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Mid Back, Rib & Chest Pain

Sayer Clinics, London, UK are world-leading Costochondritis Specialists:

Costochondritis, Rib pain, Tietze's syndrome, Slipping Rib, Chest pain and Intercostal Neuralgia pain.

Best costochondritis manual treatment specialist practising at SAYER Clinic Kensington, West London W8 6PX

Sayer Clinics Costochondritis/ Rib Pain Team: 

Dr Marek Gibson - AxaPPP, Aviva, Cigna, HSA, BUPA GLOBAL / International.
Dr Ed Timings  -  AXAPPP, Aviva, WPA, BUPA UK & BUPA GLOBAL / International
Our expert specialists successfully treat acute or chronic Costochondritis involving chest and rib pain referring to the shoulder, upper back, arm pain.
Our team has huge experience in successfully treating and helping longterm costochondritis which always involves ergonomic postural rehabilitation


The most effective costochondritis treatment it is essential to have a combination of expert spinal mobilisation / manipulation treatment as well as Specialist Manual Therapy with Maria-Madalina Grigore MSc to treat acute or chronic Costochondritis, Intercostal Neuralgia, Tietze's syndrome and 'Slipped rib' involving chest pain and rib pain referring to the shoulder, upper / middle back or arm pain.

Costochondritis Chiropractors: 

Marek Gibson - AxaPPP, Aviva, Cigna, HSA, BUPA GLOBAL / International.

Dr Ed Timings  -  AXAPPP, Aviva, WPA, BUPA GLOBAL / International


Sayer Clinics Specialist Masters Physical Therapist Maria-Madalina Grigore worked with and was personally taught by Sayer Clinics founder and world-leading Costochondritis expert Dr Michael Durtnall with his uniquely-effective specialist techniques for Costochondritis treatment.

Maria-Madalina is now the only practitioner performing Dr Durtnall's effective costochondritis treatment.

Maria-Madalina is highly-experience in successfully treating longterm costochondritis and chest pain which involves ergonomic postural rehabilitation and specialist manual chest muscle release therapy to improve musculoskeletal function and breathing posture for pain-free flexibility.


Are you suffering Costochondritis with severe chronic or acute chest pain in your ribs, brought on by an impact, coughing, weight-training or years of poor posture or long hours sloucing at a computer. Does the pain spread from your ribs or breastbone throughout your chest, between your ribs and under your breast?

Is there pain on touching or pressure on your ribs as well as with breathing, twisting movements or turning over in bed?

Have you been told that "it's muscular or stress" and been prescribed drugs like pregabalin, gabapentin, amitryptalline or other addictive codeine or morphine-based drugs which minimally reduce pain but make you feel miserable, tired and low? 

Drugs, cortisone injections and nerve blocks do not cure Costochondritis (spelled 'Costocondritis' in Spain)

If you can travel to London, contact us for effective Costochondritis, Tietze, Intercostal Neuralgia, Rib pain treatment and posture renewal, rehabilitation and advice.

Computer and laptop work with poor posture or enforced inactivity following injury, flu, illness or surgery are the universally prevalent prime factors causing chronic costochondritis, intercostal neuralgia, rib pain and chest pain.

Severe referred rib pain to the side and front of your chest can be caused by nerve and muscle inflammation at the facet joints of your middle-back, rhomboid muscles or ligaments between your shoulder blades or from nerves in your lower neck or mid-back. It can be aggravated by breathing in, forced inspiration, coughing, lifting, twisting or side-bending of the neck or mid-back spine and ribcage.

Signs & Symptoms of Intercostal Neuralgia:

● Intense, sharp, stabbing upper chest pain

● Deep aching upper chest pain

● Pain worsens with coughing or laughing

● Pain that spreads around the chest wall

● Skin in the area has reduced sensitivity

Causes of Intercostal Neuralgia: 
● Poor posture  
● Prolonged coughing 
● Chest or rib impact or injury 
●  Pregnancy

  • The most important factor in Costocondritis in so many cases is prolonged inactivity associated with illness, injury, intense studying with poor posture, either sitting or lying in bed or the generalised inactivity and lack of exercise in Covi-19 lockdown!

