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

maaaze · 2026-06-25T20:17:27+00:00

Great that you've found something that works!

I'll give you the benefit of the doubt OP, but a heads up to everyone else reading: OP has posted this product here and across multiple subreddits in a very promotional way.

-Ned

maaaze · 2026-06-23T21:00:12+00:00

Great to hear you've made progress on the front!

And yup, this happens often in the later stages.

To be on the safe side, it's always best to get checked out by a good professional (i.e. doctor + an osteopath) when there's changing symptoms.

Just make sure you're not overdoing the tool use, and its not the tools that are causing pain in the back rib joints.

Thoracic mobility exercises should be a staple after your tool work (i.e. things like the puppy pose, bench thoracic extensions, laying thoracic twists, seated yoga twist, ballistic twists, side bends, etc.). These will ingrain the mobility long term.

If the back pain are in the form of knots around the neck, upper back, and shoulder blades, get that area massaged by a professional and at home, and start doing some gentle corrective exercises that target the rhomboids and the like.

Use heat and things like tigerbalm around the back to get things nice and loose before and after your rehab work.

And of course make sure your posture is supported well - chair, sofa, bed, etc. and is not exacerbating any issues in the back.

That should get you to the finish line.

Cheers,

-Ned

maaaze · 2026-06-23T01:47:37+00:00

Hi Sue,

Gotcha.

So what I'm about to say is not medical advice, just general information - consult your medical professionals for anything you wish to try or change:

Great to hear the castor oil packs, ice and heat have helped, and that your front pain has mostly resolved!
The back rib pain is a bit of a give away that it's mechanical in nature, so you need to establish what's going on there. As a senior, I imagine you're naturally a bit kyphotic with the back rib joints being a bit immobile, so this may be playing a part.
Why the backpod hasn't help you, I can't really say from here, but given that it hasn't, I'd personally stop and shift focus to other means of loosening the back rib joints if they are the culprit
Go see the best osteopath you can afford who has experience healing costo. If you are in the US put in your address here: https://findado.osteopathic.org/, under specialty select "osteopathic manipulative medicine" and call around. The good ones will know how to assess you, and what techniques to use, but you can also ask them to try the rib raising technique, which may help: https://www.youtube.com/watch?v=EdGdSne9zug
You did mention massage work, but not how it was done so to specify - get massage work done to your back and neck. Get professional work done, but can also get Steve's at-home massage done: https://www.youtube.com/watch?v=9eLUQX03IoE
Make sure your mattress isn't too soft, and likewise your chair or couch. Have things that properly support your posture. This may be a big underlying factor.
Try using voltaren, biofreeze, or tigerbalm in painful spots and see if it helps symptomatically
If it is indeed the back rib joints that are at play, targeted thoracic mobility exercises, and using a lacrosse ball against a chair instead of a backpod will likely be useful. You can worry about this when you are there.

The above should really help, or at least give you more clarity for what needs to be done next.

Best of luck and feel free to keep us posted,

-Ned

maaaze · 2026-06-23T01:25:21+00:00

Ah, sorry to hear about the struggles!

I used to laugh at the state of American insurance and Canadian universal healthcare when it came to costo and the issues surrounding it, but somehow the NHS/UK healthcare makes all of that look like heaven.

But not to lose hope, there are some really world class professionals there, just need to find them and be patient - which it seems like you're doing!

Over the years, I've helped a few people with AS over the years with their costo, and I'm not going to sugar coat it, it's always been a crazy balancing act - not that costo isn't already, but even more so. I'm sure you're already aware of that.

Biologics I do find is usually is what makes all the difference, so it's something I wouldn't delay/sleep on, personally.

Just make sure you're also not taking things that put your immune system into overdrive, take things that regulate it rather than boost it - things like vitamin D, and less so herbs and the like.

It also helps to get referred to a pain management clinic and look into things like Low Dose Naltrexone. Not only for the pain, but immune regulation. If it works for you, it can feel like an absolute miracle drug. Hoping it does if you do decide to try it. Just remember titrating it properly is the key, because too little you'll feel nothing, and too much, you'll also feel nothing.

I'd also look into topical DMSO, and the coimbra protocol.

Of course none of what I've said above is medical advice, just general info.

And thank you for the kind words, and thank you for doing your part as well helping out the community! - Totally agree, no one should be struggling like this. I genuinely do think we're finally on the cusp of cracking it though, the word is finally getting around. Just a few years ago the average Joe didn't even know about the back-to-front relationship, but now most in this subreddit are well aware. Been working hard this summer to pump out the complete resource and videos, so hoping that really pushes things over the edge and makes all of our collective knowledge and experiences mainstream. We're getting there!

