Chest pain is often assumed to be a heart problem. Although a heart attack should always be excluded, a common cause of chest pain is chest wall and rib pain, such as costochondritis. So what causes chest and rib pain, and how do we treat it?
Important: if you have sudden, severe, or crushing central chest pain — especially with breathlessness, sweating, or pain spreading to the arm, neck, or jaw — treat it as an emergency and call 999. This page is about musculoskeletal rib and chest wall pain, not cardiac chest pain.
What causes rib pain?
Chest and rib pain can come from the muscles, joints, and nerves of the chest wall. Most causes are benign and not concerning, but some are serious and need immediate treatment.
Rib trauma
Chest trauma can be sudden and obvious (a fall onto the chest) or more subtle (lifting a heavy object). Trauma can cause a rib bruise, a rib fracture, or a cartilage fracture.
- A bruised rib results from a strain or damage to the bone, cartilage, or muscles of the chest wall.
- A rib fracture is a complete break of a rib or the cartilage attached to it. Fractures tend to be more severe and last longer.
Costochondritis
Costochondritis is inflammation of the cartilage that joins the ribs to the breastbone (sternum) — one of the most common causes of chest wall pain. It causes sharp or aching pain, usually near the sternum, that’s worse with deep breathing, coughing, twisting, or pressing on the area.
Treatment involves avoiding activities that move the ribs, alongside anti-inflammatory measures. In some cases, an injection helps. Costochondritis generally lasts a few weeks, though the pain can sometimes last for months.
Rib stress fracture
A stress fracture of the rib is an uncommon cause of chest wall pain, usually affecting active people — including tennis players, baseball pitchers, and rowers. The pain worsens with activity and settles with rest. A rib stress fracture can also occur after a prolonged bout of coughing from pneumonia or a viral infection. Rest improves the pain.
Other causes of rib pain
Other causes of chest wall pain include inflammation of the sternocostal joints from inflammatory arthritis, and, rarely, growths in the ribs, such as tumours. With any rib pain, it’s important to see an experienced doctor who can rule out serious conditions such as a heart attack, a lung clot (pulmonary embolism), or pneumonia.
How is rib pain diagnosed?
We take a history and examine the chest wall, pressing along the ribs and sternum for tenderness, and checking whether movement or breathing reproduces the pain. Where needed, imaging and tests help — an X-ray for fractures, ultrasound or MRI for soft-tissue and cartilage problems, and an ECG, chest X-ray, or blood tests to exclude cardiac, lung, or other serious causes.
Treatment of rib pain
Most chest wall and rib pain settles with simple measures — relative rest, avoiding activities that move the ribs, and anti-inflammatory medication such as ibuprofen. Depending on the cause, an ultrasound-guided cortisone injection can help inflammation that doesn’t settle — for example, costochondritis or chest wall trauma that hasn’t responded to anti-inflammatory measures.
Frequently asked questions about rib pain
Is rib pain a sign of a heart attack?
Usually not — most rib and chest wall pain is musculoskeletal (such as costochondritis) and reproduced by pressing on or moving the chest. But cardiac pain must always be excluded. Call 999 if chest pain is sudden, severe, or crushing, sits centrally, or comes with breathlessness, sweating, nausea, or pain spreading to the arm, neck, or jaw.
What is costochondritis, and how long does it last?
Costochondritis is inflammation of the cartilage joining the ribs to the breastbone. It’s benign and one of the commonest causes of chest wall pain, typically lasting a few weeks — though it can occasionally persist for months. It’s treated with rest, anti-inflammatories, and sometimes an injection.
Can coughing cause rib pain?
Yes. A prolonged, forceful cough — for example, during pneumonia or a viral illness — can strain the chest wall muscles or, less commonly, cause a rib stress fracture. The pain settles with rest as the cough improves.
What causes rib pain in athletes?
Rib stress fractures are the classic sporting cause, seen in rowers, tennis players, and baseball pitchers, from repetitive loading. Intercostal muscle strains and costochondritis are also common. The pain typically worsens with activity and eases with rest.
When should I see a doctor about rib pain?
Seek urgent care for chest pain with breathlessness, coughing up blood, a fever, or after significant trauma — to exclude a fracture, a lung clot, or pneumonia. See a doctor for any rib pain that’s severe or isn’t settling, so the cause can be identified.
How is rib pain treated?
Most cases settle with relative rest, avoiding movements that aggravate the ribs, and anti-inflammatories. An ultrasound-guided cortisone injection can help persistent costochondritis or chest wall inflammation. The right treatment depends on the cause, so an accurate diagnosis comes first.
Final word from Sport Doctor London about rib pain
Most chest and rib pain comes from the chest wall — the muscles, joints, and cartilage — and is benign and treatable. The key is to exclude the serious causes first, such as a heart attack, a lung clot, or pneumonia. Once these are ruled out, most cases of rib pain respond well to rest, anti-inflammatory measures, and occasionally an injection.
If you have persistent rib or chest wall pain, Dr Masci can assess you in London, including an ultrasound in the clinic. Contact the team here or call +44 (0) 203 488 0350.
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