Xiphoid Process Pain: Causes, Symptoms & When to See a Doctor

Xiphoid Process Pain: Causes, Symptoms & When to See a Doctor
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The xiphoid process is located in the center of your chest and is found just at the end of your sternum (breastbone). Inflammation, digestive issues, or injury can cause xiphoid process pain which doctors refer to as xiphoid syndrome, xiphoidalgia, or xiphodynia. Xiphoid process pain is a common source of chest pain that can also cause abdominal discomfort and pain that radiates to other areas of your body.

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The symptoms of xiphoid process pain can be difficult to diagnose because it can mimic symptoms of other health issues. Your chest contains many important organs protected by your rib cage. Sometimes xiphoid syndrome discomfort can be mistaken for heart-related pain, rib or breastbone pain, or chest infections. Because squeezing, pressing chest pain can be a sign of a heart attack, you should see a doctor for chest pain, even if you think it could be caused by your xiphoid process.

Treating xiphoid process pain successfully usually requires plenty of rest if the pain is caused by injury. Also, hot and cold treatment for xiphoidalgia can help to relieve pain caused by inflammation, infection, or trauma. If you have symptoms of digestive upset like heartburn, mid-chest pain, and excessive belching then drinking baking soda water can help to relieve the pain.

In this article, you will learn about xiphoid process pain and about natural ways to get rid of the pain in your chest.

What is the Xiphoid Process?

Your xiphoid process is a small cartilaginous extension at the lower end of your breastbone, or sternum. At birth, it is a thin, roughly triangular region of cartilage which gradually turns into bone in adulthood and forms part of the sternum.

Doctors on MedicineNet describe the xiphoid process as the lowest segment of the sternum and it has no particular function. The size of the xiphoid process can range from very tiny to a few inches in length.1 Another name for the xiphoid process is xiphisternal bone, the xiphisternum, or metasternum.

Your breastbone or sternum is located in the middle of your chest and comprises of 3 bones – the manubrium, the corpus, and the xiphoid process. Together the 3 bones of your sternum resemble the shape of a necktie with your xiphoid process being the pointy end at the bottom.2

The sternum joins to your first 7 ribs and collarbone and helps to protect your heart, lungs, and major blood vessels from injury.

To find the exact location of your xiphoid process, use your fingers to feel down the bone in the middle of your chest between your ribs. At the end of that bone, you should be able to feel the xiphoid process if you gently press on the area.

Symptoms of Xiphoid Process Pain

Conditions that result in aches and pain in your xiphoid process can cause various types of symptoms. Xiphodynia can cause pain directly in the center of the chest, or pain that radiates to the shoulders, throat, and arms.

For example, the journal Chiropractic & Osteopathy reports that problems with the xiphoid process can cause abdominal pain, middle back pain, and even throat pain. In some instances, patients mistake xiphoid process pain for cardiac pain and they may even have nausea, vomiting, and diarrhea.

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Sometimes the pain can resemble a dull ache that causes discomfort in the chest or the pain can be severe, especially when moving the upper body or lifting heavy items. A person may feel discomfort around the middle of the chest after eating a large meal. This happens as the stomach pushes on the xiphoid process and causes mild pain.

For some people, misdiagnosis of xiphoid process pain may mean that their chest pain lasts for many weeks. Doctors may run checks for cardiac pain, look for rib injuries, treat a person for gastrointestinal problems, or look for signs of costochondritis (inflammation of the sternum). Then, after exhausting all other possible causes of the chest pain, a person gets relief from xiphoidalgia when the cause of xiphoid process pain is treated.

Warnings about other causes of chest pain

It is important to never ignore any kind of chest pain. Your heart is located on the left side of your chest and cardiac-related conditions will usually result in feeling severe pain under the left rib cage. However, sometimes pain that is caused by a problem with your heart can also be felt in the middle of your chest or cause severe discomfort under your right breast.

The American Journal of Emergency Medicine reported that sometimes the first signs of heart attack can feel like xiphoid process pain. The journal recommends that doctors investigate symptoms of chest pain for serious conditions like heart attack or angina before assuming that it is xiphodynia, heartburn, or chest pain under the ribs from a panic attack.4

Causes of Xiphoid Process Pain

Let’s look in more detail at what can be the reason for xiphoid process pain and what you can do to relieve the pain naturally.

Injury

The most common cause of xiphoid process pain is an injury to the chest cavity. This can include a blow to the ribs, sternum, or upper abdominal area.

For example, the journal Occupational Medicine reported on a case where hard physical work over many years caused multiple micro traumas to the xiphoid process and breastbone. This resulted in mid-chest pain that doctors mistook for gastroesophageal reflux. Only when the man was treated for xiphoid syndrome did his painful symptoms go away.5

Other reports show that trauma to the chest while playing sports or injuries sustained after a vehicle collision are also common reasons for xiphoid process pain. Other causes of pain in the lower part of your sternum are stress fractures, falling on your front or back, or having osteoporosis.6

Another reason for damaging the xiphoid process is receiving cardiopulmonary resuscitation (CPR). To administer CPR a person must place their hands just above the xiphoid process and push down on the sternum. In some cases, the xiphoid process can snap or break. However, that is a small price to pay for being resuscitated after a heart attack or nearly drowning.

