How to fix (most) Costochondritis and Tietze’s Syndrome, Part (2): Exercises and Treatment Details

How to fix (most) Costochondritis and Tietze’s Syndrome, Part (2): Exercises and Treatment Details

Most costochondritis is NOT a mysterious inflammation which nobody knows anything about. I’m a New Zealand physiotherapist – we’d see it as a straightforward problem where the rib hinges at the back are jammed, so the ones at the front work harder to compensate, get irritated, then inflamed. If there’s also swelling then it’s called Tietze’s Syndrome.

This is explained in detail in my YouTube video ‘How To Fix (most) Costochondritis and Tietze’s Syndrome Chest Pain’. We got swamped with requests for more specific details of how you fix it – here they are.

Serious note first: chest pain could be heart, so definitely get yourself checked out by a doctor first. But more than half of chest pain isn’t the heart or anything else dire.

The ’-itis’ ending of costochondritis (CC) means ‘inflammation.’ This sends doctors and sufferers alike off on a mystical quest to find something to suppress it, e.g. anti-inflammatory medications or steroid shots into the rib joints on the breastbone, or Omega-3, turmeric, etc. These aren’t wrong, but they miss the point, which is why they don’t work well, or at all, or give a lasting result on most CC.

The ribs are designed to hinge at both ends (like a bucket handle) to let you breathe. If the hinges at the back are frozen, the ones around the front have to frantically work overtime. So they get irritated, then inflamed – and there’s your costochondritis.

You fix it by getting the rib cage movement back to normal, especially the costovertebral (CV) joints where the ribs hinge onto your spine. Here’s how we do that. You might not need all of the components I’m describing, but chronic cases probably will.

(4.38) Get the frozen CV joints moving again. This is the core of it. If you’ve had the chest pain for more than a few months, you’ll need a Backpod. Sorry, but I just cannot locate anything else on the net that will actually give you enough specific leverage to stretch the collagen which has tightened around the immobile CV rib joints. It’s a shaped high-tech cushioned fulcrum you lie back on, which uses your upper body weight to free up the tight rib hinges. You have to stretch the tightened collagen around the hinges or they just freeze up again. The Backpod is also the gentlest way to start these back rib hinges moving again, with no pressure on the inflamed rib joints around the front.

(The Backpod has other uses. We built it primarily to counter the iHunch – the frozen stooped upper back that drives most neck pain and headache, especially if you’re hunching over laptops, tablets or smartphones. Just Google ‘Backpod’, or link is

The CV rib joints can be so frozen that they may also need the extra leverage of a manipulation to unlock them fully. An osteopath, chiropractor or manipulating physio can do this. However don’t get sucked in to going back repeatedly for the same thing – it’s expensive and won’t last anyway. Health practitioners vary. You can ask any of them, including your doctor, to watch these videos – that’s a perfectly reasonable request. In my experience, if they don’t listen then they tend not to be much good at what they’re doing anyway.

(8.52) Massage simply has more leverage on shortened scarred muscles than stretching. A good massage therapist will cover the usual back, neck and shoulder muscles, serratus anterior, the lats, pecs, intercostals, sternalis and the specific scarring after chest surgery or mastectomy.

(10.07) The two stretches are useful, but stretching can’t get effective leverage on scarred intercostal muscles between the ribs. Add the specific hands-on rib stretch I showed with the buckle handles.

(12.43) Working the hinges: As things loosen up, do the twisting exercise to work the rib machinery back into full movement– like putting oil on a door hinge and moving it backwards and forwards. Go gently initially or it’ll just stir up the irritated ribs around the front – back off for a few days if this happens.

(14.37) Work an anti-inflammatory gel like Voltaren or diclofenac into the painful bits twice daily to suppress the inflammation on the rib hinges – better targeted than taking a pill. The occasional flare of the pain as things are getting moving again is quite common – just back off for a day or so and use more gel.

(17.00) Very low dose tricyclic antidepressants, e.g. amitriptyline, used NOT as an anti-depressant but in a very low dose over a few months to settle down the fired-up nervous pathways that have been carrying the pain signals for so long and have become really good at it: see your doctor.

I hope all this helps you. YouTube diagnosis and treatment can’t be a perfect fit in all cases. But you can see where I’m coming from and it does make sense. Assume that of course costochondritis is fixable, and in a logical and practical way. Of course it’s not a mystery.

Cheers, Steve August.

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