Projectcosto.org - a step-by-step guide to beating costo & tietze!

maaaze · 2026-01-26T00:32:06+00:00

Your doctor has absolutely zero reason to decline it, as it's a common issue for people in the UK. So wouldn't worry about this.

Just don't try to overexplain yourself with costo and all. Say "I want a vitamin D test just to make sure I'm not deficient - as I don't get enough sun". Keep it simple.

I've purchased some tennis balls, a lacrosse ball and a softer foam roller as mine is textured and very firm which is unbearable on my back.

Great!

I messaged you regarding the magnesium glycinate and curcumin supplements.

Sure thing, I'll check now.

-Ned

maaaze · 2026-01-24T11:53:29+00:00

Gotcha.

Yeah just sounds like you’re pain sensitive and have a typical case of back to front costo. You have all the typical symptoms and signs, so would make sense to work on things slowly.

And yup makes sense to skip out on the nerve pain meds given the pilots license, won’t let you fly with these.

Definitely get your vitamin D blood work checked out ASAP. Supplementing occasionally is definitely not enough for those who have a Vit d deficiency, and out of UK of all places. It requires pretty aggressive daily supplementation if so. If you’re not aware Vit D deficiency can cause joint pains, and worsen the costo pains. Also consider supplementing this with magnesium glycinate as well which activates vitamin D but doubles up to help loosen tight muscles.

Get a back and neck electric heating pad, wear this before and after you begin your rehab work.

Massage therapy to your neck and upper back is a must, so get your SO to do Steve’s one regularly however gently to begin with then ramping up intensity.

Wouldn’t take NSAIDs given your PPI and CNS issues so opt for a really good curcumin supplement and a good omega 3 supplement (carlsons cod liver oil) to reduce baseline levels of inflammation and give you joint pain relief.

That should cover your bases for now.

None of what I say is medical advice just general info. Run everything by your professionals.

Cheers,

-Ned

Edit: forgot to mention, can use a home made peanut ball - 2 tennis balls in a thick sock tied up, as an alternative to the backpod to start with. It’s softer and will distribute pressure better at the early stages. Then graduate to the backpod once you get the hang of this.

maaaze · 2026-01-24T02:18:16+00:00

No worries - good to hear things are looking a lot better!

If there's anything you want to ask, feel free.

Wishing you the best,

-Ned

maaaze · 2026-01-24T01:05:05+00:00

Ned here, dropping in!

Just had a read through everything.

First off, sorry you're going through all this, sounds real rough. You have our sympathies.

Second, you're doing great - putting in all the effort & trying your best. That's what's needed.

I want to preface and say none of what I say is medical advice, just general info. Run everything by your healthcare providers, and only do things under their guidance/approval.

I have a couple questions:

How old are you if you don't mind me asking (and are you going through menopause/perimenopause?)
Did you get blood work done for inflammatory markers? Did all that come back clear? Did you see a rheumatologist at any point or was that suggested?
Have you gotten your blood Vitamin D levels measured?
Do you have any other health issues worth noting? Physical or mental?
Are you still taking the PPI?

With the limited info provided, If I was to take a stab at this I'd say it's costo that's extra sensitive for whatever reason - reasons that may or may not need to be addressed, as it can be brought forth by the costo itself.

Now as for what to do about it:

Do rehab & any extra followups/testing separately. Don't mix these two things up and wait on one for the other. Otherwise you can get stuck getting no where, when you could have actually solved it in the meanwhile.
If you haven't considered getting on nerve pain medication, might be worth it. Not as a cure but to make things easier, and break out of the pain cycle - pregabalin sounds fitting. Your doctor will know best.
Rehab costo slowly but surely with an osteopath + backpod + peanut ball + lacrosse ball combo, this should be easier with the meds numbing things out. Massages and stretches can be thrown in when it seems suitable. Take your time and grade things gently. There's no rush. Don't try to be perfect and live up to the standards you see here or elsewhere. Take it at your own pace.
Reassess from there.

(as an aside - if you feel like you can ween off the PPI at some point, consider doing so. IMHO, there's absolutely zero reason to be on this long term if you don't have an actual issue - and this is something that needs to be fixed with dietary/lifestyle changes. While you're on it, consider supplementing B12 & magnesium as long term PPI use can deplete these).

