Costochondritis Complete Guide: Why Chest Pain Comes From Your Back

By Grant Frost · Physiotherapist • Last clinically reviewed: 27 September 2026

If you've found your way here, you're likely familiar with a particularly frustrating kind of pain: sharpness, tightness, pressure, tenderness or popping around the front of your chest.

You may even have been assessed for something more serious and eventually told that your symptoms are consistent with Costochondritis. That can be reassuring, but it can also leave you with another question:

Costochondritis is generally considered a benign musculoskeletal cause of chest wall pain, but diagnosing it is not simply a matter of finding tenderness around the ribs. Other causes of chest pain need to be considered first, particularly when symptoms are new, severe or accompanied by other concerning features.

This article is based on a detailed live stream I recorded about Costochondritis. It explains the clinical framework I use when assessing people with persistent chest wall symptoms, including why I often look beyond the painful area and how I use movement, mobility, breathing and strengthening to guide treatment.

Part 1: The Big Picture - Understanding Costochondritis

Watch the full explanation: For a deeper dive into the concepts discussed in this article, watch part one of the live stream below. I explain my clinical reasoning, answer live questions and demonstrates key concepts.

Is the Trigger the Real Cause of Costochondritis?

One of the most useful clinical questions is not simply "What happened when the pain started?" but "What was happening before the pain started?"

A cough, sneeze, respiratory infection, twist, new exercise or sudden increase in activity can clearly coincide with the onset of chest pain. These events can be important. But they do not necessarily tell us the whole story.

LIke the onset of most physical dysfunction, it's best to think of it as the "last straw". Imagine your tolerance to physical stress as a threshold. You may have been gradually moving closer to that threshold through poor postures, poor movement habits, etc., without experiencing obvious pain. Then one relatively ordinary event provides the final challenge that breaches the threshold and symptoms appear.

This does not mean that the cough, sneeze or movement was irrelevant. It just means we should be careful about assuming that the moment your symptoms revealed themselves alone fully explains why they developed. After all, things like coughing, sneezing and moving are normal.

This distinction can be helpful because it changes the question from "How do I stop that one movement from hurting?" to "How can I improve my overall capacity so everyday movements are better tolerated?"

• It reduces fear: a painful movement does not automatically mean that you have seriously damaged something.
• It broadens the assessment: we can look at movement, mobility, strength, breathing and loading rather than focusing only on the painful spot.
• It creates a rehabilitation goal: rather than simply avoiding symptoms, we can gradually build your tolerance and capacity.

Can Upper Back Stiffness Contribute to Costochondritis Symptoms?

This is where my clinical approach differs somewhat from simply treating the area that hurts.

In my clinical experience, the front of the chest typically a symptom of what's going on around the back. I often assess the thoracic spine, the joints where the ribs attach to the spine, rib movement, surrounding muscles, and the way the chest moves during breathing.

The rib cage is a connected structure. Ribs extend from the thoracic spine around toward the sternum at the front, and movement at one part of the rib cage can influence movement elsewhere. That makes the upper back and ribs clinically relevant when someone has persistent anterior chest wall symptoms.

Clinically, stiff, tight, overloaded tissue through the thoracic spine and posterior rib joints can change how movement and load are distributed through the chest wall. The more flexible structures at the front may then become more sensitive or irritated.

This is also why I prefer a test-and-retest approach. Rather than assuming that the back is responsible, we can assess whether changing a particular movement restriction around the back actually changes a person's symptoms through the front.

A frustrating feature of costochondritis is that you may have very little or no pain in your back to make this feel meaningful. The symptom location and the area that responds to treatment are not always the same thing, so it often takes a test-and-retest approach to shine a light on a hidden root cause.

Part 2: Your Action Plan - Exercises and Strategies

Once you've identified relevant restrictions or contributing factors, the goal is not simply to chase pain. The aim is to improve movement, restore capacity and gradually make everyday activities easier to tolerate - and pain typically resolves in the process.

The following exercises are the strategies demonstrated in part two of my live stream. They are not intended as a universal treatment protocol, but are the kinds of techniques that work clinically. The right exercises for you will depend on what your assessment actually finds, and obviously what you feel works the best.

Watch the full demonstration: I demonstrate every exercise below in real time, including how I use symptoms and movement changes to guide the treatment.

How to Mobilise a Stiff Upper Back

One of the simplest ways I assess whether upper back stiffness may be relevant is to compare movement and symptoms before and after a targeted mobility technique.

Tennis Ball or Lacrosse Ball Mobilisation

What you need: A tennis ball, lacrosse ball or another firm, round object. A lacrosse ball provides more specific pressure, while a tennis ball is usually more forgiving.

The goal: Identify areas of reduced movement or stiffness around the upper back and ribs, rather than simply searching for the most painful spot.

A useful clinical observation: the area that feels most restricted may not be on the same side as your chest symptoms. I sometimes see asymmetrical findings in people with chest wall pain, including restriction on the opposite side. However, this is a clinical observation rather than an established rule, so you need to take the time to figure this part out for yourself.

