A common injury we treat at our Boulder office is pain coming from the patient’s ribs. While this is a common injury, it is often misunderstood by our patients and is often a lingering source of pain without intervention.
The ‘rib joint’ or costovertebral joint is the junction between the rib head and the thoracic vertebra. It is stabilized by a capsule and ligaments.
The term "costovertebral joint dysfunction" describes abnormal motion between a rib and its vertebral connection(s). Dysfunction involving the costovertebral joint complex is common, and is a frequently overlooked source of chest and upper back pain.
The joints between the thoracic vertebrae and the ribs must move together for pain-free motion.
Activities such as breathing, reaching, rotating, etc, necessitate that the ribs rise or rotate at the joint where it interacts with the spine. In cases of joint dysfunction, the rib stops moving the way it should, leading to pain.
Why does it happen?
Costovertebral joint dysfunction may result from trauma, postural strain, or repetitive injury- especially compression or rotation.
Rib pain is most common in people who look down and work with their arms in front of them, i.e. students, a person working at the computer, and someone who drives a lot because they are in a forward rolled posture.
Athletes who participate in cycling, wrestling, rugby, football, golf, or butterfly stroke swimming may be predisposed to rib irritation due to the posture needed for sport or the forces put on your spine and ribs.
Restrictions of the upper ribs may occur after carrying heavy weight on the shoulders or a whiplash injury. Patients with biomechanical deficits, including a forward head posture, upper crossed syndrome, hyperkyphosis, scoliosis, or dysfunctional breathing may be predisposed to thoracic and rib dysfunction. Costovertebral and rib cage pain is also a common complaint during pregnancy.
Symptoms sometimes begin following sudden, unguarded, or explosive movements, like coughing or sneezing. Patients will often report a history that includes reaching, pushing, or pulling. Costovertebral joint dysfunction presents clinically as localized pain in between the shoulder blades with possible radiation of symptoms. When your body senses local irritation at the ribs, it will spasm muscles in that area to protect you while also signaling that something is not right in that area. Presenting complaints of costovertebral joint dysfunction range from focal burning to sharp, stabbing, and radiating.
The pain is often provoked by: breathing, coughing, sneezing, twisting, or bending. Reaching, pushing, or pulling requires scapular muscle activation and may provoke symptoms where the scapular stabilizers attach. Costovertebral joint dysfunction of the upper thoracic region may be provoked by reaching or carrying loads on the shoulder, while mid and lower costovertebral problems are provoked by motions of bending, side bending, and rotation.
How do we fix it?
After conducting a full examination to be sure that you are in fact suffering from rib dysfunction, we will get to fixing it!
Step 1: We need to loosen the muscles that attach to the rib(s) that are dysfunctional. If we do this first, we can get the rib to move without having to over power the muscle tension.
We will do this by using a number of different soft tissue modalities. Our wonderful massage therapists can spend extended time working the tissues to decrease muscle tension in that area as well as help to address postural imbalances that led to the rib dysfunction.
We also offer:
Active Release Technique (ART) to help restore the movement between muscle tissue layers with specific movements
Graston Technique uses a metal tool to help break up fascial tightness and scar tissues that develop with chronic postural issues
Trigger Point Dry Needling where we use acupuncture needles to break up muscle tension
Step 2: Now we need to restore proper alignment and movement of the costovertebral joint.
Using chiropractic mobilization and manipulation techniques we can restore normal alignment and movement to the spine and costovertebral joints.
Restoring normal movement to the thoracic spine will help to optimize posture
Step 3: Strengthen the postural muscles
Our physical therapist will identify the weakened postural muscles of your back and help you restore normal strength.
Typically the middle and lower traps become weak while your pecs and lats are tight. This combination makes holding your shoulders down and back a real chore.
By strengthening the appropriate muscles you will eliminate these postural imbalances and avoid future rib irritation, neck pain, or headaches.
At home remedies:
If you believe you are feeling some rib pain, there are a few things you can do to relieve pain and promote movement of those ribs. (note: there is no substitute for an exam by a qualified physician. If you are dealing with pain, schedule an appointment for a full examination and a plan to get you back to 100% ASAP)
Things that commonly help with rib pain:
Pec Stretch - Your pecs will pull your shoulders forward and cause excess pressure on your neck, shoulders, and ribs. So let’s loosen them up
2. Foam Roll your Lats - Your lats are also internal rotators of the shoulder. When these are tight, they will make it hard to correct your posture. The pecs and lats often pull you into that less than optimal forward rolled shoulder position. Loosen them like this:
3. Use a lacrosse ball or tennis ball to loosen the muscles around the rib. Your rhomboids, upper and middle trap, and your levator scapulae are all going to be tight and spasming if you are dealing with rib pain. Using the ball, you can self massage them to help loosen them.
4. Foam roll mobility of your thoracic spine and ribs - using your foam roller, mobilize your ribs and spine like this:
5. Side lying book openers - lay on your side with your legs up at 90 degrees and bring your top arm over top, follow with your head. like this: