Rib Pain

Does it hurt to take a breath? Did you recently experience a fall, have some type of serious sporting event, or just all of a sudden, you have this pinpoint pain in your rib or in the middle of the back area that makes it hard to take a deep breath? If so you could have a rib issue. And the craziest thing? Sometimes when you have a rib issue it can cause radiating pain down the arm/s, or can even manifest as viscogenic in origin (meaning the pain makes it look like it is coming from your organs). One study found that in a group of 76 individuals with rib pain, 8 had been treated with a non-curative cholecystectomy (1). Yikes! Bottom line, rib pain can often go undiagnosed and can be a real drag when it makes it hurt to take a deep breath.

Thankfully rib pain can often be pretty easy to treat as long as you understand breath mechanics. When you inhale deeply, the following should happen:

  • The lower ribs should flare outwards, like a bucket handle swinging

  • The abdomen should expand outwards

  • The upper ribs should also expand outwards, like a pump handle moving up and down

  • The clavicle (collar bone) should elevate just a little bit

And when you exhale it goes in the reverse direction. For a more in depth explanation visit the link below! Put your hands on your ribs and tummy and feel for yourself the ebb and flow of the breath. This process is reliant upon the ribs -which are seated in the spine in the front along the sternum and in the back along the bones of the spine itself- to be able to move freely in their joint spaces. When something is off with the ribs -if you’ve ever had a rib “out of place” you know intimately what that means- these mechanics can’t follow their normal process making it hard to take those nice deep inhales and exhales. 

This is where PT comes in. First off we determine that the rib pain is actually rib pain by conducting a thorough musculoskeletal examination, neuro screen and asking key questions in our subjective exam. Once we make sure you are good to go, we move into treatment. Treatment of the ribs involves:

  • Manual therapy involving cupping, myofascial release, often focusing along lines of fascial restrictions, or “anatomy trains” (2) which may start all the way down in your knee believe it or not!

  • Joint mobilization/manipulation of the ribs and thoracic spine

  • Neuromuscular re-education focusing on re-establishing normalized breath mechanics; sometimes it can be hard to remember to breathe when you’ve been hurting/stressed for a while!

  • Progressions into yoga asana sequences to encourage continued breath-work practice as indicated

For most cases of rib-pain we should notice changes pretty quickly, within four sessions. It may not be ALL gone mind you, but we should notice improvements. So, if you’ve been struggling with rib pain, ribs “out of place” or pain taking a deep breath, don’t wait, reach out and schedule an appointment with us. So you can, finally, take a deep breath, and know it is going to be okay.

  1. Scott EM, Scott BB. Painful rib syndrome--a review of 76 cases.. Gut 1993;34:1006-1008.

  2. https://www.anatomytrains.com

https://teachmephysiology.com/respiratory-system/ventilation/mechanics-of-breathing/