Dr. David Kulla, DC provides individualized conservative care for patients with costochondritis and musculoskeletal chest wall pain at Synergy Wellness Chiropractic & Physical Therapy in New York City. With more than 26 years of clinical experience, Dr. Kulla evaluates the thoracic spine, ribs, posture, mobility, and surrounding muscles when mechanical chest wall dysfunction may be contributing to persistent symptoms.
Our Manhattan office is located at 237 First Avenue near East 14th Street. Treatment may incorporate chiropractic care, manual therapy, physical therapy, therapeutic exercise, and cold laser therapy when clinically appropriate.
Important: New, severe, unexplained, or changing chest pain should be medically evaluated before assuming the pain is costochondritis. Chest pain can have cardiac, pulmonary, gastrointestinal, vascular, and other causes that may require urgent treatment.
What Is Costochondritis?
Costochondritis is chest wall pain involving irritation or inflammation around the areas where the ribs connect to the breastbone, or sternum. These areas are called the costochondral and costosternal joints.
The pain is often felt along the front of the chest and may be sharp, aching, sore, or pressure-like. Symptoms frequently increase with movements that stress the chest wall, including deep breathing, coughing, sneezing, lifting, reaching, exercise, or certain upper-body movements.
Because costochondritis can produce symptoms similar to heart, lung, gastrointestinal, and other conditions, proper evaluation is important before treatment begins.
Common Symptoms of Costochondritis
Symptoms vary from person to person but may include:
- Localized pain along the breastbone or front of the rib cage
- Sharp, aching, or pressure-like chest discomfort
- Tenderness when the affected rib or chest-wall area is pressed
- Pain that increases with deep breathing
- Pain with coughing or sneezing
- Discomfort with reaching, lifting, pushing, or upper-body exercise
- Pain associated with certain sleeping positions
- Chest discomfort accompanied by stiffness in the thoracic spine or ribs
Costochondritis commonly involves more than one rib and frequently affects the upper chest near the sternum.
Costochondritis vs. Heart-Related Chest Pain
Costochondritis is a musculoskeletal chest wall condition, but symptoms alone cannot always reliably distinguish it from more serious causes of chest pain.
Chest-wall tenderness or pain that changes with movement can support a musculoskeletal diagnosis, but even reproducible chest pain does not completely exclude cardiac disease.
Seek emergency medical attention for new or unexplained chest pain, particularly when it is accompanied by shortness of breath, fainting, sweating, nausea, significant weakness, rapidly worsening symptoms, or pain involving the arm, jaw, shoulder, or back.
What Causes Costochondritis?
In many patients, there is no single identifiable cause. Costochondritis may sometimes develop or become aggravated after:
- Repetitive upper-body activity
- Heavy lifting or strenuous exercise
- Frequent or forceful coughing
- Chest-wall trauma
- Changes in thoracic-spine or rib mobility
- Postural or mechanical stress
- Certain inflammatory or rheumatologic conditions
Because there can be many sources of chest pain, Dr. Kulla evaluates the chest wall in combination with the thoracic spine, ribs, shoulders, posture, breathing mechanics, and surrounding musculature rather than focusing only on the painful area.
How Is Costochondritis Diagnosed?
There is no single X-ray, MRI, blood test, or other test that proves a person has costochondritis. Diagnosis is primarily based on the patient’s history and physical examination after other important causes of chest pain have been considered or ruled out.
A healthcare professional may examine:
- Location and pattern of chest-wall tenderness
- Rib and thoracic-spine mobility
- Posture and movement
- Shoulder and upper-extremity mechanics
- Breathing-related movement of the rib cage
- Activities or positions that reproduce symptoms
Depending on the patient’s age, symptoms, medical history, and risk factors, additional medical testing such as an ECG, chest X-ray, blood testing, or other diagnostic studies may be appropriate to rule out other conditions.
Costochondritis and Tietze Syndrome
Costochondritis and Tietze syndrome are sometimes confused, but they are not exactly the same condition.
Typical costochondritis generally causes chest-wall pain and tenderness without obvious swelling. Tietze syndrome is less common and is generally associated with localized swelling around an affected costochondral joint.
Visible swelling, redness, warmth, a rash, fever, or other unusual chest-wall changes should be medically evaluated rather than automatically attributed to costochondritis.