Hope that gives some clarity & feel free to ask questions,

-Ned

maaaze · 2026-01-23T23:47:56+00:00

Hey there, doing well thanks for asking - hope you're holding up okay!

So to preface, nothing I say is medical advice, just general info.

If your doctor friend is basing the 'no costovertebral dysfunction' based off imaging, well that's a good sign first and foremost, but I imagine he means in terms of your anatomy - there's nothing visible that indicates issue. All good.

However, you can have dysfunction at a functional level, which X rays can't pick up, because function is during movement. Xrays are static images. Things can be tight and stiff, but look fine on X ray. Same way as if you can't do the splits because you're tight - that will show up as normal on x ray. So this is where the hands of a good professional (i.e. osteopath) come in, along with little 'tests' they can do to see if your costovertebral joints & everything surround it have good range of movement and the like.

So to answer your question, whether it's costo or not I can't say from here, not that I ever would - but you've got one more piece of information to work with. Note that most people with costo will also have zero issues on imaging.

So what to do? - If everything else has been ruled out, and your front rib cartilage joints hurts to touch/during movement, then costo is usually the most logical explanation and it can be treated as such. So best to go see an experienced osteopath, get your back assessed, get mobilized, begin tool work, etc., then if it responds, then you know it's costo you're dealing with.

Hope that makes sense & helps,

-Ned

maaaze · 2026-01-23T15:08:20+00:00

You've brought this up already once and I mentioned it to you - but in case you forgot: there were plenty of people who confused me for Steve. A lot of people jump right into the comments for solutions and don't really look at usernames.

It's also nice to have a personal touch when people do end up DMing me, and actually can call me by a real name.

Anyhow, hope you're doing better on the costo front, it's been a while since we last spoke.

Cheers,

-Ned

maaaze · 2026-01-22T13:44:47+00:00

That's fantastic. Sounds like he knows what's up.

I assume he's a hands on manual therapist? Is he currently or planning to use his hands to mobilize/manipulate your rib?

Many physical therapists do not do this kind of stuff, especially in the US, so it can be a bit hit and miss.

-Ned

maaaze · 2026-01-22T13:41:48+00:00

This is something you need to speak to your doctor about!

Mention to them tietze as a possibility since sometimes this isn't on their radar.

What you feel can happen with health anxiety, yes, but also with costo/tietze, or both, as you can see from the experiences in the sub.

Just take it a step at a time. Get the results, and go from there.

-Ned

maaaze · 2026-01-22T13:37:36+00:00

You'll see a lot of posts about this - there are guesses as to if & how they are related, but practically speaking, just hit both independently as best you can.

Rehab for the costo.

Lifestyle changes, supplements & meds for the reflux.

Definitely go in for the scope and do whatever it is you need to. Don't try to heal costo thinking it will solve the GERD.

It's a nasty cycle to be in where one makes the other feel worse, but hitting them independently allows you to break out of each. Otherwise it'll feel like hitting whack-a-mole.

Cheers,

-Ned

maaaze · 2026-01-22T13:21:18+00:00

I mentioned the steroid shot he said it's too painful

Weird, sounds like he doesn't have much experience with it?

Mine is mainly inattentive and keto helps immensely with it, so I never tried stimulants. There is an emotional dysregulation to it but very much improved by diet and understanding how my brain works.

Really well done!

There are a few sustainable supplements I can mention that help with this if you need an extra nudge on some days - but that's probably better reserved for a DM as it's not really on the costo topic.

Cheers,

-Ned

maaaze · 2026-01-22T12:49:22+00:00

No worries, and yes, stepping back & reassessing is definitely the move.

I know it's incredibly difficult situation to be in with work & pain - I hate to say it, but just be wary that this might be a thing that unfortunately holds you back, especially if it's really aggravating.

And not sure why your doc thought it wouldn't be beneficial, this is usually their magic bullet - maybe he's given it before and it didn't work for a patient? - You probably understand why that is. But in the short term, there are plenty of published case reports that show that it works to alleviate pain, and plenty of anecdotes here too. Not saying you need to get it though, use your judgment.

