Pain in Ribs/Costocondritis

Hi, I have been getting chronic pain in the left bottom ribs and back at same point for last 2 & 1/2 years. It initially started with a bad chest infection/ cough for 6 weeks. The pain comes in episodes which lasts for few weeks or months. All X-rays/reports come normal and even got checked for cancer scan but nothing wrong. Over time have also started getting severe pain in middle chest bone sternum, the ECG also came normal. Was referred to Pain clinic who gave cortisone injection and physio, but nothing is helping. Although now after 2 1/2 years have been told it is Costocondritis, can anyone please tell me how to fix it? Or is it a life long thing I have to live with ☹️ Any suggestions on what has helped you please.

[Timmer79]

Hi scor, if you find anything out please tell me! I have terrible pain in left ribs, and side of body. Sometimes feels like something moves under ribs when I bend, like a twitch or something.Do you get any twitching with it?

Also pain in sacriollic joint, but I think that's something else 🤔

Hope you get somebody light relief, a hot bath is a little useful for me, but gabapentin has been the only help as can't take NSAIDs

Tam x

[Hidden in reply to Timmer79]

Thanks, my pain is upper back related and hot water bottle is my best friend for pain relief along with Parcetamols, ibuprofen & codine prescribed by GP and depending on pain levels. The thing is they say Costocondritis heals in a year but for me it has been on/off for last 2-3 years.Hope you feel better soon & will update if I find any more information. Thanks

[Hidden in reply to Timmer79]

Please see comments below from Leigh Blyth

[LeighBlyth]

Muscle pain, trigger points and poor positioning can lead to the pains you are experiencing. Costochondritis is the label used to describe the pain when, as you've found, nothing shows up on X-rays or scans.

Have a think about your anatomy - how you are put together - and what muscles are associated with the painful areas. Where in the pain in your back?

The intercostal muscles between the ribs can get strained with coughing, the pain then tends to make you alter your positioning to avoid more pain but that then stresses other areas of the body.

To improve your positioning the muscles to focus on using are the rectus abdominis muscles which attach to the cartilage at the front of the lower ribs. The rectus abdominis muscles should be fully active and extended, like the body's 'core pillar of strength'. Think of activating the rectus abdominis muscles section by section, from pelvis to chest, extending your midline as you breathe in and up through your nostrils and see how that feels. Does your pain increase/decrease/move about?

I've written more here: healthunlocked.com/painconc...

Have a look at the anatomy and how it relates to what you feel. I'm more than happy to answer questions and provide more images if you want.

rectus abdominis from pelvis to chest. Attaching to the sternum and lower ribs

[Hidden in reply to LeighBlyth]

Thanks you Leigh Blyth and really appreciate your input. Totally agree an unidentified pain is termed as Costocondritis and to be honest it does feel like doctors have no idea why it’s hurting or it’s something insignificant that NHS doesn’t want to spend money on ☹️My problem is in rectus abdominis line or the muscles above it, looking at the diagram and from last year the sternum also hurts. It mainly last rib just above the stomach. The doctor at pain clinic did say there is thoracic tenderness and may be nerve entrapment.

How do I activate the muscles in rectus abdominis or the part above? Would a tens machine help? Any suggestions would be appreciated as not easy to live with chronic pain. Thanks

[LeighBlyth in reply to Hidden]

How is your anatomical knowledge? Just so I can gauge my level to describe things!

Do you do/are familiar with any exercise forms like Pilates, yoga, Tai Chi, ballet, martial arts etc.?

As for activating muscles - all skeletal muscles have the potential to be under voluntary control, it's a matter of focusing on the right muscles in your mind and training your brain to send activation signals to the right muscles.

It can take a bit of time and practice to get the messages sent to the right place. Look at anatomy pictures, find the muscles on your body (use your hands) and picture the muscles in your mind as you focus on them activating. (Muscles tend to be described as contracting - but this 'contraction' can actually involve them lengthening which is why I prefer to use the word 'activation').

Take a few deep breaths, breathing in through your nostrils and out through your mouth, thinking of your midline extending as you breathe in.

To work with your rectus abdominis I find it helps to start by activating my pelvic floor muscles (read up on Kegel exercises and sphincter ring muscle activation). The pelvic floor the solid Base foundation of the body and helps to lead onto the rectus abdominis.

I think of the rectus abdominis activating from pelvis to chest - thinking stronger and longer with every in breath. Saying "red, orange, yellow, green" helps me focus on each of the pairs of the rectus abdominis muscles activating in sequence. Like a series of lights to be switched on, each breath moving up my abdomen. Using my hands to tap up the muscles also helps to focus my mind on the muscles.

Activating the rectus abdominis involves extending them - standing up taller, lengthening the body if lying down. Do what feels good for you.

I've very little experience with TENS machines so can't comment on using them. Use your mind, use the pictures. Keep asking me questions if you like!

