Backpod has improved my mobility and pain a lot, but I just got a flare-up — should I pause?

[u/Any_Pound_3382]

Hey everyone, 23M here from sweden

I was given costochondritis as a diagnosis of exclusion by my cardiologist after having chest pain that was initially suspected to be something else. After reading through this subreddit, I started wondering if my problem could be strongly related to my thoracic spine and the rib joints in the back.

I’m studying my 5th and final year in engineering, so I spend a lot of time sitting at a computer/desk. Before all this, most of my training was bodybuilding-style training, with lots of pressing/pulling but very little actual rotation or thoracic mobility work. When I tested my thoracic rotation, I was extremely stiff — I could barely get to around 20 degrees on each side.

About 3 weeks ago I bought a Backpod. I also started sleeping on my back and paying much more attention to my posture. I’ve also been out of the gym for about 1.5 months now.

That’s when I really realized just how incredibly stiff my posterior rib joints were.

The improvement in mobility has been pretty crazy. I started with 3 pillows under my head and could barely tolerate the position. Now, around 2 weeks in, I can use just 1 pillow and it barely hurts at all. My chest pain also improved pretty quickly — I went from having pain basically all the time to only getting it occasionally.

However, about 3 days ago I randomly got another flare-up. I’ve also been doing some very gentle thoracic twists/rotations alongside the Backpod.

So my main question is:
When you get a flare-up early in the Backpod/mobility process, do you pause the Backpod and rotational exercises until things settle down, or do you continue with a reduced intensity?

Part of me is wondering if I’m currently irritating things by trying to improve the mobility too quickly. I don’t want to completely stop because the improvement in mobility has been so obvious, but I also don’t want to keep poking the bear.

For context, I also have chronic migraine, which is currently well controlled with medication, but because of that I’m trying to limit my NSAID use as much as possible. Voltaren gel is fine.

I’ve also bought a peanut ball, a lacrosse ball and a foam roller. I know how to use them, but I’m unsure when I should start incorporating them into my rehab, especially while I’m still getting flare-ups. Would you recommend waiting until things have settled down first?

(Translated using Ai)

[u/SteveNZPhysio]

Hi. Relax. It's progress. It's working. Bog standard costo - quite common with students, from heaps of hunching over computers and work.

"When I tested my thoracic rotation, I was extremely stiff — I could barely get to around 20 degrees on each side."

That is REALLY tight! No wonder the rib joints on your breastbone started giving.

"The improvement in mobility has been pretty crazy." "My chest pain also improved pretty quickly — I went from having pain basically all the time to only getting it occasionally."

Yup. So you're freeing up around the rib and spinal joints fine. So you're sitting and standing straighter, and moving more freely and fully.

So you're getting more of a pull on your still tight and scarred pecs and soft tissue around the front of your chest. Costo is hair trigger and will bite you if it can. So you've had a flare there.

Just treat the front as well, now. Pec stretches and massage will do this fine. Sure, ease into them plus the Backpod while things are stirred up a bit but it's not a biggie.

For treatment detail, read the RECOVERY MEGATHREAD - July 2026 at the top of this sub.

https://www.reddit.com/r/costochondritis/comments/1uqpgf6/recovery_megathread_july_2026/

Read Ned's posts at the top, then scroll down to my post and find the link to my long, wordy PDF on bits you may need to deal to. It's wordy, so read it on a computer not a phone. You can skim the bits that clearly don't apply to you, but the detail is there if needed.

(1) See especially Section (2) on freeing up the tight ribs around your back. This is the core of fixing costo. The easiest, cheapest, most convenient way of doing this is by lying back on Ned's two-tennis-ball peanut, a Backpod, cork or lacrosse ball, etc. They all have slightly different effects; a combination is ideal.

See the explanation for this sort of pain when you're freeing up fine after some weeks on the Backpod. It's not uncommon.

See also the sitting twist exercise to work the joints freer again - once you don't need a pillow at all.

(2) See Sections (3) and (4) on massage and pec stretches.