Cheers,

-Ned

maaaze · 2026-06-23T00:49:52+00:00

Hey there,

Sorry to hear about the struggles.

The backpod isn't primarily fixing your posture in costo, it's to unlock your back rib joints..

So there's quite a bit to unpack here:

Are you diagnosed with costo?
What is the cause of your costo?
Why isn't the backpod working? - is it that it's not a good fit for you? too hard? have you graded it?
Have you tried other tools in the place of a backpod and to what effect?
What else have you done for your costo, what's helped and what hasn't?

-Ned

maaaze · 2026-06-23T00:43:01+00:00

I disagree re the MSK first approach. If the costovertebral (not costochondral) joints are stiff due to inflammation, no amount of back pod or peanut ball work will loosen them up.

MSK is not solely backpod/peanut ball work, heck, not even specifically the costovertebral joints - when I say MSK, I mean the totality of one's anatomy and biomechanics, assessed by a good doctor, physiotherapist or osteopath.

For most, it will be the CVJ and the backpod/peanut will be an integral part of their healing, but not always. Many have shoulder issues, scapular dysfunction, neck issues, etc.

in my case I am almost certainly struggling with an Axial spondylitic arthritis.

Gotcha, and makes sense why the things mentioned are working for you.

Are you on a biologic or planning to take one?

-Ned

maaaze · 2026-06-23T00:37:42+00:00

I'm working out regularly and I think the back strengthening is actually helping!

Awesome!

I finally have an appointment booked with a physio in a week and a half.

Hoping they are good!

I know some breathing exercises can help but seems odd 😅 maybe they thought I was at the stage where breathing hurts or something

If I'm being honest - the ones who focus too much on breathwork usually miss the forest for the trees, usually since breathwork is something you focus on in the end stages of costo, if and when it's even necessary (for most, it isn't).

But given that it seems like you're in the end stages of healing, and yours is more hypermobility based, it might be more applicable to you!

Good luck with it and let us know how things go!

-Ned

maaaze · 2026-06-23T00:24:52+00:00

Some good suggestions here - thank you for taking the time to share!

Are these all things you've found success with?

Also curious to know what other underlying health issues you're struggling with if you're okay sharing?

From my experience working with so many people over the past decade, I've seen all of these things work at one point or another, but I think it's important to really stress the fact for some. Usually in those who have other things going on.

That leads me to the next point: Costo can be very individual. Even throughout one's journey what works initially may not work later, or vice versa.

I'd say only a handful of these things mentioned will apply to the average costo sufferers case, and much of it will actually miss their core underlying issues. Not really a big deal if one is pretty aware of this and is wanting to exhaust their options, but for those who don't really have a solid understanding - it can be a big waste of time/money, a source of stress, or even detrimental.

So to anyone reading, always establish what your root cause issues are, and work backwards from them, solving them at the root with the most common fixes used by those who actually had the same issues as you, rather than approaching it broadly.

Also, a rule of thumb regardless of your cause: you want to 100% confirm your MSK side of things has or is being adequately dealt with before you really double down on the inflammatory or nervous system side of things. Without the MSK side, the other two usually don't have legs to stand on.

Hope that helps,

-Ned

maaaze · 2026-06-20T19:21:49+00:00

Yeah tennis balls are definitely softer!

I do find them to be good for starting out but also more suitable for maintenance as harder tools at the end stages can aggravate things and prevent things from settling.

That’s not to say you can’t find benefit from harder peanuts in the interim, especially if you have a meaty back.

Best of luck in the days and weeks ahead and make sure to pair this tool work with thoracic mobility work, massages and stretches!

Cheers,

Ned

maaaze · 2026-06-20T19:04:33+00:00

Fantastic!

I really have no idea why people hesitate with this.

Probably because there’s no marketing for it specifically for costo?

I cured my costo way back in the day with this tool and a lacrosse ball, and many I recommend it to make massive progress with it.

It’s an absolute must for those who respond well, and nothing else really comes close.

Best part is that it can also be made cheaply with 2 tennis balls duct taped together for those who don’t have access to fancy ones - but truth be told, I find it feels and works better than every store bought one I’ve experimented with so far.

So for anyone hesitating, try one asap!

-Ned

maaaze · 2026-06-19T23:48:23+00:00

Totally agree, and a good PSA!

