How does physical therapy help with rib cage pain?

A previous patient returns for neck pain, and on examination, we found a very tender spot on the left 8th rib. He mentioned the rib pain increases with deep breath and laying on his side or stomach. He has been to the doctors and got pain medication which only helped temporarily when it's really bad.

So what causes rib pain?

• Broken or bruised rib
• Strained intercostal muscle between the ribs
• A rotation of a thoracic vertebrae (upper back) causing a shift of the rib either forward or backward
• Anger and resentment built up manifesting in physical body according to Chinese Medicine theory

Where do you feel rib pain?

Rib pain can be felt in the form of:

• Upper back pain
• Chest pain
• Neck pain with inability to turn head to one side
• Side pain

A basic anatomy lesson

Your thoracic cage is made up of 12 pairs of ribs, your sternum or chest bone, and 12 thoracic vertebrae. The thoracic cage acts as armour for your most vital structures – your heart, lungs, and largest blood vessel, the aorta. In the front of your body, ribs 1 through 7 are attached to your sternum and ribs 8 through 10 are attached to cartilage at the bottom of the sternum. They all wrap around your body to attach to your thoracic vertebrae 1 through 10. Ribs 11 and 12 are known as floating ribs as they only attach to thoracic vertebrae 11 and 12 and have no attachment in front.

Respiration is initiated through your diaphragm, which is situated between your thoracic cage and your abdomen. During respiration, your lungs and rib cage expand, the ribs separate via the intercostal muscles, and then come back to resting position when you exhale.

What can you do to relieve rib pain?

Medically speaking, there is nothing you can do (besides take pain medication). Physical Therapy, on the other hand, can be extremely helpful. Here are a few methods we use to treat rib pain:

Fractured or bruised ribs

For fractured or bruised ribs, there is gentle manual therapy and kinesiotape.  

Strained intercostal muscle or side pain

A strained intercostal muscle will not allow the ribs to separate like they need to during respiration, which causes pain. Treatment requires a more deep tissue form of manual therapy, which can be uncomfortable, and dry needling to reset/reactivate the muscle. (highly professional trained skill due to the risk of puncture lung when dry needle intercostal muscles.)

Upper back or chest pain

These usually go hand-in-hand, requiring hands on techniques to the involved thoracic vertebrae and rib.

Neck pain with inability to turn to one side

This is usually caused by an elevated 1st rib, and rotation of the 1st thoracic vertebra. This usually requires manual treatment and stretching exercise to settle. For reference, your back 1st rib is just below your neck and the front 1st rib is just underneath your collarbone (clavicle).

Gentle movement exercises

Gentle movement exercises allay fear of movement and begin improving movement of the thoracic cage.

Breathing exercises

Breathing exercises are used to mobilize the thoracic cage which can be done lying on your back with your knees bent and in sitting. Here are a couple of methods:

• Diaphragm Breathing. Diaphragm breathing is done by placing your hand on your upper abdomen (diaphragm), and breathing into that hand as deeply as you can tolerate, exhale slowly
• Bucket handle breathing:. To practice bucket handle breathing, place your hands on your sides/lower rib cage, breathe into your hands expanding your rib cage out, and exhale slowly.

Like any soft or bony tissue injury in the body, it takes at least 4 to 6 or more weeks to heal, so the above treatments will not get rid of your pain 100%, but speed up the recovery, and it will allow you to move, breathe, sleep and function better with less pain and return you to the activities you love to do sooner.

Now that you can see a PT without a prescription, don’t suffer with rib pain! Come in as soon as you can for relief.