The xiphoid process is the smallest region of the sternum, or breastbone. It’s made up of cartilage at birth but develops into bone in adulthood. It’s located where the lower ribs attach to the breastbone. The tip of the xiphoid process resembles a sword.

Although the xiphoid process is small, it serves as an attachment point for organs and large muscles that make the floor of the diaphragm.

Pain caused by the xiphoid process is called xiphoidalgia. Xiphoid process pain occurs for varying reasons. Pain — which can be mild, moderate, or severe — is typically felt in the lower part of the sternum. The sternum is the bone that makes up the middle front of your ribcage.

Pain is described as pressure or tightness, and you may have other symptoms like upper abdominal pain, chest pain, and back pain. Some people also notice a lump or swelling in this area.

Xiphoid process pain has several possible explanations. Pain can occur after an accident that causes chest trauma. This damages the structure of the xiphoid process, causing it to bend or break off. Damage can also occur from incorrect cardiopulmonary resuscitation (CPR) or resuscitation with too much force. A broken xiphoid process increases inflammation, which leads to pain and tenderness in the chest.

You may also experience xiphoid process pain with acid reflux. This is when stomach acid backs up into the esophagus. 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.

Other factors that contribute to xiphoid process pain include:

  • heart disease
  • overeating
  • lifting weights

Xiphoid process pain caused by minor trauma may resolve itself. See a doctor if pain doesn’t improve after a couple of weeks or gets worse. A doctor may be able to diagnose problems with your xiphoid process based on your symptoms and the presence of a lump near your breastbone. Your doctor may ask about recent traumas and other symptoms you’re having, such as chest pain and coughing.

A lump near your xiphoid process can be mistaken for a tumor or hernia. For an accurate diagnosis, your doctor may schedule an imaging test of the lower part of your breastbone. An X-ray can reveal damage to the xiphoid process. If X-ray results are inconclusive, your doctor may recommend further testing. Additional diagnostic tools include an MRI and CT scan. These tests can take pictures of the inside of your body and help identify masses, inflammation, and other abnormalities.

Treatment for xiphoid process pain depends on the underlying cause and the severity of your symptoms. If symptoms occur after a recent trauma, your doctor may prescribe a prescription anti-inflammatory to relieve pain, or recommend alternating between hot and cold therapy throughout the day. Your doctor may also suggest limiting certain activities until the injury heals.

Modifying eating habits can treat xiphoid process pain associated with acid reflux disease. Eat smaller meals five to six times a day and avoid certain trigger foods (e.g., alcohol, chocolate, peppermint, and tomatoes). Acid reflux is also controllable with over-the-counter and prescription medications that reduce stomach acid and promote healing of the esophagus.

Although the xiphoid process has a specific role in anatomy, a broken xiphoid process can cause serious problems, such as puncturing internal organs. Your doctor may recommend surgical removal for breaks or fractures. This is a last resort procedure when other therapies fail. To perform this surgery, a surgeon makes an incision along the base of the xiphoid process. Using electrosurgical dissection, the surgeon cuts and releases the exposed xiphoid process from the sternum, and then uses electrocoagulation (electric currents) to stop bleeding.

You may have bruising after surgery and tenderness until the wound heals. Recovery times vary from person to person, but you may be able to resume normal activity within a few weeks. In one study, a 53-year-old surfer was able to resume surfing 26 days after xiphoid process removal.

If you develop pain, a lump, or swelling in the xiphoid process that doesn’t resolve in a few weeks, you should speak with your doctor. They can help you uncover the underlying cause and then discuss your treatment options.