2 1/2 years of pain won't be fixed overnight so keep thinking about your muscles and how you use them, and how your posture (the position you are in) affects your pain.

rectus abdominis. Find the top and bottom pubic symphysis and xiphoid process of sternum

[LeighBlyth in reply to Hidden]

If you find yourself hunched forward, or tension in your upper body, think about your trapezius muscles too. (more on that later if you'd like - I'm out of time!)

trapezius muscles. from midback to the back of the head, shoulder to shoulder.

[Hidden in reply to LeighBlyth]

Thanks Blyth, sorry took few days to take in the information provided. My anatomy knowledge is quite limited and agree it will take time to sort this. I have practiced Tai-chi before nhs Devon link provided by a physio for about a year but struggle to do on days with too much pain. torbayandsouthdevon.nhs.uk/...

[Hidden in reply to Hidden]

I am trying your recommendations and will update you in few weeks. My problem area is the bottom left rib and same point towards the back and only since last year & 1/2 have pain and swelling in sternum. It is frustrating and now I am determined to try anything to help fix these pains. Thanks for your guidance. And let me know if you have any more information. Thanks

[LeighBlyth in reply to Hidden]

Are you aware of the concept of trigger points? Sore bits in muscles that can also cause referred pain (pain somewhere else on the body).

There is a good website called triggerpoints.net have a look round to see if any pain patterns match yours.

Two pages to start with:

triggerpoints.net/muscle/in... - for the muscles between the ribs.

triggerpoints.net/muscle/ab... - look at the external oblique expecially.

Fingertip exploration of the muscles between your ribs is a good way to investigate, Gently tapping, moving your fingers a tiny bit at a time. If you find a sore spot you can try a pressure release technique. The idea is to when you find a sore bit keep your fingertips there and then release the pressure until the pain disappears. Increase the pressure again and see if the pain is still there, if so release again.. press and release, press and release etc. to ease the muscles.

Also working around your bottom ribs may reveal tender areas, gently pressing under them starting from your sides and working towards your sternum. Feeling for tense areas and seeing how that affects your pain.

Some people (me!) like hotwater bottles/other sources of heat. Other people prefer cold packs to help. If either appeal then use them, but if it doesn't feel right/your body is saying no then don't!

[Timmer79 in reply to Hidden]

Mine is the same place Scor, left rub and similar place jn the backI've started proforma pilates, as I sort of came to a conclusion that the only thing left for me to do was work on my strength, but can't currently do anything too major (as I'm sure you'll understand!!)

Going OK so far, bit sore for the day or too after. But am pushing though.

Are you thinking of doing something similar?

[LeighBlyth in reply to Hidden]

Being in water can help. If in a swimming pool I like to use a couple of floats, one in/under each hand which really helps to find an equal balance between left and right on the surface of the water, and then letting my body move as feels natural thinking of activating my Base-Line muscles and my midline anatomy aligning.

If in the bath, a rubber ball around my shoulder blades and back makes a great massage technique!

Base-Line pelvic floor base of body. rectus abdominis central line pelvis to chest.

[LeighBlyth in reply to Hidden]

Thanks for the link, I'm afraid I don't have the patience to do Tai Chi as such, BUT it is a good source of inspiration for movements and I do use a lot of the actions when I work from Base-Line.

The first standing video demonstrates a good range of movement for the arms.

After activating my Base-Line through breathing and extending I think of the movements of the upper body starting from my lower trapezius muscles and my arms extending from midline of my back including my shoulder blades (rather than starting from the shoulders) to get the full extent of the action. From arms wide to the side, hugging a beach ball (that's how it was described to me and it stuck!) and circling in various directions.

Do what feels right to you. It's not a matter of following a routine, it's about listening to your body and building the connection between body and mind as you think about your posture and state of alignment and balance, working through problem areas and releasing the pain.

Don't worry about replying quickly, just when you're ready or if you have questions

[LeighBlyth]

Another image might be useful to see the rectus abdominis and it's relation to the rest of the body!

rectus abdominis and pelvic floor. Alignment of the body

[Timmer79 in reply to LeighBlyth]

Thanks for the information leigh, very useful for me also...interesting this image, as my pain also seems to be along this middle line from tight neck, sore ribs, tk pelvic pain.

[LeighBlyth in reply to Timmer79]

Looking at some anatomy and how the human body is put together can be very useful to improving posture and reducing pain.

The 5 main muscles to focus on are firstly the Base-Line muscles: pelvic floor that should be the solid Base of the body, and the rectus abdominis the body's central line.

The image below has the lumbar spine removed but you can see how the rectus abdominis at the front of the body connects the pelvis to the chest, if the rectus abdominis is not functioning correctly it puts a lot of strain on the back and spine.

