The xiphoid process is mainly the smallest and most inferior region of the sternum (breastbone). At birth, it is formed as a thin, roughly triangular region of cartilage that ossifies into a bone and fuses with the body of the sternum. The xiphoid process is widest at its superior end where it is attached to the body of the sternum by a very thin, slightly movable fibrous joint, which is known as a syndesmosis. From its syndesmosis, it tapers gradually to a point. In addition, there are two common variations in the shape of the xiphoid process, including the following:
- Bifurcation with a split into left and right branches at its inferior end.
- Perforation with a small foramen in its center.
These two variations in anatomy do not result in any sort of the change in the function of the xiphoid process and may be inherited genetically. Developmentally, the xiphoid process starts as a structure made of hyaline cartilage at birth and childhood, slowly ossifying into a bony part of the sternum. As a matter of fact, the ossification progress of the xiphoid process is extremely slow that it commonly does not end until a patient reaches the age of 40.
Xiphoid process pain (also known as xiphodynia) is a medical term used to describe an uncommon syndrome with a series of symptoms ranging from upper abdominal pain, chest pain, and sometimes throat and arm symptoms which are referred from the xiphisternal joint or the structures attached to the xiphoid process. Usually, causes and symptoms of the xiphoid process are closely related to conditions that are involved within the chest wall and the breastbone of a patient. Therefore, one of the most common causes includes trauma, heavy lifting, and falls in which you impact your chest.
Causes & Symptoms
Xiphoid process pain has many possible causes. Pain can occur after an accident that causes chest trauma. This damages the structure of the xiphoid process, causing it to bend o break off. Damage may also happen from improper cardiopulmonary resuscitation (CPR). A broken xiphoid process can increase inflammation, which then leads to pain and tenderness in the chest.
In severe cases, you may also experience xiphoid process pain with acid reflux. Acid reflux occurs when contents from your stomach move back up into your esophagus. This action is also known as acid regurgitation or gastroesophageal reflux. Therefore, acid reflux can irritate the lining of the esophagus, and since the esophagus is located behind the breastbone, xiphoid process pain can develop along with reflux symptoms.
Since the xiphoid process is a close relative of the sternum, stress fractures can be a factor that is heavily linked to this condition. Stress fractures of the sternum are breaks that aren’t due to a major injury. You may have a higher chance of a stress fracture of the sternum if you have one or a combination of the following below:
Kyphosis is a spinal condition. In people with kyphosis, the spine curves outward more than it should. As a result, the upper back looks overly rounded. The curvature can make people look hunched or slouching. People sometimes call it hunchback or round back.
Osteopenia is a loss of bone mineral density (also known as BMD) that weakens bones. It is more common in people older than the age of 50, especially women. Osteopenia has no signs or symptoms, but a painless screening test can measure bone strength. Therefore, osteopenia isn’t as severe as osteoporosis, a disease that weakens bones so much that they can break more easily.
Osteoporosis weakens bones, making them more susceptible to sudden and unexpected fractures. The disease often progresses without any symptoms or pain and is not found until bones fracture. Most of these fractures associated with osteoporosis include the hip, wrist, and spine.
The symptoms linked to xiphoid process pain tend to be varied. The main symptom is a pain in the lower section of the sternum. The pain felt is often described as dull and aching. The intensity of the pain varies, ranging from mild discomfort to severe pain. Pain is typically worsened by turning and bending.
Increased pressure over the area of the stomach region after a large meal may also worsen the pain. In addition to pain, applying pressure directly on the xiphoid process will cause the pain to radiate retrosternally or behind the sternum. The pain may also radiate towards the epigastrium. Referred pain symptoms may get in the way of proper treatment due to the misdiagnosis it cases.
Other symptoms may or may not be present with the pain over the xiphoid process. Some patients with this condition also experience the following symptoms listed below:
- Pain radiating to the neck, shoulders, chest wall, arms, and back
- Pain in the stomach region
Who gets Xiphoid Process Pain?
The following risk factors can increase your risk of fracturing your sternum:
- Sports participation – Playing certain contact sports, such as hockey, football, or baseball, increases your risk of chest trauma.
- Age – Older adults ages 50 and up are susceptible to fracturing their xiphoid process due to general wear and tear.
- Osteoporosis – Living with osteoporosis in which your bones lose their density makes you more susceptible to a fracture in your sternum.
How Does it Affect You? How Serious is it?
By itself, the injury to the xiphoid process generally does not cause any further damage to the internal organs. This only depends on the extent of injury sustained. Severe injury to the xiphoid process may lead to several complications. In xiphoidalgia, nausea and vomiting are among the leading complications. An injured xiphoid process can be a source of irritation to the adjacent structures and organs. One, in particular, is the stomach, which is located just beneath the xiphoid.