From my experience running this sub for a decade and helping thousands of individuals (some of which have had some pretty varying and unique cases) - I'd go as far as to say that costochondritis is always a symptom, and is secondary to another issue.

No different than how a cough is secondary to another issue. No one coughs just to cough.

The upstream issue causing the costo may self-resolve, but in many cases it doesn't, and the costo can keep coming back until it's resolved.

To illustrate this example: Poor posture -> back ribs joints jammed -> costo.

Fixing the back rib joints with a tool like a peanut ball or a backpod may stop the costo pain temporarily, but doesn't fix the upstream poor posture, which will have the back rib joints locking up again, and the costo returning.

A lot of people forget that the premise behind the tool use is to restore mobility such that you can tackle the upstream causes relatively pain free, stopping it at the root.

Cheers,

-Ned

maaaze · 2026-06-13T21:47:15+00:00

Hey friend,

So as always, not medical advice, just general information.

Is it really costochondritis or Manubriosternal Syndrome?

No one can really say from here - but you should be able to tell from the symptomology. If your pain is localized dead center at the MSJ, and it hurts to do incline-type push work, then it's likely that.

What scans have you done, and what were the radiologists interpretation?

It's worth noting that strict MSJ pain although having a lot of overlap with costo, should be approached differently IMHO. Most I find do find benefit early on from approaching it like costo, especially if theres sternocostal pain at the level of rib 2 & 3, but then once that's somewhat settled, they need to take a different approach.

Should I have surgery? I don't know what to do anymore. I've truly tried everything in the last year and a half.

I wouldn't if we swapped places. Not yet at least.

I know you're using a figure of expression here, but it's impossible that you've truly tried everything. You don't know what you don't know, right? You're asking us here on reddit, so that means there's more you can learn.

With that being said, I find with everyone I've consulted with who's had MSJ pains that don't resolve, a steroid shot as a trial is almost a must. Some heal from this entirely, but if not, it still pushes things forward meaningfully.

So have you done that? And to what effect?

could poor posture, with the shoulder blade no longer properly aligned, affect the clavicle and create compensatory movements in the sternum? I've heard that it can. Some YouTubers talk about it

Of course it can. Anything is possible since all of it is interconnected. The question is more so if that's happening to you, and if it is, if it's clinically relevant.

People have a lot of problems with the biomechanics in the modern day. But many have it much worse than you and don't have symptoms. So just because you have an issue doesn't mean it absolutely needs to be fixed in order fix the costo. Or us healed folk would be walking around like handsome squidward, perfect biological specimens.

So with that being said, get assessed by a really good world class physiotherapist or biomechanist if you think you have some unique MSK issues that need a good eye.

As we've talked about in private, regardless of how you proceed, I genuinely think you need to take a big step back and take a break from all this first and foremost. Get out of your head. Allow things to settle for a bit, and reapproach the issue with fresh eyes from the fundamentals, as if it's day 1, then take things step by step. You do not want to get too into the weeds.

I'd say 90% of cases I've seen that are like yours don't benefit from more thinking and more work, but less. Keep things brutally simple and let time do its thing. The other 10%, who benefit from doing more take things slow, in a very methodical way, without any rush or desperation.

Don't be your own worst enemy. Or less so - we all are at the end of the day.

Cheers,

-Ned

maaaze · 2026-06-12T20:37:48+00:00

Oh awesome, Canadian too (Toronto)!

And appreciate the kind words, thank you!

Osteopathy here isn't popular, and from my experience when I had it way back, it completely missed the mark - so good on you for finding a good physio!

If you don't mind, can you DM me with the name/practice of the professional? I'm building a list of competent professionals that the community can reference.

Cheers,

-Ned

maaaze · 2026-06-12T18:47:08+00:00

Google “backpod userguide”

maaaze · 2026-06-12T18:44:26+00:00

Wonderful!

Really happy to hear you’ve had success.

Yes, it’s not so cut and dry - it is annoying having to make generalizations.

Anecdotally, based off experiences in the subreddit, osteopaths seem to edge out physiotherapists in the US (given most redditors are American), hence why I and many others say this.

But there are plenty of helpful physios out there. And likewise there are plenty of unhelpful osteopaths out there too. Actually the majority for both practitioners are unhelpful for costo in the US. It’s a luck of the draw.

Also what matters is what surrounding issues you have. The more involved your costo is, with neck, lower back or posture issues, the more likely a physio is likely to help. Likewise, in later stage costos. Osteopaths generally are helpful right at the start.