How to do it:

1. Find the joints: Place the ball beside the spine over the muscles and bony structures of the upper back. Move slightly farther out to explore the rib area.
2. Compare both sides: At a similar level on each side, notice whether one side feels more restricted, dense or resistant to pressure.
3. Use steady pressure: Once you find an area that feels restricted, hold a comfortable amount of pressure for approximately 30-60 seconds rather than aggressively rolling over the area.
4. Keep it comfortable: The sensation can be strong, but it should not feel sharp, alarming or threatening. Reduce the pressure or use a softer ball if necessary.
5. Re-test: Before starting, perform a movement that normally provokes your symptoms, such as a deep breath, rotation or arm movement. Repeat the same movement afterwards and see whether anything has changed.

Why the re-test matters: If your movement or symptoms change immediately after a technique like this, it provides useful information about whether that area may be relevant to your symptoms.

What Stretches Can Help With Chest and Upper Back Tightness?

If your assessment suggests that the muscles around your chest, shoulders or upper back are contributing to restricted movement, stretching can be useful. The aim is not to force flexibility. It is to gradually restore comfortable movement.

1. Advanced Pectoral Stretch

• Setup: Place your forearm against a door frame with your elbow at approximately 90 degrees.
• Find the stretch: Gently step forward and rotate your trunk away from the arm until you feel a comfortable stretch across the chest.
• Optional contract-relax: Hold the stretch, then gently press your elbow and forearm into the door frame for 5-10 seconds without actually moving.
• Relax and reassess: Relax completely and see whether you can comfortably move a little farther. Do not force the range.

2. Banded Upper Back and Lat Stretch

• Setup: Anchor a resistance band securely at approximately waist height. Slide your hand under the band, palm facing upwards.
• The movement: Face the anchor point and gently rotate your trunk away from the anchored arm, allowing the band to create a stretch through the lat and upper back.
• Optional contract-relax: Once you feel the stretch, gently tense the muscles being stretched against the band's resistance for 5-10 seconds, then relax.

Can Stress Make Costochondritis Pain Feel Worse?

Pain is influenced by more than tissue damage. The nervous system continuously interprets information from the body alongside factors such as context, previous experiences, stress and perceived threat.

This means that your pain experience is likely influenced by everything else in your life - work stress, life stress, and nasty things like past trauma and abuse.

Persistent chest pain can also be stressful in its own right, which, sadistically, can wash back over a person's pain, potentially making it feel worse.

Therefore, reducing stress and threat and regaining confidence in movement can be an important part of down-regulating a heightened nervous system and optimising recovery. However, it's rarely easy to click your fingers and eliminate persistent life stress, so it can be extremely helpful to practise strategies that acutely down-regulate things.

1. Slow, Controlled Breathing

• The technique: Take a comfortable breath in through your nose, then slowly breathe out through your mouth. Focus on allowing the chest, abdomen and shoulders to relax during the exhale.
• Keep it comfortable: You do not need to take enormous breaths. If a deep breath increases your pain, keep the breaths smaller and more relaxed.
• Use it as a re-test: Take 5-10 slow breaths and notice whether your pain, tension or sense of threat changes.

2. The "Gut Smash" Technique From the Live Stream

In the live stream, I demonstrate a gentle abdominal ball technique that I sometimes use as a relaxation exercise. I would not describe this as a proven "vagus nerve treatment", because the evidence does not establish that this technique treats Costochondritis through a specific vagal mechanism - but it works time and time again in practice.

• Setup: Use a soft, medium-sized ball and lie comfortably on your stomach.
• The technique: Place the ball gently into the abdomen around the belly button area. Use only light, tolerable pressure.
• Combine it with breathing: Relax and breathe slowly rather than forcing the pressure.
• Stop if it feels unpleasant: This should feel calming or comfortable, not painful.

Can Strength Training Help Prevent Recurring Chest Pain?

Once symptoms are settling and movement is improving, strengthening can help rebuild your capacity to tolerate everyday loads.

I like to think of this as creating a larger buffer between what your body can currently tolerate and the demands placed on it.

1. Prone Back Extension

• Setup: Lie on your stomach with your arms comfortably positioned by your sides.
• The movement: Gently lift your chest from the floor while keeping your neck relaxed. Pause briefly, then lower with control.
• Focus: Think about using the muscles around your upper and mid-back rather than forcing the movement through your lower back.

2. Seated or Standing Row

• Setup: Anchor a resistance band securely in front of you and hold the ends with both hands.
• The movement: Pull your elbows backwards towards your trunk and control the return.
• Focus: Keep the movement smooth rather than aggressively squeezing your shoulder blades together or forcing your shoulders down.

What Is the Best Approach to Persistent Costochondritis?

There is no single exercise or treatment that works for everyone with Costochondritis, but there are some heavy hitters. 

For me clinically: Find and free up those hidden restrictions around the back, work on your everyday postures and shapes, build strength and capacity through the trunk, and work to down-regulate a chronically heightened nervous system.

Ultimately, the bigger picture is simple:

If your symptoms are persistent, recurrent or difficult to understand, a thorough assessment can help determine whether there are modifiable musculoskeletal factors worth addressing.

Struggling With Persistent Costochondritis?

If you'd like personalised help uncovering the specific spinal stiffness contributing to your chest pain, a thorough assessment can make all the difference. Learn more about our costochondritis pain physiotherapy services in Port Macquarie.

Want personalised guidance?

If you'd like help with your Costochondritis or any other persistent issue, you can book with Grant either in Port Macquarie or via an online telehealth consultation.

Book In-Person (Port Macquarie) Book Online Telehealth Consultation