fitness Health Lifestyle RSI

Costochondritis a pain in the chest!

SternumFor the past 14 months (it seems like a whole lot longer!) I have had another overuse injury/health issue going on. The condition is called costochondritis, which is more simply know as a strain of the sternum (that flat area at the front and centre of your chest where all the ribs join on to). It may also be considered as another form of a Repetitive Strain Injury (RSI).

Up until I injured it, I didn’t even know that there was anything there to injure. I had been working out in the garden carrying stones in a bucket (a large muscle activity involving upper arms, shoulders, core, back) on and off for a day, when I finally sat down and noticed a general ache around the sternum area, as well as everywhere else I should hasten to add! Over the course of the next few days, all the aches disappeared except the one in the sternum. It was at that stage that I realised I’d injured something, I just didn’t know how bad it would be. Symptoms can include pain, tingling and an itching sensation around the centre of the chest area.

Over the course of the following week, I resumed my normal life doing picture framing, but noticed that I could induce bad pain in the sternum area when attempting to push against something heavy. This wasn’t good! At this point I did a little research and found out about costochondritis.  It is an injury to the soft connective tissue between the ribs and the sternum and can take a long time to heal due to the fact that there is not a huge supply of blood circulating to this area. I also got the advice of my GP who said that I just needed to rest it.

For the next 3 months I did my best to rest the chest area, which meant no lifting, pushing or carrying of anything remotely heavy in weight (including shopping bags!). One main difficulty I found was trying to rest the sternum while sleeping. The natural position of the body when sleeping on your side is to have both arms on the bed. This posture forces the sternum to be compressed and as a result does not give the area ample rest during sleep. Having restless nights also doesn’t help matters in this regard. One solution that I found is to sleep whilst hugging a pillow. The pillow has to be a puffed out largish one to keep the chest area open. It has proven to be a very useful method.

After 3 months of resting, the sternum had improved to the extent that I could actually do more. The question was, how much more? This, I found out by trial and error. If I did too much, the sternum would get more prickly, “itchy” and sore. It followed the same pattern every time: perform an activity, followed by prickly, itchy soreness for a few days, then it would calm down and I’d feel better again after a week. The trouble was that this went on for the best part of a year! Even now – some 14 months after the initial injury, I still have to be choosy about whether to try lifting something heavy or not. All in all, this injury has taken a long time to get better, and is one I could most certainly have done without!

The following are a few recommendations I would make for anyone suffering from costochondritis –

  • Rest up well for 2-3 months, avoiding all lifting of things including heavy shopping bags.
  • Hug a pillow while sleeping on your side to keep sternum area from being compressed.
  • Gentle reintroduction to exercise – yoga can be a good form of exercise to start recovery, so too is swimming.
  • You can use NSAIDs, eg ibuprofen to help with symptoms, but consult your GP first. I have also found much relief by taking Devil’s Claw (a natural anti inflammatory)
  • Have patience and don’t rush your recovery. After 14 months I feel like I am back to 90%, but I’ve been in the 70-80% range for a long time (nearly a year) and have frequently found a way to aggravate it somehow, usually by carrying something heavy.  This has happened even up to the 13 month mark!

This condition has certainly been very persistent, and has been quite frustrating to deal with mentally as well as physically, but after 14 months I am finally feeling like I am getting there. Fingers crossed!

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See my newer follow up post on this subject at Costochondritis II – The wicked itch is almost dead

52 replies on “Costochondritis a pain in the chest!”

After one year I have finally recovered from costochondritis, from a point where I would get immense pain from even taking deep breaths, to now, where I can do a full push-up workout without my chest giving me pain. For those interested, read the following:

1. Who my recovery plan will help:
This will only help people who experienced the same onset of costo symptoms as I: a GRADUAL build up of pain, rather than a sudden onset. When my pain first started, I was doing exercise with gymnastic rings and there was a reasonable (6/10) pain in my sternum. I continued to do the same exercise and the pain increased to 8/10, but still not so noticeable whilst not doing exercise. I then avoided chest exercises completely, but the pain remained largely the same and then began to get worse. I made a point to strictly avoid doing activities that could be annoying my chest, but the pain continued to get worse, and all activities became painful, even just deep breathing and twisting my torso. If this type of gradual pain onset sounds familiar, then I am almost entirely sure that you will recover in the same way that I did, as I describe below.

2. What I did to improve:
First note that I found all types of antiinflammatory medicine (turmeric etc) to be ineffective, my recovery was purely exercise based.
It appeared that the pain seemed to get worse as I did less exercise, but this did not seem likely since when I tried exercising and doing more for a few days, the pain would come on worse than ever. I went to a couple of physios, who both told me to rest till the pain had gone (I now see in hindsight that this is completely the wrong approach). So I rested for months and nothing changed. Desperate, I then went to a new physio who gave me the following advice, which is the rule that I have stuck to ever since and is all I needed to know to improve:

”Do as much movement/ exercise as you can, but staying below 4/10 on the pain scale”

When following this, the following are important:
– ‘exercise’ can be absolutely anything that gives you a small amount of pain (< 4/10) – aim for about a 2/10 pain. For the first two weeks, deep breathing was enough to give me pain and so every hour I would cause myself some discomfort forcing deep breaths. The following couple of weeks, I began doing light pec stretching, and pushing out my chest etc. In the following weeks and months, exercises would gradually become more intense as the pain allowed. Note that my pain only initially got worse when I was doing dips because these were v painful (ie. significantly more than a 4/10 pain), and I was not doing enough light exercise (< 4/10 pain) on the chest otherwise.
– the pain gets WORSE for a few days before it gets better: this is the tricky part, and the part that had stopped me from doing this kind of thing in the past. Once you do 'exercise' for one day, the chest is a lot more painful for following 2-3 days. During this time, it is fine to ease off with the 'exercise'. But after this flare up, resume with the 'exercise'. There is therefore a cycle of exercising and subsequent flare up. After 2-4 weeks however I found that on the days that I was exercising, I seemed able to do slightly more with my chest without as much pain. 1-2 months after, improvements were definitely apparent (albeit slow). It then took me about 5 months of this to doing my first pushup without more than a 4/10 pain. And a few more months more till I could do a pushup with no pain.

For those suffering with the same kind of pain as I had, I cannot emphasize how much I recommend following this plan, paying attention to the long time-scales involved. Don't expect immediate improvement.

Interesting to hear your thoughts from a weight training perspective. I can definitely attest to needing to exercise it. It’s like any other soft tissue injury, it needs rehabilitated back to health. Rest is good initially, then light exercise is the only way to get it to settle down completely. It’s what I noticed in my case with doing swimming, core strengthening etc.

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