The mysteries of rib dysfunction

There is no pain quite like rib pain. Acute rib pain can be incredibly sharp, often described as a “knife-like” stabbing pain somewhere between or under the shoulder blades. 

The pain can be so severe that it is impossible to find a comfortable position; sitting, standing and lying down all seem to irritate it in some way. The pain can even make breathing difficult. 

For some people this injury never fully heals and it goes on to become a deep dull ache of chronic rib pain. For these people, the knife has been pulled out of their back to be replaced by an elephant standing on their chest or back. 

Rib biomechanics 

People are often surprised that a pain in their upper back or chest could be due to their ribs. There is a general conception that the ribs are only present in the lower torso. Actually the rib cage extends from above the collar bones down to the level of the belly button. 

There are 12 pairs of ribs that protect the lungs and heart. Another surprise for many people is that the ribs are constantly moving. Every breath, every twist, every bend, your ribs are flexing and moving. Unfortunately, this means that when a rib joint is sprained, every one of these movements causes pain. 

The rib cage really is a wonder. The ribs have the difficult job of being rigid enough to protect the vital organs but retain the flexibility to allow movement. 

The ribs also play a vital role in breathing movements and are the source of attachment for many muscles. 

In the upper and mid thoracic spine, where most rib injuries occur, each has two joints with the spine, as well as a joint in front with the sternum. Between each rib is muscle that can also be affected with rib dysfunction, causing radiating pain to the side and chest. 

The majority of rib movement occurs at the joints between the ribs and the spine. It is at these little joints that injury can occur due to loss of normal movement or fixation in an abnormal (sprained) position. Chiropractors term this type of injury “rib dysfunction.” 

Patterns of pain 

Not all of the rib pain is felt in the back. The altered position and movement of the rib also affects the front of the rib cage. Pain can be felt across the chest or localized to an area over the breastbone. 

The muscles between the ribs, the muscles on top of the ribs, and the cartilage between the rib and breastbone can all become inflamed and irritated in this scenario. Pain can also be felt down either arm in a phenomenon known as “referred pain.” 

Perhaps the most frustrating aspect of rib pain is how it just seems to appear seemingly without reason. A person can feel absolutely fine one morning, and wake the next morning hardly able to move due to this injury. 

Most people who sit for prolonged periods with poor posture have caused some irritation to the rib joints of the upper thoracic spine. Once these joints have suffered this minor trauma for a prolonged period, a seemingly minor extra aggravation can cause severe acute pain. Something as minor as coughing, sneezing, turning the head quickly or even sleeping awkwardly can initiate this injury. 

Rib dysfunction can generate pain that is felt in a variety of places and intensities. Pain will often be felt underneath or between the shoulder blades, upper shoulder/neck, flank pain, chest, difficulty breathing, tingling/burning in the back and chest, shoulder movement issues, and a tingling/ache into the arms. 

Other names 

It is possible that you have already been treated for rib dysfunction and not even known it. The pain syndromes associated with the ribs have many different medical names. Common diagnosis include pseudo angina, costochondritis, intercostal sprain and Tietze’s syndrome. 

Why me? 

There are certain factors that can predispose someone for a rib injury. Often chronic rib pain will be seen in a person with a slouched posture and shoulders rolled forward. 

A scoliosis or minor spine curve can also put extra stress in the rib cage. 

People who sit for prolonged periods often develop a hunching posture which stresses the upper thoracic spine and ribs. Repetitive lifting and twisting actions that fatigue the upper back will also set the stage for a rib injury. 

Shoulder issues 

Shoulder/arm movements are often thought of the arm swinging around the torso. However, the arm (humerus) attaches not to the torso but to the shoulder blade. 

The shoulder blade has an incredible amount of mobility to assist shoulder movements. Roughly 30 percent of shoulder mobility occurs due to the shoulder blades’ ability to glide over the rib cage, called scapulo-thoracic movement. 

Rib dysfunction can cause restricted scapular mobility with pain on shoulder movements. The loss of full scapulo-thoracic movement places more stress on the shoulder muscles and can exacerbate rotator cuff injuries. 

Chiropractic treatment and rib dysfunction 

Rib dysfunction can mimic some very serious medical conditions. 

Therefore, the chiropractic examination is first focused on ruling out medical issues. It is then followed by a detailed examination of the joints and muscles of the rib cage and spine. 

The chiropractor assesses the movement of the individual ribs, checking for any loss of normal joint alignment and mobility. 

The aim of the treatment is to restore the normal joint movement patterns, free any tissue that is being compressed and reduce the muscle spasm. This is done using a variety of different “hands on” techniques, exercises and mechanical therapies. 

Dr. Jemal Khan is a chiropractor based in the Cayman Islands. 

Rib pain can often be very severe.
Rib pain can often be very severe.
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