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Middle Back pain, Costochondritis, Intercostal Neuralgia and Chest Pain

Michael Durtnall, Chairman and Founder of Sayer Clinics London, shares his knowledge and experience in this informative article.

Imagine the misery of months of constant computer-related daily neck pain, middle-back, intercostal and chest pain. Increasingly many of us don't need to imagine it because we suffer this agony every day - if you repeatedly self-click your neck and grind your shoulder blade against your ribs it does not help - it perpetuates the pain.

Sayer Back and Neck pain Clinics in the City of London, West End and Kensington can efficiently diagnose and effectively treat this ubiquitous, yet marginally-recognised and poorly-treated problem.

Middle back pain with referred chest pain and arm pain has become a universal problem because almost everyone is sitting arched forward over their mobile phone and at computers in stylish and expensive but still appallingly bad ergonomic chairs.

Everywhere, absolutely the wrong advice is given by so-called ergonomics experts - who tell you to place your feet in front, to lean-back in the chair and to work with your screen just below eye-level - this is guaranteed to create a hideous posture where your upper-back is rounded, chest is dropped down, shoulders are jammed backwards and up and your chin is poking forwards and upwards at a ridiculous angle.

If your screen is also further away than your visual focal-distance it will create a forward shearing of the lower neck joints which cause compression and pinching of the nerves of the lower neck with chronic pain and spasm. Your neck becomes increasingly arthritic in just a few years.

Typically stretchier young people from teenagers to late-thirties with looser ligaments suffer chronic neck most with pain initially referring into the rhomboid muscles between the shoulder blades which then refers pain deep through to the front of the chest between the ribs and around the chest wall with a sickening, gnawing ache and muscular spasms. This chest-wall muscle, tendon and ligament pain and inflammation of the intercostal muscles and joints where the ribs attach to the breastbone (sternum) then refers more intense pain usually down the left arm with deep, depressing, heavy pain into the shoulder, elbow, hand and wrist.

You can't sleep on your front without exacerbating the problem and you can't turn your neck to reverse cars or carry more than a little shopping a short distance without getting severe spasms and burning pain into the neck and shoulder. These relatively looser-ligamented people then find themselves clicking and overstretching their necks and grinding their shoulder blades against their rib cage in a perpetually repetitive cycle of misery. Their friends comment on these repeated self-stretching tics but they are not even aware that they are doing it.

The sickening pain just continues DAY AFTER DAY, chronically for months until the chest pain is so unbearable that they think they are having a HEART-ATTACK. So they end up in HOSPITAL for days of expensive medical scans and tests for cardiac conditions!!! - but which are all NEGATIVE!!!

Sufferers eventually and anxiously arrive at Sayer Clinics in miserable pain.

We digitally visualise the neck, chest and thoracic spinal areas with extremely detailed,  high-definition , low-dose x-rays and diagnostic Ultrasound scans. We are able to show you the multiple depths and layers of your anatomy from spinal curvatures and early arthritic changes to signs of old injuries often from many years before. We can even show you our digital computed x-ray signs of the earliest beginnings of osteoarthritic joints in your neck or back.

We address the difficult but necessary postural changes alongside measured and skilled chiropractic muscle and fascia manipulation and specific therapeutic ultrasound 'inflammation calming treatment' to regain the normal movement of previously locked and torsioned neck, thoracic spine, chest and intercostals.

We give UNIQUELY knowledgeable advice and exercises and we work very hard to reduce the strain and tension in the inflamed lower cervical spine muscles: Trapezius, Levator scapulae, Rhomboids and the countless deeper, postural muscles of the neck and upper thoracic spine. This condition needs extremely focussed massage and very deep muscular manipulation by our expert physical therapists.

For total rehabilitation the computer screen needs incrementally raising higher to eye-level and we recommend the correct forward-tilted chair with neck-rest and exactly how to sit in it.
Once successfully treated, our patients stand and sit taller, with beautiful, vibrant posture and are soon fitter, more positive, happier and energised. They absolutely love their new pain-free posture and mobility. They refer us their colleagues and friends who have suffered similar musculoskeletal problems who then come in to see us for their course of 'posture makeover treatment'!

So, Do you suffer pain in your chest? Does it spread to your neck and upper dorsal spine into the front of your chest or around your ribs and down your arm? Computer and laptop work for long hours with poor posture is the major cause of neck, shoulder, rib and chest pain. It can also be the result of whiplash and traumatic sports injuries.

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 spine and ribcage.

