IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES

Abstract

Background: Costochondritis is commonly encountered in primary care, but is not routinely referred to PT. Costochondritis can last from several weeks to several months, limiting the patient's ability to perform tasks at work and home.

Purpose: Identify common impairments and examine the effects of treatment in subjects with costochondritis.

Study design: Retrospective case series.

Case description: Eight subjects were referred to physical therapy for costochondritis (mean duration of condition 6.3 ± 1.3 months) and reported that their condition restricted their ability to participate in occupational and fitness activities. The numerical pain rating scale (NPRS) and patient-specific functional scale (PSFS) were administered at the initial evaluation and at discharge. The Global Rating of Change (GROC) scale was only administered at discharge. All subjects received treatment directed at the cervicothoracic spine and ribcage and consisting of manual therapy and exercise.

Outcomes: Subjects were seen 4.8 ± 0.9 (mean±standard deviation) times. All subjects showed clinically meaningful changes at discharge. The mean NPRS decreased by 5.1 ± 1.7 points; the mean PSFS increased by 5.3 ± 1.4 points; and the mean GROC was 5.9 ± 1.1 points. All subjects were able to return to participation in previous activities without restrictions at discharge.

Discussion - conclusion: The results of this case series suggests that PT utilizing an impairment based examination and treatment approach including manual therapy and therapeutic exercise may facilitate the resolution of costochondritis.

Level of evidence: Level IV.

Keywords: Breathing; chest; manual therapy; ribs; thoracic.

Figure 1.

Thoracic flexion/extension self-mobilization timed with breathing. (A) Patient begins exercise in thoracic flexion sitting on low-back chair with hands interlocked behind cervicothoracic junction and elbows pointing toward ipsilateral knees with full exhale. (B) Patient then performs thoracic extension over back of chair in conjunction with horizon abduction of elbows and full inhalation timed with movement. Return to starting position.

Figure 2.

Thoracic flexion/extension with unilateral rotation self-mobilization timed with breathing. (A) Patient begins exercise in thoracic flexion sitting on low-back chair with one hand placed behind cervicothoracic junction with elbow pointing toward contralateral knee; opposite hand is holding chair seat with full exhale. (B) Patient then performs thoracic extension over back of chair in conjunction with rotation and horizon abduction of elbow to point posteriorly, timed with full inhalation. Return to starting position.