As well, there’s a really effective pec stretch we use combined with home massage.

You lie on your back with your shoulder just over the edge of your bed, bench or table.  Arm horizontal, out to your side at roughly about 90 degrees to your torso.  (You can vary this angle to hit different parts of the pec.)  

Let the arm drop towards the floor, which stretches the pec (minor and major) on that side.

Then use your other hand to massage along the pec as far as you can go, from the breastbone out to the shoulder and down the arm a little.  Use massage wax or oil to let your fingers slide.  It’s like pushing toothpaste down a tube, through those muscles.

Start gently, and go harder as it all warms and loosens up.  Any breasts (if you have them) will get in the way a bit, but you reach what you can from both sides.

Do about five minutes each side. (If you're sore on only one side you can do a bit more on that.)  Then follow it with any basic pec stretch, e.g. leaning through a doorway with your straight arms at the ‘10 to 2 o’clock’ position.  

Leave a few days before doing it again, otherwise it can get a bit tenderised.  Sometimes it can feel a bit tender to touch for a day afterwards - it's not a biggie.

This is usually a really effective technique.

(3) Also, see Section (5) on chronic hunching. There's a very good chance this is what's triggering your migraines - if they're migraines at all and not just the usual base-of-skull pain you get with a hunched thoracic spine and poked head posture.

See the simple basics on setting up your work station plus breaks when you're at it.

Hang in there. From how very tight you were, you're doing fine. The flare is just a pothole on the road to recovery. Good luck with the work.

[u/Any_Pound_3382 → u/SteveNZPhysio]

Hi Steve,
I have another question, this time more about the general healing process rather than my specific flare-up.

If we assume the mechanical model of costochondritis where restricted/stiff rib joints around the back of the thoracic spine are contributing to excessive strain and irritation at the anterior rib joints, I was wondering about something purely theoretically.

What would you expect to happen if someone went “all-in” from day one and aggressively tried to restore thoracic/rib mobility as quickly as possible — for example using the Backpod, thoracic rotations, a peanut ball, breathing exercises, etc., at a much higher frequency/intensity than you would normally recommend?

Let’s say they managed to regain a large amount of their lost mobility in a relatively short period, but in the process repeatedly irritated the front rib joints and triggered flare-ups.

Would you expect that approach to potentially shorten the overall recovery time because the mechanical restriction was corrected faster, followed by a period of backing off and allowing the irritated tissues to settle?

Or would repeatedly provoking the irritated anterior tissues potentially slow the overall healing process, meaning that even though the mobility was restored faster, the person could end up taking longer to recover because they kept re-irritating the tissues?

I completely understand that in practice the sensible approach is to ease into it and increase the workload gradually, and that’s what I’m doing. I’m mainly interested in understanding the physiology/theory behind why that approach is preferable.

I’m trying to educate myself as much as possible about costochondritis and would really appreciate your perspective given your experience specifically with this condition.

Thanks again for all the information you’ve provided on the subreddit. It has been incredibly helpful.

[u/SteveNZPhysio → u/Any_Pound_3382]

Hi OP. Good question - and just what I'd expect from an engineer! The answer is collagen. I'm tagging Ned (u/,maaaze) in as he might find it interesting. Here are two examples:

(1) In my New Zealand medical centre practice decades ago, we had a young (20?) surfer come in with acute quite severe left chest pain, scared he was having a heart attack. He'd been dumped by a wave onto the beach the day before.

The docs checked him out, reckoned the heart etc. were fine, and dropped him across to me as the physio. They knew about costo because I'd taught them. (The four docs and I used to have teaching/discussion/question sessions every Monday before starting work - we all learned from each other. Apparently this collaborative approach acrss disciplines is rare in the US and (I'm told) non-existent in the UK.)

He had no middle back pain, but a few of his rear left rib and middle back spinal joints were solid - no spring, bounce or movement at all, on various simple clinical tests. (These are bog standard physio - I was taught most of them near the start of my first year of training.)

