Xiphisternum Pain - Causes, Symptoms and Treatment

Pain below the breastbone can be worrying, especially when it mimics heart or stomach problems. Xiphisternum pain - also called xiphodynia - is often misunderstood, and frequently misdiagnosed. Understanding this condition can help you recognise the signs, and seek the right care. The xiphisternum, or xiphoid process, is a small extension at the bottom of your breastbone, just above the diaphragm. Several muscles and soft tissues attach here, including the diaphragm and abdominal muscles. When this area becomes inflamed, irritated, or injured, it can cause significant discomfort that radiates across the chest. Because of its location - xiphoid pain often mimics more serious conditions. Many patients undergo extensive cardiac or gastrointestinal tests before the true source is identified. The most common symptom is tenderness or pain at the lower sternum. This may feel sharp; dull; or like pressure beneath the breastbone. Pain often worsens with bending; lifting; deep breathing, or lying down. The pain may also radiate to the back; shoulders; or abdomen. Several factors can trigger xiphoid pain. Direct trauma from a fall or accident is common. Repetitive strain from heavy lifting; vigorous exercise; or poor posture may also contribute. Rapid weight changes; tight clothing; and conditions like acid reflux can aggravate the area. Some patients develop symptoms without an obvious cause. Diagnosis typically begins by ruling out serious conditions affecting the heart, lungs, or digestive system. I take a detailed history and perform a careful physical examination. If gentle pressure over the xiphoid reproduces your pain - this strongly suggests the xiphoid process is the source. Imaging such as chest X-rays or CT scans may be helpful to exclude other causes or identify structural abnormalities. Once serious conditions are ruled out, we can focus on treating the xiphoid pain directly. Most patients respond well to conservative treatment. This includes rest, avoiding activities that strain the chest, and using anti-inflammatory medication to reduce pain and swelling. Gentle stretching, posture correction, and lifestyle changes such as addressing acid reflux or adjusting exercise routines often provide significant relief over time. If conservative measures do not provide adequate relief, I may recommend a local injection around the xiphoid process. This typically combines a local anaesthetic with a steroid to reduce inflammation. Many patients experience lasting improvement - and the procedure also helps to confirm the diagnosis. In rare cases where pain persists despite other treatments surgical removal of the xiphoid process may be considered. This procedure, called a xiphoidectomy, is performed through a small incision and typically provides excellent results. The xiphoid is considered a non-essential structure, so its removal does not affect normal function. Recovery varies depending on the severity - and underlying cause. Many patients improve within weeks with conservative care alone. Those requiring injection or surgery typically return to normal activities within a few weeks. Addressing contributing factors like posture or reflux helps prevent recurrence. Xiphoid pain is often underdiagnosed because symptoms overlap with cardiac and gastrointestinal conditions. If you have been experiencing unexplained chest or upper abdominal pain, specialist assessment can help identify the true cause and guide effective treatment. Please seek urgent medical attention if you experience severe chest pain, breathlessness, or symptoms radiating to your jaw or arm. If you have persistent pain below your breastbone, please contact my team to arrange a consultation and discuss your options.