Gastroesophageal reflux (GERD)

Gastroesophageal reflux is another common reason for xiphodynia. The esophagus is found close to the xiphoid process and chest pain caused by GERD can also make the xiphoid process painful.

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According to the book Clinical Methods, GERD can irritate nerves in the thoracic region that cause painful symptoms both in the neck and the xiphoid process. Irritation of these nerves can cause chest pain in general or localized pain that is felt in just one spot, for example, your xiphoid process.7

The Middle East Journal of Digestive Diseases reported that some of the causes of digestive issues that result in pain below the sternum are an unhealthy lifestyle, fast foods, and inactivity. These lifestyle choices can also lead to another cause of xiphoid process pain and that is obesity.8

Being overweight

Being overweight can cause xiphoid process pain that is constant or comes and goes. Pressure caused by carrying around too much weight can push on the xiphoid process or damage it.

The journal Case Reports in Surgery reported that weight gain and strenuous physical work can damage the xiphoid process. For example, one overweight man who had to do a lot of lifting at work was treated for GERD because of constant chest pain. However, after treatment for GERD didn’t improve the symptoms, doctors found that pressure on the xiphoid process caused by obesity was to blame for the middle chest pain. In this case, removing the xiphoid process surgically resolved the pain completely.9

Xiphoid process deformity

Some people have recurring pain in the chest due to a deformed xiphoid process. The journal Thorax reported that the xiphoid process can cause chest pain if the tip of it protrudes inwardly. This can rub on the heart and cause pain similar to angina.10

It is difficult to diagnose a xiphoid deformity as a cause of pain due to the fact that the deformity doesn’t always show up in X-ray exams.

Inflammation of xiphoid process

Inflammation of the sternum bone can also cause inflammation of the xiphoid process leading to pain in the front of the chest wall. The pain of an inflamed xiphoid process may be dull and constant or it could cause sharp pain especially when you cough or breathe deeply.

The journal JACEP said that inflammation of the sternum and joints of the rib cage can cause pain in the chest. Tietze’s syndrome may also result in painful swelling at the rib-cartilage junction.11

Usually, you can tell the difference between pain caused by xiphoid process inflammation and heart-related pain because the sternum will feel tender to touch.

Infection

A rare condition that can affect the xiphoid process is an infection called xiphisternal tuberculosis. Tuberculosis is a bacterial infection that usually affects the lungs and causes upper respiratory symptoms like coughing and chest pain.

According to the Polish Journal of Radiology, tuberculosis can affect just the xiphoid process and cause pain and swelling in the lower part of the sternum.12

How Doctors Diagnose Xiphoid Process Pain

As mentioned in this article, it can be difficult for doctors to diagnose xiphoid process pain. One reason is that there is a risk that any chest pain is cardiac-related and any heart problems need to be ruled out before looking for other causes.

Usually, doctors will apply pressure to the xiphoid process, the sternum, and rib cage area around the sternum. For example, pressing on the xiphoid process may cause sharp pain at the lower part of the sternum. However, pain may also radiate to the shoulders, arms or back.

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Many doctors also diagnose xiphoid syndrome by looking for symptoms of GERD. This may also involve examining your digestive system with an endoscopy. Depending on the length of time you have had unresolved chest pain, a doctor may order an X-ray, CT scan or MRI scan.

Is a lump in the sternum something to worry about?

A lump in the middle of your chest at the base of your breastbone is usually a protruding xiphoid process and is nothing to worry about. Sometimes, injury or irritation can cause the xiphoid process to swell and cause a visible lump in your chest.

However, any type of new lump that you notice and doesn’t go away should be examined by a qualified medical professional. The University of Rochester says that both malignant (cancerous) chest wall tumors and benign (non-cancerous) tumors in the chest wall can cause a visible lump.13

In most cases, a lump in the center of your chest is often a protruding xiphoid process, so, a visit to your doctor will help to put your mind at rest.

How to Treat Xiphoid Process Pain

There are various ways to treat xiphoid process pain naturally depending on the cause of xiphoidalgia.

Hot and cold treatments for xiphoid process pain

If an injury has caused xiphoid process pain, then use cold and heat treatments to relieve pain. You can apply a cold pack (immediately after the initial injury) or a warm compress (for recurring pain) to relieve the pain.

According to doctors from the Mayo Clinic, cold helps to numb the nerve endings and prevent swelling of the traumatized area. After that, warmth helps to increase blood circulation and speed up healing of the xiphoid process, sternum, and ribs.14

Dr. Jesse Borke on MedlinePlus says that ice packs should be used for the first few days after injury.15 After that, you can switch to a heat pack.

How to use:

To get rid of pain from a damaged, fractured, or injured xiphoid process using a cold pack, this is what you should do:

  1. Place crushed ice in a sealable plastic bag or a bag of frozen peas and wrap in a thin towel.
  2. Apply the ice pack to your xiphoid process for 20 minutes every hour in the first 2 days after the trauma.
  3. On the third day, apply the cold compress for 10 to 20 minutes 3 times a day to your sternum to reduce pain and any swelling.