Each rectus abdominis (left and right sides) is split into panels of muscle (they are what give the "6 pack" look but the number of panels can vary between individuals). By focusing on activating and lengthening the rectus abdominis, section by section from pelvis to chest these muscles can be strengthened and elongated which improves the state of alignment and balance of the body.

5 main muscles. pelvic floor, rectus abdominis, gluteus maximus, rectus femoris, trapezius

[LeighBlyth in reply to Timmer79]

The rectus abdominis muscles lie either side of the linea alba - part of our midline. The linea alba should be able to align fully. This is possible when it is fully extendable under the action of the rectus abdominis.

The linea alba connects 3 anatomical midline markers (that are easy to find) the pubic symphysis of the pelvis, the navel (belly button) and the xiphoid process of the sternum (breastbone). Touching these markers can help focus and improve "breathing with your Base-Line". Breathe in and up through your nostrils and out through your mouth. Think of the pelvic floor muscles activating, then the rectus abdominis from pelvis to chest. It can take time to activate the right muscles if you are not used to using them so keep breathing and thinking about where the muscles are on your body.

The linea alba, connecting the midline markers: pubic symphysis navel and xiphoid process

[Strollingrose]

Hi Scor. I have exactly the same symptoms and also the same problems with sacroiliac joint and feeling something move under my left rib when I bend as Timmer experiences. I take Gapabentin and Naproxen, but limited help. I am going to try LeighBlyth suggestions.

[Timmer79 in reply to Strollingrose]

Hi stollingrose, sorry to hear you are in a similar boat, frustrating isn't it!Out of interest, do either of your hips pop when lifting your leg up?

Pilates instructor said to me today that my hip abductor was weak, and to clench stomach&glutes tighter when moving leg.

Just wondered if you had this too, or if you or SCOR had felt a shudder when you stand and lift your leg up and down slowly??

I've been told I have fibro now, but i don't believe it,..

I think its still the SIJ problem and the pain has spread to other places n my body because I'm all out of balance from the SIJ's.

[LeighBlyth in reply to Timmer79]

Pain spreads! If the body is imbalanced it'll only get worse until it is rectified so yes an initial problem in the lower back/sacrum will cause more and more issues as the body adjusts to avoid the pain but puts the strain on other areas instead.

Pilates was my "in" to learning to use my body better. I went to several different classes and each instructor had different approaches and bits of information to share. I'd suggest watching videos on youtube and finding exercises that feel OK to do. If you are not ready to do something don't strain to do it. I spent a few weeks mostly lying on my back and focusing on my breathing, I couldn't lift a leg off the floor without using my arms - and my hips/knees/ankles popped, cracked and clicked as physical restrictions that were reducing my range of movement were released as I activated my main muscles of movement and worked towards alignment and balance.

The key muscles for the legs are the:

Gluteus maximus - big ass muscles, hands on buttocks feel for them contract. The gluteus maximus are the superficial layer of the back of the pelvis, covering a lot of complicated anatomy prone to strain and pain if the gluteus maximus are not adequately functioning.

Rectus femoris - like strong poles down the front of the thigh from shin to pelvis, aligning the hip and knee joints when fully active. Think of pulling your kneecaps up to active these muscles.

These muscles work in tandem, connecting the legs to Base-Line support.

gluteus maximus, rectus femoris the main muscles for the legs

[Strollingrose in reply to Timmer79]

Hi Timmer79. I don’t get the popping you get. I do get clunking under my left rib midline when I lay on back and twist my legs to the right. This then sends really painful spasms which radiate into back , hip and leg and my left foot curls up in spasm. My leg also shudders when I raise it. I think that my problem Started in the pelvis. When I pull in my pelvic floor muscle I feel severe pain running up my spine so this muscle is weak . Nerve pain? Overtime everything seems to have gone out of sinc.

I too have been diagnosed with Fybromyalgia as problem has not been rectified.

[Hidden]

Hi All, came across this video on YouTube today on how to treat Costocondritis, wondering if any one has heard of these options?

youtu.be/r7ve6nNVdWc(Not working as expected?)

[LeighBlyth in reply to Hidden]

The link isn't working, you'll need to provide words to put into a search on youtube instead.

[Hidden in reply to LeighBlyth]

Sorry, used it from another older post in health unlocked. Try using this by copying the text and pasting on top of screen

bodystance.co.nz/en/costoch...

[Hidden in reply to Hidden]

Or try typing in YouTube: “How to fix (most) Costocondritis and tieteze syndrome”.

It’s the 1st & 3rd video with a physio from new Zealand

[Hidden]

Hi, all have an update - went for check up through BUPA and I have a floating rib termed as slipping rib syndrome. It was found by dynamic ultrasound and only specialists can find it. Waiting for next dr consultation and will post further progress. Posting as few of you with similar condition might have the same problem.LeighBlyth Strollingrose