Overview
This video by Dr. Zach Griffin explains costochondritis, its symptoms, causes, treatment approaches, exercise modifications, and how to distinguish it from similar conditions. Key advice is given for pain management, safe exercise practices, and when to seek further medical evaluation.
Understanding Costochondritis
- Costochondritis is irritation of the cartilage in the front of the chest, usually affecting the costochondral or costosternal joints.
- Symptoms include sharp, achy, or pressure-like chest pain, worsened by compression, deep breathing, or upper body movement.
- Palpation of the affected area typically reproduces the pain.
- Usually affects the second through fifth ribs with no visible swelling.
- About 14% of chest wall pain cases are due to costochondritis.
- Main causes include severe coughing, chest injury, heavy lifting, exertion, and infections like pneumonia.
- Condition is primarily due to mechanical irritation or overuse, not inflammation.
Management and Treatment Strategies
- Rest and reducing aggravating activities are most effective for healing.
- Modify posture and avoid sleeping on the stomach or affected side to minimize irritation.
- Avoid heavy or fast lifting, and do not lean to the painful side when sitting.
- Use hot/cold packs, over-the-counter medications (if safe), cough suppressants, and topical NSAIDs as needed.
- Isometric and gentle thoracic mobility exercises are recommended, provided they do not cause pain in the acute stage.
- If exercises increase pain, stop and allow more rest before resuming.
- For chronic cases, gradual reintroduction of exercise is appropriate.
Exercise Modifications
- Wall plank, anti-rotation isometric, banded row, external rotation isometric, 90/90 shoulder rotations, and floor angel are suggested exercises.
- Exercises should be pain-free in the acute phase; intensity and resistance can be increased over time as tolerated.
- Modify type, intensity, frequency, and duration of exercise to avoid aggravating symptoms while maintaining activity.
Distinguishing from Other Conditions
- Tietze syndrome is similar but more rare, usually affects one rib (2 or 3) under 40 years old, and presents with visible swelling.
Safety and When to Seek Further Evaluation
- Rule out cardiac causes for chest pain, especially in individuals over 35, with family history of heart disease, or accompanying shortness of breath or left arm symptoms.
Recommendations / Advice
- Reduce aggravating activities and modify posture to minimize pain.
- Only perform pain-free exercises in the acute setting.
- Seek medical evaluation for chest pain with concerning features or cardiac risk factors.