Chest wall pain can be frightening, especially when it mimics more serious problems. In our clinics in Hoxton, London and Worcester, we see many people with costochondritis—pain arising where the ribs meet the sternum via cartilage—and our philosophy is simple: make a precise diagnosis, reduce local irritability, restore healthy rib and thoracic mechanics, and help the whole system adapt so it stays better. We favour non-invasive, osteopathy-led care supported by sports therapy and physiotherapy, with medical options available when they’re genuinely necessary. This approach reflects both current evidence and classic osteopathic principles: the body is self-healing and self-regulating when given the right conditions.
Costochondritis is distinct from Tietze syndrome, and clarity here matters. Costochondritis typically presents with tenderness and pain in the costosternal or costochondral junctions without visible swelling, often involving several rib levels and behaving like a mechanical, irritable joint-and-soft-tissue problem. Tietze syndrome is rarer, usually involves a single level with obvious local swelling, and can follow infection or trauma; its inflammatory flavour means it sometimes responds to short-term steroids in the right context, though it still benefits from careful rehabilitation afterward. NCBI+2PMC+2
Understanding why it hurts begins with mechanics. Each rib articulates posteriorly with the thoracic spine via the costovertebral and costotransverse joints and anteriorly with cartilage at the sternum. These joints share load. When the posterior rib joints are stiff, the rib doesn’t glide and rotate well at the back, so the front must move more to compensate. Over time, that extra micro-shear and tensile stress at the costosternal junction can irritate the cartilage and surrounding tissues and perpetuate symptoms. Restoring posterior mobility often reduces the anterior overload, which is why we rarely “chase the pain spot” alone and instead normalise motion across the thorax as a system. This systems view is consistent with contemporary chest wall pain guidance and with case literature showing clinically meaningful improvements when manual therapy to posterior ribs and targeted exercise are combined. NCBI+2PubMed+2
Pain, however, is not only mechanical. Local nociception from micro-trauma and inflammation blends with myofascial contributions from intercostals, pectorals, serratus, and accessory breathing muscles, and in longer-standing cases the nervous system can become sensitised so that otherwise normal stretching or deep breaths feel threatening. Anxiety about chest pain understandably amplifies this loop: fear of something “cardiac,” guarded breathing, movement avoidance, and catastrophising each raise baseline tone and lower tolerance. Addressing these psychosocial contributors—through clear reassurance, graded exposure to movement and breath, and confidence-building—supports faster, more durable recovery and is part of our standard pathway in both Hoxton and Worcester. Evidence across non-cardiac chest pain and musculoskeletal chest wall pain consistently supports a biopsychosocial model for better outcomes. RACGP
Our treatment pathway is deliberately progressive and minimally invasive. In the early phase we calm local irritability and restore motion with osteopathic manual therapy and soft-tissue work, often focusing on costotransverse and costovertebral mobility and easing intercostal and pectoral tone. We then pair this with movement rehabilitation: rib and thoracic mobility drills, breathing retraining to reduce chest wall tension, and gradual functional loading to build tissue resilience. Case evidence suggests this combined manual-plus-exercise approach yields meaningful reductions in pain and improvements in function—even in persistent cases—with some reports of complete resolution over just a few sessions when the impairment drivers are accurately
We are transparent about medical options, and sometimes we use them. NSAIDs can be helpful in acute irritability, and in stubborn, inflammatory-dominant presentations—particularly those with visible swelling consistent with Tietze syndrome—short-term corticosteroids can provide faster symptom relief. A pragmatic randomised study in 2022 reported that adding a brief oral steroid course to standard care improved pain and quality of life at one to three weeks, with benefits persisting at mid-term follow-up. Our stance is that such measures are adjuncts rather than endpoints: useful to open a therapeutic window, but best coupled with the rib-mechanic restoration and graded loading that create long-term change. We can coordinate these options with your GP and discuss risks, benefits, and timing honestly. PubMed
For recalcitrant focal tenderness at the costosternal or costochondral junctions that hasn’t fully settled with manual therapy and rehabilitation, we may also integrate extracorporeal shockwave therapy (ESWT). This non-invasive modality uses acoustic waves to stimulate local cellular repair mechanisms, improve microcirculation, and modulate pain signalling. We frame ESWT as a regenerative complement to the rest of the pathway rather than a quick fix; it tends to work best when rib mechanics and breathing have already been normalised, and when patients are actively rebuilding tolerance through movement. ESWT is available in both our Hoxton and Worcester clinics and, depending on your plan, may be covered by private medical insurance.
Diagnosis remains a clinical art backed by judicious use of imaging. Costochondritis is typically diagnosed through careful history and examination—palpation findings, symptom behaviour with breath and movement, and exclusion of red flags. When symptoms persist beyond six to eight weeks, when swelling suggests Tietze syndrome, when there is diagnostic uncertainty, or when patients need clear reassurance, we can arrange further investigation. Musculoskeletal ultrasound can visualise focal swelling and help distinguish Tietze from classic costochondritis, while MRI offers detailed views of cartilage, bone marrow oedema, and adjacent structures and is especially helpful if we are ruling out inflammatory arthropathy or rare posterior causes. In London and in Worcester we can refer privately for sonography or MRI, or liaise with your NHS GP to facilitate appropriate imaging and cardiac screening where indicated. Recent clinical reviews emphasise this safety-first, stepwise approach that reserves imaging for the right scenarios while keeping the focus on effective conservative care. NCBI+1
Because we treat the person in front of us, we also stay alert to rare but important differentials like thoracic disc herniation after trauma. True thoracic disc herniations are uncommon—far less than one percent of all herniations—thanks to the stabilising “tensegrity” of the thoracic cage and the relatively low segmental motion in this region; that is exactly why the thorax protects the cord so well. When symptoms, history, or neurological signs raise suspicion, we perform a detailed neurological screen and, if needed, arrange MRI to rule this in or out. In practice, this is rarely the driver of anterior chest pain, but it is part of a thorough diagnostic phase of care in both clinics. MedRxiv
Everything we do is designed to build resilience rather than dependency. We don’t rely on posture “fixes” or chase quick changes that fade; we cultivate physiological adaptation—tissues that tolerate breath, rotation, reaching, pressing, laughing, and training again. We find that when posterior rib mechanics are restored and breathing becomes freer, the anterior irritation often resolves naturally; when fear and avoidance are replaced with confident, graded movement, sensitivity calms and life opens back up. That is the heart of our osteopathic-led pathway.
Accessing care at Remedium Wellness is straightforward. We welcome self-funded patients and can often treat under private medical insurance including AXA, Vitality, Aviva, Allianz and WPA, subject to individual policy terms and pre-authorisation. We’ll help you navigate referral requirements and documentation so you can begin promptly in Hoxton or Worcester.
If chest wall pain is disrupting your days—if it worsens with deep breaths, certain movements, or pressing along the rib–sternum junctions—book an assessment with our team. We’ll confirm the diagnosis, keep you safe, and guide you through a structured, evidence-informed plan that emphasises manual therapy, movement, mind–body support and—when needed—medical adjuncts and ESWT, so you can feel better and stay that way.
