Rib pain

How can it happen?

Rib pain can show up in unexpected places, and the majority of cases we’ve seen most of it clears up quickly after 2 or 3 treatments.

It often starts with a upper body twisting movement or with forceful backward pulling of the shoulder blades or some other strong muscular contraction.

All ribs attach to the vertebrae (the bones) of our back. So when we twist to the right the vertebrae should also rotate and twist in unison with the ribs attached to them. If the spine is stiff and restricted the rotation of the ribs may not be adequately matched by the vertebrae and the joint between the two will be sprained.

Where does one feel it?

Potentially, anywhere where there are ribs!  But to one side of the spine is common, which is where the rib joins the edge of the vertebra.  In other cases, the pain can be at the front of the chest.This is because a joint problem can irritate one of the intercostal nerves which run along the length of the rib from back to front.

For instance, problems with the 4th and 5th rib on the left can cause a chest pain at the front, making the person worry that they’re having a heart attack.   In fact, a few of our patients have come to us for treatment only after they’ve been to A & E and had a full range of tests on their heart function. 

In less spectacular cases rib issues will result in discomfort with deep breaths, coughing or sneezing.  Another common symptom is pain with twisting movements, with the discomfort being located to one side of the spine rather than on the spine itself.

Case Study 1

A patient in her fifties complained of pain at the side of the upper chest on the right.  This had happened before and had come about this time after spending some considerable time up a ladder to attend to some hanging baskets.Turning in bed, coughing and sneezing all caused pain, & Voltarin relieved it.

The problem was with a spasm in the short intercostal muscles between ribs 4 & 5, roughly in line with the breast area, and with one of the joints between rib and spine.  Stretching the muscles & working on the ribs themselves to get more movement meant she was much better after the first treatment and had no pain when she was seen for the third time for a different problem.

The first rib is often involved with neck pain

This is a short, tightly curved little rib tucked away out of sight behind the collar bone. It can be responsible for upper shoulder pain & even symptoms into the arm.   The scalene muscles run from  the first rib  to the bones of the neck and are used occasionally for strenuous breathing.  When this happens, they lift the rib to help provide extra volume for our lungs when it’s really needed.  So both  rib and neck can become restricted in movement if the scalenes get tight.   

In fact, faulty breathing patterns are often the culprit for tightness in with this kind of breathing, especially if it’s long term.  This is quite common in those suffering from bad asthma, because of a long established pattern of shallow breathing with the upper chest rather than using the lower ribs as most people do. 

Re-training of poor breathing patterns is possible, but like any unconscious long term pattern, it does take some diligence and persistence to change.  However, we can help with some of the self training, which can be done at home with no special equipment.  A more thorough supervised training is available through specialized breathing clinics.

Other causes

These include inflammation of the joint between the rib and cartilage on either side of the breast bone, and of course, a fracture or break after a direct impact of some sort. If the joint has been badly sprained then the likelihood is that even with treatment some pain will continue until enough time has passed for the tissues to heal.

Fractures usually heal after a few weeks and are not of major concern unless the lung is or has the potential to be punctured.  With a punctured lung (pneumothorax), there will not only be sharp pain with breathing in, but also breathlessness.  Coughing may also produce blood & the sufferer will be unwell and may look discoloured.

The possibility of a fracture has to be taken more seriously and investigated in the case of older people because of the vulnerability to infection.

Anxiety, lung infections, bone tumours, gall bladder & heart problems all need to be excluded. Shingles can also cause severe pain to radiate out along the path of a rib around the side of the body, accompanied by itching, redness and blistering. But in some cases the pain may start before any visible evidence of a shingles attack.

Case Study 2

A pregnant woman in her twenties came to our clinic having been to A&E & her G.P a month earlier about pain in the back of her left chest.  Tests showed nothing, but she had pain when breathing in or sneezing, which radiated up to her shoulder.  She also remembered some numbness in the arm originally. No reason could be remembered for the beginning of the problem and it had settled to a more manageable level until a fall outside aggravated it. 

In this case the offending 9th rib was much lower than expected for her pain pattern, but immediately following treatment there was better movement in the area and no pain when breathing in deeply.  Sneezing continued to be a slight problem when she was seen the second time, but this had disappeared completely by her third and final visit.

What should you do?

Pain which could be associated with the ribs should not be ignored, but at the same time there is no need to worry and assume the worst.  As one medical saying goes: “Common things happen commonly”, which is a way of saying that most cases are due to relatively simple and treatable causes, and that we shouldn’t be too quick to panic when consulting Doctor Google!


ACC covers rib injuries, so if you’ve had an accident we can file a claim for your during your first visit & provide treatment all in the one visit.  No need to spend money going to your G.P first just to lodge the claim.