This irritation can lead to nausea and vomiting, and if these symptoms persist, they can lead to more serious problems. They can lead to an imbalance in electrolytes, malnutrition, and dehydration. A fractured xiphoid process may also cause damage to the nearby liver. The upper border of the liver lies directly below the xiphoid. A large enough fracture can cause sections of the xiphoid to puncture the liver. This can then lead to bleeding and a life-threatening situation.
Pain in the xiphoid process can also affect general well-being. It can cause irritability and even alter your mood. In addition, a patient in pain is less able to focus. Pain may even interfere with your regular daily activities, and that could lead to emotional and mental changes.
In some cases, surgical interventions are required if your xiphoid process has been fractured. The xiphoid process can be removed using an electrosurgical dissection of the lower sternum. The procedure is considered safe, with a low risk of complications. The area may feel tender for several weeks post-surgery until the wound has been healed.
Recommended Treatment & Rehabilitation
Xiphoid process pain is mainly diagnosed by reproducing the symptoms. That generally means making the symptoms appear either partially or completely. In order to make this happen, moderate pressure is applied to the xiphoid process and nearby structures by your doctor. The real problem lies in the recognition that the pain felt over the affected area is from a problem involving the xiphoid process, not from the chest or abdominal problems.
The first thing your doctor does is to rule out any thoracic or abdominal problems. These conditions can quickly make a turn for the worse. Early diagnosis and treatment are key to successful management and reduction of complications with the help of physiotherapy.
After a diagnosis has been successfully processed, radiologic studies will be carried out. Imaging techniques such as X-rays and ultrasound will be utilized to help show images of the xiphoid process, revealing if there are indeed injuries causing the pain. There are other imaging procedures such as computed tomography (CT) scans and magnetic resonance imaging (MRI) to discover the problem if an X-ray fails to locate it.
Additional treatments can be done at home by following certain steps given by a physiotherapist. These treatments include:
Rest from your physical activities. Additionally, limit the use of your chest and shoulder muscles. No pulling, pushing, lifting, or activity requiring heavy breathing. To initiate the pain relief, hold crushed ice in a plastic bag against the breastbone without adding pressure to the xiphoid process pain. Hold the ice, cycling 20-30 minutes on and off, for the first 24-72 hours.
Range of motion
To help combat xiphoid process pain and re-instate proper respiratory function, practice slow and controlled breathing. This will expand the chest, stretch the tissue surrounding the sternum, and re-establish the range of motion. Complete 8-10 slow, deep breaths. To stretch the muscles of the chest, begin a comfortable standing position with your arms by your sides. Raise both arms in front of you, at 90 degrees. Move one arm at a time out to the side and as far back as you can without pain. Hold for 30 seconds, then complete 3-5 repetitions for each arm.
Even though rest is necessary initially for the chest muscles, they need to be strengthened later in the rehabilitation process. Begin by standing facing a wall. Then, plant your hands on the wall, directly in front of your shoulders, and perform small push-up movements against the wall. Progress doing push-ups on the floor, but from your knees. Progress further to a regular push-up from your feet. Repeat this training 10-12 repetitions for 3 sets a day.
Other exercises can help you boost your recovery from your xiphoid process pain after recovery has been done. Some exercise examples are targeted directly to your chest, such as:
Wrap the band around your feet, then hold the band with your thumbs facing upwards. Next, keep your arms at your side with your shoulders down and relaxed. Pull your elbows back squeezing the shoulder blades together toward the back. Perform this stretch 10 times a day with 25 repetitions.
Foam rollers are light foam tubes that can be used to improve flexibility as well as for self-massage. They can be used to roll out thighs muscles, which relieves tension and speeds up muscle recovery.
Doorway pectoral stretch
To perform this stretch, stand facing an open doorway. Then, raise your arm with your elbow bent 90 degrees. Rest your forearm against the wall with your elbows at shoulder height. Lastly, lean forward to gently stretch your chest muscles. Perform this stretch 2-3 times a day.
Alternative & Homeopathic Treatment
While your xiphoid process is healing, there’s a lot you can do to help prevent a chest infection and ease your pain. Most homeopathic treatments include:
- Rest – Avoidance of activity or activities that increase pain may boost your chest recovery. Deep breathing or coughing may exacerbate the pain but need to continue to avoid developing lung issues.
- Ice – Apply an ice pack to your injured area immediately and regularly for several days to reduce pain and local inflammation.
- Compression – A contentious issue in the early treatment of a xiphoid process pain due to concerns that wrapping the chest in a bandage, corset, or rib strap may exacerbate breathing issues. There is still a role for rib strapping following chest pain but only with specialist supervision.
- Pain medications – Taking non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce further swelling and inflammation.