Signs & Symptoms of Costochondritis: 

● Pain to the side of your sternum - breastbone

● Pain feels sharp and inflamed

● Pain increases with coughing or taking a deep breath in

Causes of Costochondritis Include:

● Overdoing weights, gym exercises and intense coughing

● Injury or impact to the chest

● Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis

● Joint infections or shingles

● Poor posture with stiff rounded middle back from slumped sofa and computer posture.


Chronic chest pain is often found to be referred from the lower neck or upper mid-back pinched nerves causing local pain as well as a deep ”hot knife or deep, sick ache” of referred intercostal nerve pain into the ribs at the back and to the breastbone and costal rib cartilages at the front of the chest. This referred rib pain may also be felt in the arm and hand.

  • Chiropractic manipulation treatment – specific, gentle spinal manipulation to mobilise and normalise spinal or rib joint and muscle function.
  • Physiotherapy and Physical Therapy – laser, ultrasound, electrotherapy, massage, exercise and rehabilitation
  • Dry needling or Medical Acupuncture and Therapeutic Massage helps relieve chronic and acute neck, rib and shoulder pain
  • Postural training and advice on correct ergonomic seating and computer screen height and position is essential. We train you how to stand and sit properly and how to adjust your workstation in our uniquely effective way to avoid repeated future damage to your neck and spinal joints.
  • Medical treatment of mild muscle pain includes non-steroidal anti-inflammatory drugs (NSAIDs) but at Sayer Clinics we recommend Turmeric (Curcumin) capsules or tablets as an anti-inflammatory option without the side-effects of NSAIDs which should only be used in the very short term, if at all.
  • Specialist manipulation costochondritis treatment – specific, careful spinal manipulation to mobilise and normalise spinal joint function
  • Physiotherapy and Physical Therapy – laser, ultrasound, deep tissue trigger point massage, exercise and rehabilitation
  • Medical Acupuncture or Therapeutic Massage helps relieve chronic neck and middle back pain
  • Advanced and unique postural training, treatment and advice on correct ergonomic seating and computer screen height and position is key



*** Patients with fever, severe cough or breathing difficulties plus frontal chest pain should first consult their medical practitioner ***


Consulting us for your costochondritis at Sayer Back and Neck pain Clinics in London includes a full case history, neuromusculoskeletal examinations and check of your heart and lungs.

We examine and detect mechanical sources of pain (if indicated take digital computed x-ray or an ultrasonic examination) of the chest and ribs. Our aim is to successfully and safely treat musculoskeletal rib or referred nerve or muscle pain conditions physically.

Our unique recipe for effective costochondritis treatment helps cure rib and chest pain using expert specialist Manipulation, Physiotherapy, Medical Acupuncture and Therapeutic Myofascial Massage:

Effective treatment for Costochondritis 

Rib and chest pain is often a deep ache or sharp, stabbing pain between the ribs which may spread as a sick-ache around or through to the front of the sternum or under the breast.    

It is usually very tender to touch the tender points between the ribs.

Many sufferers spend a lot of anxious time in hospital having extensive examinations and tests to eliminate heart, lung and breast problems.  If these tests are negative but your pain persists, our expert in costochondritis can quickly pinpoint and diagnose the source of the pain when it is a simple but excruciating intercostal neuritis or referred dorsal rib pain which radiates into the chest and ribs as well as potentially into the side of the neck and arm as an ill-defined sickening ache. 

Costochondritis may cause acute inflammation of the cartilage that connects ribs to breastbone or sternum at the costosternal joints. Pain caused by traumas, falls and fracture are obvious causes of chest and rib pain whilst costo-sternal pain (Tietze’s syndrome) or intercostal neuralgia feels more like a heart attack or a very tender 'bruise' pain between the ribs or where your ribs attach to your breastbone or sternum, but usually worsen following hours of inertia on a laptop or sofa.

Rib pain may be called costochondritis, intercostal neuralgia, intercostal neuritis or costo-transverse sprain and can be caused by heavy lifting, sustained awkward posture, sleeping on your front or with the ‘wrong’ pillow.