If you still have some pain after 3 days, you should switch to a heat pack. This is what you should do for xiphoid process pain relief:

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  1. Fill a hot water bottle with hot (not boiling) water and wrap in a towel.
  2. Hold to the middle of your chest for 15-20 minutes to help increase blood circulation, reduce pain, and speed up healing.
  3. Apply 2-3 times a day until any pain from your xiphoid process has gone.

Baking soda for GERD symptoms

If a digestive issue like gastroesophageal reflux syndrome is to blame for xiphoid pain, then baking soda can be used as a temporary solution. GERD is a chronic digestive condition that usually requires supervision by a doctor.

According to PubMed Health, baking soda (sodium bicarbonate) neutralizes excess stomach acid and can help to relieve heartburn and acid indigestion.16

How to use:

To quickly get rid of the pain that too much acid in the esophagus causes, including xiphoid process pain, this is what you should do:

  1. Mix 1/2 teaspoon baking soda in an 8-oz. glass of water.
  2. Drink before every meal to help relieve chest pain that too much stomach acid can cause.
  3. Continue using for up to 2 weeks to get relief from heartburn and gas pain in chest.

Ginger to relieve xiphoid process pain

Another way to help relieve xiphoid process pain is to increase the amount of ginger in your diet. Ginger is a natural anti-inflammatory herb that helps to relieve painful symptoms of arthritis and joint pain. It may also help to provide relief from chest pain due to xiphoid syndrome.

The International Journal of Preventative Medicine reports that components in ginger help to reduce pain associated with various inflammatory diseases, including rheumatoid arthritis. Ginger can also help manage symptoms of various digestive and intestinal issues and improve gastrointestinal health in general.17

You can add fresh ginger root or dried ground ginger to help spice up your meals. Alternatively, you can take ginger supplements to help relieve pain. Another option is to mix ginger with turmeric to make an anti-inflammatory turmeric ginger tea.

Ginger has also been proven to help with weight loss and may help relieve xiphoid pain if being overweight is causing chest discomfort.

Physiotherapy to treat xiphoid process pain

Some doctors recommend physiotherapy to help relieve xiphoid process pain and prevent it from returning. Xiphoid syndrome is classed as musculoskeletal chest pain and it is known that physiotherapy can help relieve persistent aching pain, sharp pains in the chest when moving, or discomfort.

According to the journal SAGE Open Medicine, massage is an effective way to alleviate chest pain that in non-cardiac in origin. Massage techniques performed by a professional practitioner can target areas around the sternum, rib cage, and spine to help get rid of pain and prevent pain in the musculoskeletal chest wall.18

Surgical removal of the xiphoid process

Depending on the intensity, frequency, and cause of your xiphoid process pain, doctors may recommend surgical removal as a last resort.

According to doctors who treat xiphodynia, a xiphoidectomy (removal of the xiphoid process) can result in complete disappearance of the symptoms of xiphoid process pain.9

Xiphoid Process Pain – When to See a Doctor

Even though xiphoid process pain is harmless in itself and doesn’t usually cause any other complication other than discomfort, you should never ignore any kind chest pain. Mild, dull aches in your chest or severe squeezing pains can all be the first signs of an impending heart attack.

Dr. Jennifer Robinson on WebMD says that you should call your doctor if chest pains persist and home remedies don’t help to get rid of the pain. If you have any of the following symptoms, see a doctor immediately:19

  • An intense squeezing pain in your chest under your sternum.
  • Chest pain that radiates to your left arm, jaw, or back.
  • Chest pain that comes on suddenly and is sharp.
  • Nausea and dizziness along with a loss of color in the face, rapid heartbeat, and confusion.
  • Low blood pressure.

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Article Sources

  1. MedicineNet. Xiphoid process.
  2. MedicineNet. Sternum.
  3. Chiropr Osteopat. 2007; 15: 13.
  4. Am J Emerg Med. 1998 Mar;16(2):177-178.
  5. Occupational Med. 2014 Jan;64(1):64-66.
  6. J Emerg Trauma Shock. 2013 Apr-Jun; 6(2): 113–116.
  7. Clinical Methods. Dysphagia.
  8. Middle East J Dig Dis. 2010 Sep; 2(2): 78–83.
  9. Case Rep Surg. 2016; 2016: 9306262.
  10. Thorax. 1969 Nov; 24(6): 750–751.
  11. JACEP. 1977 Dec;6(12):536-42.
  12. Pol J Radiol. 2017; 82: 41–45.
  13. URMC. Chest wall tumors.
  14. MayoClinic. Self-care approaches to treating pain.
  15. MedlinePlus. Rib fracture – aftercare.
  16. PubMed. Sodium bicarbonate.
  17. Int J Prev Med. 2013 Apr; 4(Suppl 1): S36–S42.
  18. SAGE Open Med. 2015; 3: 2050312115580799.
  19. WebMD. Chest pain causes.
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