Sports Injuries- Costochondritis - Sports Physio


How repositioning the ribcage with a neurological approach can get rid of sternum pain, in just one session.

A patient, Ben, recently attended my Sports Injuries Clinic for treatment of his sports related injury. He is a keen athlete and works full time as a personal trainer. Ben had recently increased his own training load in the gym and this had produced moderate to severe symptoms of pain in his sternum, the pain was aggravated by further lifting weights and thus limiting his ability to train and affecting him at work.

His doctor diagnosed him with costochondritis (inflammation of the joint between one of the ribs and the breastbone (sternum), for which he had been prescribed anti-inflammatories. Costochondritis can be caused by a direct blow to the ribcage/sternum area (e.g. in ball / contact sports) or overactivity and excessive pull from the pectoralis major muscle in those individuals who perform repeated trunk and ribcage rotation. This is more commonly seen in gym goers who train their upper body with weights, such as weight lifters and personal trainers. Ben’s condition had become chronic and had not responded to the prescribed treatment and rest. Ben presented to my sports injury clinic 9 months post injury.

Ben Winn PT 5* Review - Sports Injuries Costochondritis
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Sports Injuries & Complex Injuries Specialist

initial assessment

I do not look to treat the symptoms of a sports injury, I use specific tests to identify the positioning of the body, how the position of one muscle influences another. So I can then understand and address the underlying cause of the sports injuries or pain.


On initial physiotherapy assessment of this patient I identified his pelvis was positioned in a strong clockwise orientation (the left side of his pelvis was tipped forward). The physiotherapy assessment tests also showed his lumbar spine was orientated to the right (in line with his rotated pelvis) and his ribcage was then orientated to the left.


Despite Ben’s ribcage being orientated to the left, his sternum (breastbone) was orientated to the right. As you can see from image 2 below, the pectoral major muscle connects to both the sternum and the humorous (arm). With the sternum orientation to the right and the ribcage to the left, this positioning was resulting in overactivity in the left pectoral major muscle.


The overactivity in the left pectoral major muscle was limiting his ability to rotate his ribcage to the right and thus he was unable to achieve ideal (reciprocal) pelvis and ribcage mechanics, which are required for efficient movement. 

Treatment approach

Utilising manual techniques developed by Ron Hruska at the Postural Restoration Institute (Image 3), my initial treatment focused on restoring the correct position to Ben’s ribcage and sternum. Treatment then continued with specific exercises to turn Ben’s pelvis in a counter clockwise direction which would also turn the spine to the left (counter-clockwise) below the diaphragm and orientate his ribcage (above the diaphragm) back to the right (clockwise). (Image 4 & image 5)

With the repositioning techniques I guided the sternum in to a left orientation, improved the position of the left diaphragm leaflet and allowed air flow back in to the right chest wall, therefore improving right trunk rotation. These techniques also neurologically inhibited certain muscle groups in the ribcage, including the left pectoralis major muscle, thus allowing right trunk rotation and increased range of movement at the shoulder and ribcage.

The costochondritis pain that Ben was experiencing was immediately eased by the re-positioning and he continued with exercises at home to maintain his new position.

Left Posterior Mediastinum

Following the manual techniques I used this exercise to improve airflow in to the right chest wall and the back of the left chest wall. This reinforces the new diaphragm position achieved with the manual techniques.

Right Glute Max with left hip approximation

I used this exercise to produce counter clockwise rotation at the pelvis. This is achieved by activation of the right glute max in the transverse plane. On the left the oblique abdominals and left hamstring and left anterior gluteus medius muscles are engaged to hold this new position of counter clockwise rotation at the pelvis.

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Simple to follow steps that you can take to prevent costochondritis returning

Hi I'm Martin

In your first appointment I will identify the cause of your injury or pain.
Rather than just confirm you have 'costochondritis', 'back pain' or 'tight hamstrings' and give you a programme to 'stretch them out' or foam rolling, I will identify the specific underlying pattern or reasoning why you have that tightness in the first instance and put a clear plan together to help you address it.


Patients with costochondritis pain can often be experiencing additional symptoms including difficulty with breathing and anxiety related symptoms. Repositioning the diaghragm can help with these additional symptoms.

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