Costochondritis Treatment in New York City
Treatment depends on the patient’s history, examination findings, symptom duration, and contributing mechanical factors. Many cases improve over time with conservative management.
For appropriate patients, care at Synergy Wellness may include:
- Modification of aggravating activities
- Thoracic-spine and rib mobility work
- Gentle chiropractic or manual therapy
- Physical therapy and rehabilitation
- Postural and movement training
- Thoracic mobility exercises
- Breathing-mechanics exercises
- Gradual strengthening of the chest, back, and shoulder musculature
- Cold laser therapy when appropriate
Patients may also be advised by their medical clinician regarding medications or other pain-management options when appropriate.
Chiropractic Care for Costochondritis
Some patients with persistent chest-wall pain also demonstrate limited movement or tenderness involving the thoracic spine, rib joints, or surrounding musculature.
Dr. David Kulla, DC evaluates these mechanical factors and may use gentle chiropractic or manual techniques when examination findings indicate that they may be contributing to the patient’s symptoms.
Treatment is individualized. The objective is not to forcefully manipulate a painful rib or sternum, but to identify relevant movement restrictions, muscular tension, and mechanical stresses and address them in a controlled manner.
Cold Laser Therapy for Costochondritis
Synergy Wellness also offers cold laser therapy, sometimes called low-level laser therapy or photobiomodulation. It may be incorporated into a broader conservative treatment program for selected patients with musculoskeletal pain.
Cold laser therapy should not replace appropriate evaluation of unexplained chest pain, and response to treatment varies from patient to patient.
Exercises for Costochondritis and Thoracic Mobility
Movement and rehabilitation can be important for patients whose symptoms are associated with stiffness, repetitive strain, posture, or reduced thoracic mobility.
An exercise program may include thoracic mobility, gentle chest stretching, scapular control, postural exercises, breathing mechanics, and progressive strengthening. Exercises should be selected according to the patient’s symptoms and should not repeatedly reproduce significant chest pain.
In this video, Dr. Kulla demonstrates several of his commonly used exercises for costochondritis and thoracic mobility:
How Long Does Costochondritis Last?
Costochondritis often improves over several weeks, but the duration varies. Some patients experience symptoms for considerably longer, especially when aggravating activities, mechanical factors, or other medical conditions continue to contribute to chest-wall irritation.
Persistent or recurrent symptoms deserve reassessment rather than assuming that every episode of chest pain is caused by the same condition.
Chronic Costochondritis
Patients with longstanding costochondritis may require a broader evaluation of thoracic mobility, rib mechanics, posture, breathing patterns, activity levels, exercise technique, and other possible sources of chest pain.
This video follows one patient’s experience with longstanding costochondritis. Individual patient experiences do not predict how another patient will respond to treatment.
Other Conditions That Can Cause Chest Pain
Chest pain has many possible causes. In addition to cardiac and pulmonary conditions, symptoms may arise from the thoracic spine, ribs, muscles, gastrointestinal system, or other structures.
For example, gastrointestinal conditions including reflux and hiatal hernia can sometimes produce symptoms that patients perceive in the chest. These conditions require a different evaluation and treatment approach from costochondritis.
When Chest Pain Requires Immediate Medical Attention
Do not assume that new chest pain is costochondritis simply because the area feels tender.
Seek emergency medical attention for sudden, severe, unexplained, or worsening chest pain, particularly if accompanied by:
- Shortness of breath
- Fainting or severe dizziness
- Cold sweating
- Nausea or vomiting
- Marked weakness
- Rapid or irregular heartbeat
- Pain radiating to the jaw, arm, shoulder, or back
- New neurological symptoms
- Fever or significant illness
Schedule a Costochondritis Evaluation in NYC
If serious cardiac, pulmonary, or other medical causes of your chest pain have been ruled out and you continue to experience musculoskeletal chest-wall pain, Dr. David Kulla, DC can evaluate the thoracic spine, ribs, posture, mobility, and surrounding musculature to determine whether conservative treatment may be appropriate.
Synergy Wellness Chiropractic & Physical Therapy
237 First Avenue, 5th Floor
New York, NY 10003
Near East 14th Street in Manhattan
Call (212) 533-4900 or book an appointment online.