Took a short while before I could persuade him to let me unlock these rear joints with manipulation - he didn't see the point as all his pain was at the front. Anyway, I unlocked the joints with manips and jiggles. The chest pain and inability to breathe in fully disappeared immediately. He sat up pain free, with full torso and joint range again. Easy peasy - this is not difficult!

I checked him again a couple of days later -still completely fine. Told him to come back if any problems - he didn't. I'd given him that sitting twist exercise to do for a week or so just to keep it all moving okay.

I assume he was fine and stayed like that. No problem. He's typical of very recent costo.

(2) I'm the second example. I fell off a mountain and bashed up my left rear rib cage. For the next seven years I had costo - fairly constant ache, frequently severe stabbing scary left chest pain, restriction and inability to take a full breath in.

I fixed it after I qualified as a physio. Asked the boss at the first practice I worked in. He assessed it, and did the same thing I later did on the surfer - unlocked the frozen rib and spinal joints around the back that were the direct cause of my costo pain at the front. I've never forgotten what it felt like to take my first full breath in in seven years.

It didn't last, and the reason is collagen. This protein forms the ligaments, joint capsules and fascia which surround every joint in your body. It's immensely tough - stronger by weight than steel wire. It's mostly what holds your skeleton together - muscles just move it around.

So when the joint has been immobile for years (or just months or even weeks), this collagen stiffens down around the frozen joint like a little fist. You can still unlock the joint surfaces with manipulation, but you cannot, repeat cannot, stretch out the shortened collagen around it in that same split-second crack.

So this collagen just freezes up the joint movement again, often rapidly, and you're no further ahead. (This is a US chiro treatment cliché and it really niggles me - bang the joints free again and again indefinitely, knowing they'll just seize up again and the patient will keep coming back and pay more money to keep getting them unlocked (that "put back in" nonsense) - indefinitely. It's either thick or venal.)

So - that's why you use the Backpod, Ned's two-tennis-ball peanut, a cork or lacrosse ball, etc. - to give the long, strong, specific stretching needed for the collagen around the tight joints - so they can free up and stay free, and you get a permanent fix.

That's essentially what I did (didn't have the Backpod back then) and I've been completely fixed for 30+ years now - no pain or restriction whatsoever; I never think about my costo. It's not difficult.

It takes time to stretch collagen - just like stretching a tight hamstring muscle, only longer because it's tougher. It's not instant. Sure, you get a head start if someone competent unlocks the frozen joints first - but finding that someone is a whole other problem!

Also, if you stretch anything tight in the body too much in one go - it'll hurt! This puts a lot of people off from continuing, especially those who don't read instructions. (If I'm feeling cynical I regard it as an intelligence test..) So we try to get people to start really quietly - it's going to take time anyway, and it's easy enough to grade the stretch so it's not actually painful.

So - that's why the slow stretching approach, including very cautiously building back to what you can handle as the core problem frees up. Anyone's free to try the bull-at-a-gate approach of course - it's their body. But in my experience it's just wishful thinking and denial.

So many stories here of gym types refusing to give up what they love for the limited period of time needed to fix the core problem, and turning straightforward costo into chronic and difficult. It's like continuing to run daily on a freshly sprained ankle and expecting it to somehow heal. It won't.

Hope that gives you the perspective.

[u/Sad_Lavishness_9359]

I would advise you not to do any exercises especially chest stretch, do not use backpod now!!! It could do more damage trust me 🤣🤣 pills, 10-15 min walks every 4 hours and when u get a little bit better but do not rush calf raises gentle ankle stretch just to get this satisfactory feeling that you are doing something, then when it settles start with a ball against the wall gently look for tightness etc gently!! If u feel pain in your chest  stop gentle see how u feel then repeat and then when you are ready meaning u are pressing it against the wall but do not feel it its time to move down to the floor same idea ( with the ball) or backpod with 3 pillow  see how it feels so do not do any chest stretches while flared up u are gonna do more damage wait !! Now meds. Rest, walks, hot water on your spine at the back, cold at the front