I’ve been asked by the British Medical Journal (Australian office) to submit a paper reassessing costochondritis. Lord knows it’s needed. I've also been lecturing on costochondritis to the doctors at various medical conferences and hospital Accident & Emergency departments (EDs) in New Zealand. I'm part of a multi-disciplinary group of doctors, cardiologists and physiotherapists in New Zealand running a randomised controlled trial comparing the usual medical anti-inflammatory approach with our New Zealand manual physiotherapy approach.
We’ve now surveyed the published medical literature on costochondritis, and two things stand out:
(1) The published medical research conclusively shows that costochondritis is NOT a systemic or auto-immune inflammation - no matter what you’ve been told by your doctors, specialists, the popular medical sites or popular patient sites and groups. A research paper on costo in an ED published in 1994 in the American Medical Association Archives of Internal Medicine by Disla et al found no higher inflammation levels in the bloods of a group of costochondritis patients compared to a group without costochondritis. That’s why just treating it like an inflammation does not work and does not fix it.
The only reason it's called an inflammation at all is because of the adoption of the term 'costochondritis' for it back in the 1960s: the '-itis' ending means 'inflammation'. There is no medical research basis for the term whatsoever - the problem was also called various other things including simply 'chest wall pain.' Calling the actual problem by a name which implies it's an inflammation sends doctors and patients alike off down the wrong road for treating it - it is simply incorrect.
(2) The single best published piece of research evidence on how to fix costochondritis is from Zaruba and Wilson (2017) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455195/ ), who fixed eight chronic costochondritis patients by freeing up their tight thoracic spine and rib joints. This is only a case series of eight patients, but it is better than anything else so far published in English (as at August, 2019). It is further supported by several individual case studies which essentially demonstrated exactly the same thing.
All of these entirely conform with and support our New Zealand manual physiotherapy understanding of costochondritis - that it is essentially strain at the rib joints on the sternum, because the rib joints round the back can’t move, and that you fix it by freeing these up again.
We’ve put up an easy-to-follow YouTube video explaining what we found in the research, called ‘Costochondritis and Tietze’s Syndrome: The published medical research on how to fix them.’ The link is https://youtu.be/t8k2LCLeR24 There is also a pdf of the detailed text to go with the video near the bottom of this page.
Doctors (and physiotherapists) are supposed to practice 'evidence-based medicine', where what you tell the patient is supported by actual published medical research. Telling the costochondritis patient that what they have is a mysterious inflammation that will respond to anti-inflammatory medications, and will anyway settle down soon, is simply wrong - according to the research and our New Zealand manual physiotherapy experience. And also according to my personal experience of fixing costochondritis on patients over my 30 years as a physiotherapist, including completely fixing my own costo 30 years ago.
Yes, this is a crazy situation. The doctors are not uncaring or malicious. But they are busy, and simply passing on the standard popular medical view of what costochondritis is and how to fix it - and this is incorrect.
So you are unlikely to find a doctor or specialist who will fix your costo for you. It's up to you - you are the one in pain. Cheeringly, it's a logical physiotherapy-type problem and not particularly difficult. Good luck with the work.
Steve August (B.A.,Dip.Physio.).