Our manual treatment to alleviate costochondritis in pregnancy is also effective and it is felt as deep chest pain as if from the heart, lungs, breast or oseophagus, or can cause pain on deep inspiration - breathing in. For pregnant patients we assess scarred or contracted muscle tissues and trigger points between the ribs using safe state-of-the-art diagnostic ultrasound.

Sayer Chiropractic and Physiotherapy experts in London for successful specialist treatment and costochondritis cure for rib pain.

Rib pain most often follows years of poor, rounded posture where the middle thoracic spine becomes rounded (kyphotic) with the chest dropping vertically from slouching at desks, laptops and sofas. This kyphotic, rounded posture has become the norm in the last 10 years due to our laptops, iPads and nearly all of us sitting awkwardly all day at computer work-stations.


People typically try to ‘stand up straight’ by pushing their shoulder blades up and back, and poking or jutting their chins up and forward. This unnatural-looking posture loads huge strain into the supporting muscles and ligaments which hold up the head and worsens muscle and joint pain in the middle-back, chest and neck. Scoliosis or sideways spinal curvature further aggravates these stresses and pain.

When rib pain becomes chronic, recurring and longterm, treatment with painkillers, anti-inflammatory drugs (NSAIDs) or steroid injections into spinal joints is short-term, of limited help and with potential side-effects.

At Sayer Clinics we can, where indicated, take diagnostic low-dose digital x-rays of the spine and ribs or Ultrasound scans of soft tissue scar-tissue or cysts and alleviate spinal, rib and chest pain with spinal manipulation, long-term postural rehabilitation, deep muscle massage and specific muscle exercises.

Our rib and chest pain treatment is painless and helps you to long-lasting postural improvement, better spinal function, better breathing and fitness.

Our multidisciplinary Sayer clinics team are world-leading rib pain, costochondritischest and intercostal neuralgia manipulation and specialist physiotherapists here in London, UK. We efficiently diagnose, effectively treat and intelligently advise on the cause and resolution of your costochondritis pain to rehabilitate your health, posture, ergonomics and exercises towards pain-free future health.

Our evaluation assesses the external muscles and fascia in your neck, thorax, upper abdomen, middle back and overall postural influences on musculoskeletal chest pain.

After carefully discussing with you the patient, with your written consent and valid verbal consent for each body area of the examination and each proposed manipulation or myofascial treatment, an examination can then be performed to assess the health and function of your spine and chest muscles, fascia and rib joints and effective treatment started. Treatment may begin during your initial consultation appointment and is aimed towards resolving any dysfunction noted. You will be provided with feedback regarding home management, exercises, and behavioural changes as needed.

Sayer Clinics: London and world-leading Costochondritis Treatment.

Sayer Clinics Chiropractors in Central London are trained in medical diagnosis and will check for and rule out more serious medical conditions before starting physical treatment. If we suspect a heart or lung problem, fracture, osteoporosis, rib infection or cancer we will refer you to your GP, medical practitioner or hospital without delay.

The upper ribs form attachments for neck muscles and pectoral muscles where tightness or acute spasm can constrict nerves and blood flow causing numbness in the arm and hand. The shoulder blades (scapulae) should glide smoothly over the ribs but rib dysfunction causes restricted scapular movement with pain on shoulder and arm movement and can cause the ”hot knife” agony pain of rhomboid muscle spasm as well as longer-term levator scapulae shortening, rotator cuff injury and ‘stiff chest’ syndrome.

Sayer Clinic chiropractic and physiotherapy treatment techniques for chronic and acute rib pain involves a detailed examination of the joints and muscles and assessing movement of individual ribs. Treatment helps to restore movement and reduces pain and muscle spasm for chest, shoulder or arm pain.

Rib Pain, Intercostal Neuralgia, Chest Wall Syndrome and Posture 

Most musculoskeletal chest pain seen each day at Sayer Back and Neck Pain Clinics across central London involves costochondritis or intercostal muscle strain. The diagnosis is made after other causes of chest pain such as Rib Fracture, Shingles, Myositis and Thoracic Outlet Syndrome have been excluded.

