There is a sort of mad disconnect between how costochondritis is understood and fixed in manual physiotherapy in New Zealand, and how it is not understood and not fixed in most other places in the world. Of course it’s not a mystery and of course it’s fixable.

Most costochondritis is NOT a “mysterious inflammation” that nobody understands and which will settle down shortly. This standard medical view is NOT supported by the research evidence. The best evidence fully supports our New Zealand manual physiotherapy view that most costo is a straightforward rib joint locking problem, and as such is readily fixable.

WHAT CAUSES ALMOST ALL COSTOCHONDRITIS: This is easy to follow. Think of your ribs like bucket handles, hinged at the front (onto the breastbone) and at the back (onto your backbone). The ribs lift up and down as you breathe, and also move as you twist and move around.

Now, if the posterior rib joints (where the ribs hinge onto your spine) are frozen solid and not moving, then the more delicate joints where the ribs hinge onto your breastbone HAVE to work excessively, just to let you breathe. So they strain, get irritated, then get inflamed – and there’s your costochondritis. If they’re inflamed enough to produce obvious swelling then it’s called Tietze’s Syndrome.

(The rib movement round the back can freeze up for a variety or reasons – strain, impact (including the percussive impact of much coughing), chronic asthma, scarring and strain after chest operations, scoliosis, and much hunching over computers and smartphones a.k.a. the iHunch.)

This means that EVERY treatment, medical or non-medical, which is just trying to heal just this “mysterious inflammation” on the breastbone, misses the point. That’s why they don’t help much if at all, don’t last, and don’t fix the problem.

PERSONAL HISTORY: I had costo myself for seven years after a climbing fall onto my rib cage – with all the sharp stabbing chest pain, the breathing difficulties and the fear I was having a heart attack that comes with it. I fixed it after coming through physio school in New Zealand, and haven’t had even a twinge in decades. I can do anything physical – it’s completely fixed.

HOW YOU FIX MOST COSTOCHONDRITIS: This is perfectly logical – you free up the tight rib machinery around your back and sides which is causing the overuse strain and pain of the rib joints on your breastbone. This is quite quick and not difficult. How to do it is explained in more detail in our YouTube video ‘How to fix (most) costochondritis and Tietze’s Syndrome chest pain; Part (2)’ – link is

This sensible New Zealand approach is validated by the best evidence on fixing costo, from Zaruba and Wilson (2017) in the US – link is By comparison, there has NEVER been a clinical trial to test whether anti-inflammatory medications or steroid shots into the rib joints on the breastbone actually help.

OTHER TREATMENTS: Sure, medications or topical CBD cream such as Penetrex may help suppress the pain a bit, plus a healthier diet may help your body cope better. But they still miss the CAUSE of the problem and therefore cannot fix it. Anyway, you know this – most people with costo also have some pain and tightness round the back where the ribs are immobile, but this gets disregarded because the overuse pain on the breastbone is much worse.

MORE INFO: See the COSTOCHONDRITIS page on the Backpod’s website – link is The Backpod with its home program was developed to treat the iHunch, but it is important for costo because it will also do a really effective stretch on tight rib joints, and this is the irreducible core of fixing almost all costo.

SERIOUS NOTE: Chest pain could be heart so emphatically get yourself checked out by a doctor first. Doctors are good at this – they’re just not usually good at costo. But up to a half of patients presenting to a doctor or hospital Emergency Department with chest pain don’t have heart problems – so here’s the way to go if you’re one of them.

Think for yourself and good luck with the work.

Steve August (B.A.,Dip.Physio. (New Zealand)).