’s more likely muscle- or cartilage-related rather than a heart problem.

Costochondritis is usually diagnosed based on the patient’s history and a physical exam. The key signs are tenderness on palpation of the area near the breastbone and pain during specific manoeuvres, such as the “crowing rooster” or crossed-chest adduction tests.

Once a musculoskeletal or chest wall cause is suspected, the main possibilities include costochondritis, muscle injuries (from overuse or surgery), arthritis, fibromyalgia, infections, shingles, Tietze syndrome, painful xiphoid syndrome, or slipping rib syndrome.

What causes Costochondritis

Costochondritis often appears without a clear reason, but certain factors can make the cartilage in your chest inflamed and painful. Some common triggers include:

Illness: Respiratory infections, like the flu, bronchitis, or a bad cold, can inflame the chest cartilage. Frequent coughing during these illnesses can put extra strain on the area.

Trauma: Any impact to the chest - from sports, a fall, or an accident - can cause pain and inflammation.

Sudden increase in activity: Lifting, pushing, pulling, or twisting more than usual can irritate the chest muscles and joints, especially if your body isn’t used to it.

Repetitive movements: Activities that involve frequent twisting, throwing, or other repeated motions can trigger costochondritis, particularly if you suddenly increase intensity. Even excessive coughing or vomiting during an illness can sometimes be enough to start the pain.


There isn’t strong, high-quality evidence for treatment, but most patients will improve with simple, conservative measures. These include applying heat, using oral or topical anti-inflammatory medications, using lidocaine patches, using capsaicin cream, undergoing physical therapy, and even acupuncture or dry needling. Symptoms often resolve within a few weeks. For persistent cases, corticosteroid injections may help. Sometimes costochondritis becomes chronic, especially if it’s caused by repetitive movements that aren’t corrected. Because the condition is not life-threatening and normally improves on its own, there is limited research.

Steve August and backpod

There’s a significant disconnect between how costochondritis is approached in manual physiotherapy in New Zealand versus most other parts of the world. This is thanks to the physiotherapist Steve August, who has spent decades treating rib and thoracic spine problems. His clinical experience - backed by research and practical outcomes - led him to challenge the traditional idea that costochondritis is purely an inflammatory condition. He invented the backpod, a device designed to gently stretch and mobilise the stiff rib joints at the back. Most people with costochondritis have rounded shoulders and feel tight between their shoulder blades. This device can improve mobility at the back, and the irritation at the front settles down.

You can’t always prevent costochondritis, but you can take steps to make your chest and upper body more resilient. Warming up before exercise or any heavy activity helps your muscles loosen up, while staying active regularly makes your body better at handling sudden movement without getting sore. Take it slow when increasing how much or how hard you’re doing something, and don’t forget to stretch-especially if you’re sitting or hunched over a lot-so your chest, shoulders, and back stay flexible. Building strength in your chest, shoulders, back, and core also helps support good posture and takes pressure off your joints, making everyday movements and workouts a lot easier on your chest.