Slipping / Clicking Rib Syndrome

Dull chest joint and rib pain lasting hours or days with occasional stabbing pains brought on by particular postures or movements. 

Usually 8th-10th 'false' ribs, attached by fibrous tissue can let the rib tips slip up and back, pinching the intercostal nerve. Tenderness of the lower costal cartilages may be felt as upper abdominal pain when pulling the ribs forwards.

Effective treatment involves skilled manual therapy treatment, spinal mobilisation and postural rehabilitation of kyphotic (rounded) middle back, the usual suspect in many rib problems.

Exercise Trauma

Stress fractures of the first rib and sternum are a form of indirect trauma from extreme muscular forces seen with competitive athletes. Excessive muscular contraction with heavy lifting or excessive plank exercises can injure the intercostal muscles and rib joints with pain between the ribs aggravated by movement, coughing or breathing.

Costochondritis -  Xiphodynia - Tietze’s Syndrome

Costochondritis is chronic tenderness over the costo-chondral or chondro-sternal front rib joints. It is alleviated with skilled manual therapy and laser or ultrasound therapy at Sayer Clinics where we manually treat and rehabilitate the poor posture, contracted chest, rounded and stiffening middle back and poking-forward-chin associated with sitting at sedentary jobs with screens too low.  

Road traffic accidents can also cause seatbelt-chest pressure injuries at the chest wall between the ribs and intercostal muscles which is extremely painful and requires early physiotherapy and chiropractic assessment.

Screens should be at eye-level whilst sitting with our painfree and sustainable posture which we teach to our patients.

Xiphodynia is pain at the lowest pole of the sternum or breastbone and is a variant of costochondritis. Nerve supply from 4-8th thoracic intercostal nerves can mimic cardiac, gastric, or gall-bladder/biliary pain. Tenderness at the xiphoid process with moderate pressure is indicative.

Tietze’s Syndrome is not to be confused with costochondritis, Tietze's is an inflammatory condition of the costochondral (rib-cartilage) junction of the chest wall in teenagers and the early twenties. There is a red, hot, firm, tender, swelling, commonly at the 2nd costo-sternal joint. Our patients also present with painful tenderness at many other rib joints for which we have a good outcomes for costochondritis alleviation. Pain and inflammation resolves over several sessions of manual physical therapy treatment, including laser or ultrasonic therapy with our expert physiotherapists and chiropractors.

Precordial Catch Syndrome. Intense pain over the heart on inspiration which resolves in less than a minute, is extremely localised, with sudden onset and resolution. The cause is not known and is not of serious concern.

Breast Pain. Breast pain is common and is often cyclical with sensitivity of breast tissue to oestrogen and progesterone. Fibrocystic lumps or fibroadenomas are discrete, rubbery lesions which slowly enlarge and are usually not painful - Patients should first see their GP or breast clinic specialist.

Breast pain may also be associated with intercostal muscle spasm and inflammation due to poor slumped posture, scoliosis, twisted rib-cage or subluxated or stiff mid-dorsal rib-vertebral joints in the upper middle back. 


The ‘Backpod’ is highly recommended to free up your thoracic spine either on its own, if you cannot reach Sayer Clinics, or in conjunction with our back and chest treatment or to help maintain your longterm spinal mobility and pain-free healthy posture.

If you are considering Cortisone steroid injections to temporarily block your pain we would advise caution. The article below explains the evidence for steroid injections for neck, back, pelvic and coccyx nerve block injections -

There is minimal published research of Manual / Musculoskeletal treatment for costochondritis but the following published research study may be of interest to read:

Book to see our world-leading Specialist Costochondritis and Rib Pain manipulation experts in London for your initial consultation and, if indicated, spinal x-rays or diagnostic ultrasound Costochondritis scan before starting effective treatment.

Our skilled Costochondritis specialist physiotherapist Madalina Grigore provides specific and completely drug-free and surgery-free rehabilitation at our London Clinic in Kensington: W8.

World-leading Costochondritis Specialists

Got any questions? Not sure what appointment to book?

We're always here to help from 8am to 8pm Monday to Friday and 9am to 1pm on Saturdays.

Simply email and Gen will assist you.

World-leading Costochondritis Specialists