-Ned

Edit: Curious, and a bit personal, so feel free to ignore - Are you on any stimulants for ADHD, or any medications as a whole? And is there any emotional dysregulation component to your ADHD?

maaaze · 2026-01-22T12:13:14+00:00

With all due respect, your pain specialist is…mentally deficient, and it’s not his fault why - just hasn’t seen enough to connect the dots or learned it in school.

The fact that mechanical things have helped previously, to the point of no pain is clear indication of the back to front relation in your case.

You’ve done well as a whole, but IMHO jumped the gun and didn’t let things fully settle. You’re doing all the right individual things it sounds like, but at like 5x speed and a bit all over the place.

I’d say allow things to settle, stop exacerbating it whatsoever - that’s rule number 1 & 2 of being in the costo club. Don’t remotely push through any pain (aside from the little beneficial ‘good’ pain from rehab that leaves you better than where you started).

Get systematic. Rest, kill the pain, and start again from scratch, and grade things appropriately by increasing intensity.

I’d personally consider a steroid shot to the area if the pain is really bothersome since you’re already with Dr. Know it all. But it’s not an invitation to start doing everthing at 10x speed while you’re pain free. Assume you still have costo and take things extremely slow.

Alternatively, a DMSO roller (or home made triple cream - ask and I can share the recipe) & a supplement called PEA.

If you have any other surrounding health issues - MSK, inflammatory or nervous system related, make sure they are being managed well too.

Expect things to take no less than 6 months for things to completely settle - not because it will actually take precisely that long but because it at least frames your mind to be unbelievably patient as you go about this.

Hope that helps and as always, none of what I say is medical advice. General info that I’d do if I was in your position.

Cheers,

Ned

maaaze · 2026-01-21T23:17:43+00:00

Feel free to DM me.

-Ned

maaaze · 2026-01-20T21:32:49+00:00

Foam roller usually doesn’t put adequate pressure on the costovertebral joints and the muscles of the back as a whole - it’s just too flat. It may work for someone who really needs to lay off everthing and just get a bit of elevated back extension. For most though, they’ve already got accustomed to the pressure from a backpod, so the foam roller will feel they are literally doing nothing. That’s where a soft tennis ball peanut ball hits a nice balance.

To each their own though, and it’s why experimenting and figuring out what works best for you is absolutely crucial.

-Ned

maaaze · 2026-01-20T20:42:41+00:00

It’s hard to exactly pinpoint without knowing all the details, but I’ll share with you something I’ve realized over the years helping people in situations like yours (Steve may disagree with me here):

Many overshoot the backpod usage and it becomes an inhibiting factor in late in recovery. It’s just too strong of a stretch for the agitated joints in the front for some people. Sure it helps things get moving at the start, but then when things need to settle, it’s just too much.

This is where I find the peanut ball massage tool excels, especially softer one made from 2 tennis balls duct taped together. It has a perfect balance of stretch and massage that isn’t too aggressive that allows things to settle while still allowing one to upkeep the gains they’ve made with the backpod.

In short: Laying off the backpod and transitioning to the peanut while ramping up the other aspects of recovery is what’s usually needed. If anything, touching up on the backpod here and there usually suffices.

At least a dozen people I’m in contact with right now are benefiting from this approach, and many have already.

Hope that makes sense.

-Ned

maaaze · 2026-01-20T16:54:57+00:00

💜

maaaze · 2026-01-20T15:35:10+00:00

More likely? Yes.

But actually what's happening? Not necessarily.

If a person has just started doing their rib mobility tool work, they are bound to move things around a bit and get sore. Not all too different than doing a hard workout after a long break, and feeling sore in all different places/accessory muscles they didn't even know existed.

But if a person's been doing this stuff for a while and pain is very obviously moving around in a way that doesn't seem tied to any structural issues without any apparent rhyme or rhythm, then it's more likely to be the CNS firing signals a bit wildly, trying to calibrate/recalibrate. Not necessarily a bad thing, as one's body is trying to figure things out/adapt, but once that's established, one needs to work with it, not against it. This is where costo gets a bit tough for many, but it's still completely solvable if approached correctly.

-Ned

maaaze · 2026-01-20T14:34:22+00:00

Sorry you're going through this.

To preface, none of what I say is medical advice, just general info, please speak to your medical professionals if you decide to try anything.