Chest pain referred from the lower neck or upper mid-back causes local pain as well as a deep ”hot knife or deep burning ache” and referred intercostal nerve pain into the ribs at the back and to the breastbone and costal rib cartilage at the front of the chest. This referred rib pain may also be felt in the arm and hand.

ALERT: Patients with FEVER, severe COUGH or breathing difficulties with frontal chest pain should consult their medical practitioner.


Consulting us at Sayer Back and Neck pain Clinics in London includes a full case history and musculoskeletal examination.
We examine and detect mechanical sources of pain, may take digital computed x-rays and ultrasonic diagnostic examinations, if indicated, and aim to successfully treat costochondritis, rib or intercostal neuralgia, nerve and muscle pain condition physically.

The Sayer Clinics course of treatment is an extremely successful combination of specific and careful manipulation or gentle mobilisation of the spine, deep massage release of your diaphragm, pectoral and intercostal muscles to free your chest mobility and breathing as well as tailor-made, frequent rehabilitation exercises and ergonomic and postural change to relieve your chronic neck, rib and costochondritis pain longterm.


You will receive postural retraining and unique advice on correct ergonomic seating and computer screen height and position.

Medical treatment of muscle pain includes non-steroidal anti-inflammatory drugs (NSAIDs). These may cover just some of the pain in the short term but risk gastric acid reflux symptoms.

Rib and chest pain with deep ache or sharp, stabbing pain between the ribs spreads as a sick-ache through to the front of the chest under the breast where it is painful to touch the tender spots between the ribs:

Women as well as men spend a lot of anxious time in hospital having extensive heart tests when they actually have a simple but excruciating intercostal neuritis, costochondritis or referred dorsal rib pain radiating into the chest and ribs as well as into the side of the neck as an ill-defined sickening ache down the arm.

Trauma, 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 where your ribs attach to your breastbone or sternum.

This usually follow hours of inertia on a laptop or iPad rather than over-exertion. It can also be caused by seat-belt trauma as you are restrained during a car accident.
Rib pain - costochondritis, intercostal neuralgia, intercostal neuritis or costo-transverse sprain can be caused by heavy lifting, sustained awkward posture - falling asleep with your head lolling on a long car journey or flight, sleeping on your front or the ‘wrong’ pillow and is felt as deep chest pain as heart-pain, breast-pain or from lungs, stomach or oseophagus or as pain on deep inspiration.

Rib pain is often due to years of poor rounded posture where the middle thoracic spine becomes rounded (kyphotic) with the chest dropping vertically while slouching at desks, laptops and sofas. This kyphotic, rounded posture has become "normal" in the last 10 years due to laptops, iPads and nearly everybody sitting badly all day and working at computers and slouching on sofas.
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 not only looks utterly ridiculous but loads huge strain into the supporting muscles and ligaments which hold up your head and damages the muscles and joints in the middle-back, chest and neck. Any scoliosis or sideways spinal curvature aggravates these stresses and pain enormously.

When rib pain becomes chronic, recurring and long term, medical treatment with painkillers, anti-inflammatory drugs (NSAIDs) or steroid injections into spinal joints is short-sighted, short-term, of limited help but with side-effects!
At Sayer Clinics we take diagnostic low-dose digital x-rays of the spine and ribs and treat spinal, rib and chest pain with spinal manipulation, long-term postural rehabilitation, deep muscle massage and core muscle exercises.

SAYER CLINICS are the only UK EXPERTS to effectively treat the cause of your costochondritis rib pain and rehabilitate your posture for good. Our specialist postural training, treatment and advice on correct ergonomic seating and computer screen height and position is the key.

Sayer Clinics Chiropractors in London are highly trained in 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 medical practitioner, specialist 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 blade (scapula) 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 subscapularis or rhomboid muscle spasm as well as longer-term levator scapulae shortening, rotator cuff injury.

'Dropped chest’ and 'musculoskeletal chest pain' syndromes result from years of contracted chest posture with super-tight pectoral muscles, intercostals, diaphragm muscles and fascia. Deep muscle-stretch massage with our incredible physiotherapists, shiatsu and acupuncturists gradually rehab the chest to become posturally-corrected, flexible and pain-free.
Chiropractic treatment of rib pain and chest pain involves detailed examination of the joints and muscles and assessment of the mobility of individual ribs and joints.

We tweak the specific ‘treatment recipe’ needed for each patient at each treatment visit to maximise improvement as you progress to better health. Treatment restores wonderful pain-free movement and banishes chest, shoulder and arm pain.
The SOONER we improve your spinal and rib mobility, posture, ergonomics at work, individual exercises and core fitness the better your future health.