Chronic Costochondritis

Medical Q&A [Moderated]
1

tl:dr diagnosed Costocohondritis in a friend who refuses to train because of the condition, what can you tell me about it?

It seems I have questions everyday but I am not sorry, I can’t help that I am inquisitive.

I’ve search through the threads and found only 3 posts dealing with costochondritis all of which were labeled as possible (excluding one that was simply sternum pain). My training partner has been diagnosed with chronic costochondritis in connection with rheumatoid arthritis, his PCP has recommended not weight lifting and NSAIDS. He has had these issues for going on a year now and it has actually impacted his mental state. He has gotten depressed and every time I have asked him to train he says he can’t because of this condition. This guy loved to train with me, and I feel like a pretty shitty pal not being able to help him out and he is gaining weight being sedentary (not to much because he has adjusted his caloric intake).

Looking through PubMed just to learn more about this condition I have stumbled across a few situations similar to his the first being the treatment of a female Chronic costochondritis in an adolescent competitive swimmer: a case report (Chronic costochondritis in an adolescent competitive swimmer: a case report - PMC)

The treatments consisted of manual sternocostal joint mobilizations, manual spinal manipulative therapy of the thoracic spine and costovertebral joints, A.R.T. therapy of the thoraco-humeral musculature (pectoralis major and minor), and scapular stabilization exercises (scapular retraction and push-up with plus).

These only temporarily relieved the pain and knowing what I have learned from the painscience posts It makes me believe that it is not actually fixing the problem, if that is at all possible to do in the first place. I think it would be more or less managing the problem.

I’ve also found information regarding acupuncture for treating adolecesents with costochondritis
(Integrating Acupuncture for the Management of Costochondritis in Adolescents - PMC)

This unfortunately did not provide insight into long term management and since it was in adolescents and not adult populations I can’t really generalize that as a positive either. As an aside, I have a bias against acupuncture as a treatment for pain but if it helps mentally make the person feel better…sure go for it. He is not having to pay for it since it is a service related disability.

He has completed PT and he said this does nothing for him. It is my belief that this is because he is trying to mentally compare his strength levels to when we trained before he was diagnosed with this condition. When he was still going to the gym, he would try to follow the same programming he was doing prior. Benching would result in pain (reported to me 9/10) and he would walk away.

The information I have found on Costochondritis: Diagnosis and Treatment suggests to me that although no clinical trials have been conducted on the treatments of the condition, the recommendation would be to modify his intensity to his level of fitness at this point in time.

On multiple occasions I have attempted to do that to no avail (“bro I can’t, I want to but my chest condition”) and at this point I believe he refuses to train because he does not want to burden (although it would not be a burden) with the difference in strength levels. I have even tried following something Dr. Baraki said once “what information would you need to change your mind?”…nothing

It would be easy to just say screw it and move on but having deployed with this guy multiple times I know when things bother him and I know that not being able to train is bothering him since he has gotten out of the service. I guess what my question is this:

What would you do if your training partner had a similar circumstance to convince them to modify training and not worry about previous strength levels? Further, is there any other recommendations of literature that I could share with him so that he can educate himself in managing this condition?

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Did he tell you how, specifically, this was diagnosed?

The reason I ask is because “Costochondritis” is a stupid (IMO) term that’s used to describe someone with chest wall pain (i.e., non-cardiac chest pain) that is reproducible with palpation (in other words, it’s physically tender to the touch). There aren’t any “objective” or pathologic findings that can support the diagnosis. It’s also been called “chest wall syndrome”, “costosternal syndrome”, and a bunch of other similarly nonspecific terms. It’s unfortunate because the term “Costochondritis” gives it the impression of a true pathologic diagnosis (and thus has the potential to scare patients), which is not the case. I would train using the same rehab / load management principles we use for other pain conditions in the course of training.

As an aside, I also wrote an article for our newsletter recently discussing the importance of training in patients with rheumatoid arthritis.

3

He did say this was what his PCP said he had and it was the reason for changing his VA disability rating from 80% to 100%. This could be based on the chronic nature of it but most people are still trying to figure out how the VA makes their determinations in ratings, we only really know what those general recommendations are.

I know now it has to suck, anactodally I had it for a bit after I broke a rib but it went away, but if his pain is the same as what I felt that was miserable.

the fear of this condition may be what is preventing him from even stepping near a gym, I’ve tried pointing out the fact that becoming stationary and not doing anything is way worse for his health than a seemingly painful condition that may have more of a social influence than biological. Not detracting from his PCP I just know of a lot of Docs who try and look out for separating service members during their claims and reviews and do the whole “this hurts and impacts your daily life right?” That may or may not be the case in this instance but I believe it has an impact regardless of the intention of the PCP.

I listened to the podcast that Dr. Jordan appeared on last night and he was discussing a regression of lifts, his example was in dealing with individuals who say they can’t squat and finding if they can pin squat or belt squat etc. So I’ll have to try something along that methodology while still using the other concepts you all have provided in the templates. Hopefully operant condition him to not be afraid of weights. It seems as though this is an area that might need more research, a lot of the data I was reading really didn’t provide to much clarification on what I would see as solutions. Is this how a lot of medicine is?

I will be looking at that newsletter now, thank you.

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This information makes the problem even more complex.

One predictor of disability from low back pain is actually the potential for financial compensation (either directly or indirectly, as with the VA disability rating). These systems incentivize people to be disabled, and are a huge problem with respect to recovery and return to normal activity: Can Cross Country Differences in Return-to-Work After Chronic Occupational Back Pain be Explained? An Exploratory Analysis on Disability Policies in a Six Country Cohort Study - PMC

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Correcting this would prove to be very difficult, at least regarding low back pain. I am aware that states disabilities benefits limit your earning potential. This gives me reason to believe (along with the source you provided) that one would financially benefit from being “disabled”. I would like to see research being conducted on the Veteran population due to less limitations placed on disability. Like in my buddies case he had no limitations placed on him working while at 80% and even now he has 100% workable, which means that although he is “100%” disabled he is still able to work. I think the difference in reason for disability within this population is important to note.

According to the Department of Veterans Affairs, VA Disability Compensation is: a benefit paid to a veteran because of injuries or diseases that happened while on active duty, or were made worse by active military service. If we take in to consideration the subjective nature of “injury” (excluding major diformaties i.e. amputations

If I happened to have low back pain while in the military I am able to claim it. Like in my instance I am currently working on processing my VA disability claim since I will be transitioning out of the service soon, with that in my medical record there is “chronic low back pain due to trauma sustained during lumbar fracture”. Since I started drinking the Barbell Medicine kool-aid my low back pain has been 3 at worst and 0 regularly. Before BBM I had spikes of 10 from a constant 6.

The purpose of my anecdotal story is that the distinction between the purposes of disability payments is an important characteristic for future research to acknowledge.
Where VA disability is paid to compensate the Vet for injuries sustained during time in service and the purpose of disability insurance is to provide income to pay the expense of life even though you can’t work due to a disability.

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Sure. The other facet to consider are the potential consequences of someone just being labeled “100% disabled” in the first place, as this is likely to influence one’s beliefs and thus, outcomes.

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100% agree!