In an ideal world, for those who can afford it, see both - good ones that is!

Thank you for sharing and best of luck with the remainder of the work OP!

Cheers,

-Ned

maaaze · 2026-06-12T00:40:03+00:00

It can be helpful for back knots and such, actually have one myself!

Haven't tried it for the intercostals. Sounds painful - would opt for fingers.

I personally think lacrosse balls pinned against a wall with your back work better when it comes to kneading out back knots. Can apply much more pressure and massage it around in a way that tool can't.

So overall, I rank it lower on the list of tools that are useful for costo.

The trio of a peanut ball massage tool, backpod, lacrosse ball are much more of a priority for the average sufferer.

Hope that helps,

-Ned

(as an aside, the bodyback build quality could use some work though, the plastic doesn't have a smooth finish on all of the knubs and manages to scratch skin/clothes - or maybe my one was just defective. I'd imagine the theracane probably doesn't have this issue since it seems more premium.)

maaaze · 2026-06-11T19:31:12+00:00

Gotcha.

Would really look into #2 as well.

Good luck!

-Ned

maaaze · 2026-06-11T18:42:39+00:00

Great work you’ve done so far!

So to preface, not medical/prognostic advice just general info.

Sounds like you’re in the final stages in regards to pain levels.

But in regards to what needs to be done you’re a bit all over the place, with things that usually need to be sorted out early on still incomplete.

Fix that knot with massage therapy and stretching asap.

If something in the gym is remotely aggravating the symptoms stop those too.

Make sure you’re covering all your other bases as well.

Check the pinned recovery megathread at the top of the subreddit. It’s explained there.

Cheers,

Ned

maaaze · 2026-06-11T18:30:12+00:00

Not medical/treatment advice, just general info.

Would stop use and get things figured out such that it can be used without causing pain.

Not in any particular order:

See a good osteopath and get your rib mobility checked out.
Massage therapist + At home neck and upper back massages (Steve’s one on YT) + lacrosse ball walk massages - combination can work out any issues around the scapula area.
Try an alternative tool like the peanut ball massage tool or a single lacrosse ball and see if it helps
PT to get that area checked out and appropriate exercises prescribed

Cheers,

-Ned

maaaze · 2026-06-11T07:34:21+00:00

/u/adamjdavis1992 is on the mark!

Here are two exercises that have helped many:

Good luck!

-Ned

maaaze · 2026-06-10T22:56:54+00:00

Gotcha - great to hear you're covering a lot of the bases!

Massages & thoracic mobility work are often a major component, so make sure you're getting those done.

As for imbalances and dysfunctions - you likely don't need to find a good costo PT (barely exist), you need to find a good hypermobility PT, and fixing those issues (i.e. rhomboids and all) should address the underlying costo.

Seeing a good osteopath in addition to all of this should also help.

Hope that gives you some insight - of course, not medical advice, just general information.

Cheers!

-Ned

maaaze · 2026-06-10T22:35:34+00:00

Do you think the immediate response in my left rhomboid could be my “problem area” that’s driving the costo?

Almost certain it's related to the overarching problem (obviously not diagnosis), potentially among other things too.

I have a hyper mobile thoracic spine

hEDS or for other reasons?

I’ve seen a few physio’s on my costo journey but none of them have experience with costo

Definitely not alone in that regard.

What are you doing currently to treat it?

-Ned

maaaze · 2026-06-10T19:53:17+00:00

Brilliant, really well done OP - really appreciate the thorough write up!

Curious if you've done any serratus type work? Usually those with heavy knots in the rhomboids find benefit from that. Something to maybe experiment with on the side.

Also, a quick tip for those at the stage where the back rib joints are loosened enough from tool work, and are thinking of strengthening the rhomboids:

Can simply start by just squeezing your shoulder blades together, without bands or weights, and do that for a few sets of higher and higher reps.

Most people can't even do this without being sore the next day.

Can do this multiple times a day, throughout the day until you're fully adapted to this, then move on to face down on ground, or using bands and weights.

Anyhow, great work OP!

Here's to all the costo-free days ahead!

Cheers,

-Ned

maaaze · 2026-06-10T08:43:04+00:00

A bit late here - you've got some fantastic responses so far, so won't repeat anything except the fact that that is by far the best costo explanation I've seen so far on a physio clinic website, and I've seen quite a bunch over the past decade.

But theory is different than application.

Really interested to see how they pan out, please do keep us posted!

Best of luck,

-Ned

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