Costochondritis and What to Expect From Physical Therapy
Exercises to Relieve Chest Wall Pain
Medically reviewed by Katrina Carter, DPT
Costochondritis, an inflammation of the cartilage that connects the breastbone to the ribs, can be treated with physical therapy (PT). PT exercises can help ease the pain and inflammation caused by this condition and help you return to normal activity and function.
This article discusses costochondritis, its symptoms, and how physical therapy can help you recover.
Verywell / Zoe Hansen
Related: Causes of Breast Pain and Treatment Options
Assessing Costochondritis
When you first visit a physical therapist for costochondritis, they will conduct an initial evaluation. You'll be asked:
How your chest pain started and what it feels like
If your symptoms are changing
What makes your pain better or worse
How the pain affects your ability to perform functional tasks like breathing or rising from sitting
Your therapist can get an idea of the severity of your costochondritis during the history-taking portion of the evaluation. More severe cases cause significant limitations in breathing and changing positions; mild cases may cause some pain, but functional mobility may not be affected to a great extent.
Common Assessment Tests
After your physical therapist takes your history, they will perform several tests and measures to get an idea of what impairments may be causing your costochondritis. Common tests and measures may include:
Range of motion measurements
Strength measurements
Flexibility measures
Rib mobility
Spinal mobility in the neck, mid-back, and lower back
Pulmonary function and breathing assessment
After your therapist performs an examination, they should have enough information to determine the root cause of your costochondritis and can start treatment. A plan of care will be discussed with you, and goals for rehab for your chest pain will be set.
Related: What Is Costochondritis?
Costochondritis Physical Therapy
Physical therapy for costochondritis involves helping you manage your pain, decreasing inflammation, and improving the way you move to relieve pressure off inflamed rib cartilage. Most people with costochondritis benefit from working with an orthopedic physical therapist, an expert in the treatment of musculoskeletal conditions.
Related: An Overview of Orthopedic Physical Therapy
Different modalities and maneuvers may be used to improve the way you move. These may include:
Rib mobilizations to help improve the way your ribs move up and down during normal respiration
Spinal joint mobilizations to improve the way your thoracic spinal joints glide and slide together
Range of motion and stretching exercises that can take pressure off inflamed rib cartilage and allow for improved freedom of movement
Postural strengthening exercises to help maintain appropriate positions that keep pressure off your rib cartilage
Breathing exercises to improve the way your ribs move while you are taking deep breaths
Other treatments may be used to help decrease pain and inflammation. These may include heat to improve circulation and ice to decrease pain and swelling around inflamed tissues. Other common PT treatments, such as ultrasound or electrical stimulation, are not used, as the cartilage involved is close to the heart. Performing these procedures near your cardiac structures is not recommended.
Active involvement in your therapy is key. Your therapist will likely prescribe exercises to help your ribs and thorax (chest) move better.
Related: An Overview of Physical Therapy
Exercises for Costochondritis
Exercises for costochondritis are designed to improve overall chest wall and rib mobility. This can help decrease pain and improve the way your ribs and thorax move. Postural exercises can relieve the pressure of inflamed cartilage.
Before starting any exercise program for costochondritis, check in with your healthcare provider to ensure that exercise is safe for you to do.
Pectoral Corner Stretch
The pectoral corner stretch is meant to improve the flexibility of your pectoral or chest muscles. To perform the stretch:
Stand facing a corner about 2 feet away from the wall.
Place both arms up, with your forearms resting against the wall on each side of the corner. Your hands, forearms, and elbows should be in contact with the wall.
Slowly lean into the corner, stretching the muscles in the front of your chest.
Hold the stretch for 15 to 30 seconds, and then relax.
Repeat the stretch three to five times.
Pectoral Doorway Stretch
You can stretch your pecs using a doorway opening, too. To perform this stretch:
Stand in a doorway, and place both elbows and forearms up against the doorjamb on either side of you.
While keeping your elbows against the doorjamb, slowly lean forward, stretching the muscles in the front of your chest.
Hold the stretch for 15 to 30 seconds.
Repeat three to five times.
Scapula Squeeze
The scapula squeeze can be done to improve posture and muscular control of your thorax. To perform this exercise:
Sit comfortably in a chair, and gently squeeze your shoulder blades together in the back.
Pretend that you are trying to squeeze a pencil between your shoulder blades, and hold the position for three seconds.
Slowly release, and return to the starting position.
Repeat 10 to 15 times.
The scapula squeeze exercise can be more challenging with a resistance band:
Loop the band around something stable, and hold each end.
Bend your elbows back, as if rowing a boat, while pinching your scapulae together.
Then slowly release.
Repeat the exercise 10 to 15 times.
Stability Ball Lying Chest Stretch
Another great way to open up your chest wall and stretch your pectorals and chest muscles is to use a stability ball. To do this stretch:
Lie on your back over a 25-inch stability ball.
Hold both arms up in front of you, and then slowly open up your arms as if you were going to give someone a big hug.
Relax your back as you open your arms, and allow your arms to move toward the floor, opening up your chest.
You should feel a slight pulling sensation in your chest when you do the exercise.
Hold the stretch for 15 to 30 seconds, and then bring your arms back to the midline.
Repeat three to five times.
If any exercise gives you lasting pain in your chest or ribs, stop it and check in with your physical therapist. Often, alterations can be made to make your exercises more comfortable.
Preventing Costochondritis
One important component of any good physical therapy program is learning to prevent future problems with your condition. Prevention of costochondritis may include:
Attaining and maintaining appropriate posture
Performing regular stretching a few times each week
Working on strengthening back and abdominal muscles
Engaging in regular physical exercise
If you start to feel your symptoms of costochondritis creeping on again, performing your home exercise program for stretching, breathing, and postural exercises may help keep symptoms under control.
Outlook
Costochondritis is often a self-limiting condition. That means that symptoms and the pain may subside without any treatment at all.
Physical therapy, however, can be an effective management strategy to speed the process along and to ensure that you are moving correctly while your rib cartilage is healing.
How Long Does PT Take?
Most people with costochondritis attend physical therapy for one to two sessions a week for four to six weeks. Your length of care may be longer or shorter depending on the severity of your condition and any underlying medical conditions.
If your symptoms persist for longer than six weeks, check back in with your healthcare provider. A referral to an orthopedic specialist may be in order; occasionally, steroid injections are given to relieve inflammation in the costochondral joints.
Keep in mind that the pain from costochondritis usually abates within a few weeks, but some severe cases last for up to one year.
Summary
If you have chest pain from costochondritis, you may benefit from working with a physical therapist. Your therapist can educate you about your condition and prescribe exercises to improve your mobility and decrease your pain.
Most episodes of costochondritis are short-lived. Learning what to do and when to do it can help you recover quickly and return to your normal active lifestyle.
Read Next: How to Tell if Chest Pain is Muscular
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