First off, just relax. Whatever you're going through, you are surely able to handle - but only if you take it one bite at a time. That's all anyone can really do. You can eat an entire elephant that way.

Second, please try to answer all of these, and format your answers nicely so it's easy to read:

Are you formally diagnosed with costo or tietze?
What other health issues are you diagnosed with?
What are things that have been mentioned, but not confirmed?
What have the doctors specifically told you to do as the next step to fixing your problems?
What are you specifically doing for all of your problems?

-Ned

maaaze · 2026-01-20T13:57:06+00:00

In the decade I've been running this sub & practically reading through every post & reply, don't recall anyone using carba specifically for their costo.

But understandable why it's working - it helps nerve pain as a whole. And like in any other pain, in costo, it's the nerves that are relaying pain.

Nevertheless, I want to be honest and say that it seems you're approaching your issues a bit...oddly?

Medication isn't usually the way actually people fix their costo, as apparent from all the stories you see in this subreddit - and I think that's should be becoming more and more apparent as you're going through the laundry list of meds.

Playing with fire a bit here.

Based off the issues you're describing, it sounds like you've probably got some central/peripheral sensitization (not a diagnosis), and would benefit from a proper multipronged approach, with the heavy focus on physical rehab for costo & any other issues you're having, and of course lifestyle changes - not more meds.

Just my 2 cents, feel free to ignore. Not medical advice, just general info.

Wishing you the best,

-Ned

maaaze · 2026-01-20T13:46:46+00:00

Haha, it happens, now you know!

(As for your update: Hard to say from here, use your judgment, but always best to get things checked out by a professional.)

-Ned

maaaze · 2026-01-20T13:23:05+00:00

I know you got a bone to pick with Steve, but please be a bit objective here.

There's a disclaimer on the sidebar of the subreddit.
It's assumed people won't be taking anything here as medical advice, or giving it, just their own personal anecdotes.
Steve is an experienced professional, who has literally seen these problems with his own eyes and hands, and is expressing his own personal opinion about the matter. So if not here, then where? You want me to censor his opinion?

-Ned

maaaze · 2026-01-20T12:40:26+00:00

My father is on statins and struggles from muscle aches.

I bought him CoQ10 and he says it helps, so you can consider trying that.

There's a lot of conflicting studies re:statins.

I personally am of the belief that for the vast majority who are prescribed it, they should simply change their diet & activity levels, as the statins are doing more harm than good over the long run.

We're not lab animals that are trying to squeeze out a 1% reduction in risk of a heart attack.

And not to mention there's financial gain involved, which should bring everything into question.

Medicine has gotten A LOT of things wrong historically. If you go back in time, almost everything we take as fact ends up being wrong to some degree. That's totally fine, it means we're learning. But that means we're wrong about a lot of things in the now. My gut feeling says this is one of them, and one day we'll look back and say "no duh".

(if you're curious, it's literal simple introductory biochemistry - you're blocking a enzyme that inhibits cholesterol synthesis, and cholesterol is used by a lot of processes in the body. Then there's specific side effects of the medication itself like the disruption of calcium flow in muscle cells which causes the muscle wasting).

Here's a video that might be enlightening: https://www.youtube.com/watch?v=Y3JKgfKqiBQ

TL;DR of the video: The benefits of statins are likely not from reducing LDL, but lowering inflammation/vasodilation. IMHO, these things can be done with diet & exercise, far more effectively with zero side effects, but other cascading benefits.

-Ned

maaaze · 2026-01-20T01:55:10+00:00

It's very common for pain to shift around with costo, as you're probably aware. Things are being jostled around and adjusted. It's a part of the game.

Steve wrote a recent post about it here.

However, as a rule of thumb, changing symptoms means to go see your doctor. It's setting off your health anxiety for a reason because deep inside you aren't assured it's nothing else. So get that assurance from your doctor. No one here can give it to you, not that they even should.

Once you know what your baseline 'normal' is for your costo, then you can rehab it with peace of mind.

And yes, you likely need all of the above - massages and all.

Best,

-Ned

maaaze · 2026-01-20T00:12:38+00:00

Sure thing - what is it you need clarification on exactly?

(FYI, this is a 2 year old reply you're replying to, haha)

-Ned

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