Everybody has an achy back at some point. But could the problem really be in your ribs?
Your back feels achy and stiff, and every time you move or cough you’re jolted by pain. It’s natural to assume the problem centers in your spine and that’s where you need treatment.Yet that might not be where the problem lies. The source may be actually in your ribs.
The middle back (the thoracic spine) and your ribs interconnect, so it shouldn’t be a surprise that pain in the ribs and the back may be equally connected. Or that rib pain often mimics back pain. The two vital structures share joints, muscles, and nerves. The link is often overlooked when diagnosing pain in the back around the ribs, but an accurate diagnosis can bring relief from both knotty back and rib pain.
Understanding the Rib and Upper Back Connection
Your rib cage consists of 24 ribs, 12 on each side of your body. The horizontal rib bones curve around your torso and attach to your sternum, or breastbone, in the front. In the posterior, the ribs link up with the vertebrae of your thoracic spine. Overlaying the ribs are the intercostal muscles and cartilage. A network of joints also knit the two structures together.
Together, the rib cage and thoracic spine supports your torso while allowing safe movement. The partnership protects your internal organs and allows you to breathe in and out, as well. This close alignment also means if one part malfunctions or is damaged, the other will feel it, too. And that’s why back pain often starts in your ribs.
What Does Rib Pain Feel Like?
Rib and back pain often overlap, which makes finding the exact cause difficult. But there are several notable differences:
Rib pain
- Sharp pain when deep breathing, twisting, or coughing
- Severe pain due to a rib fracture from a sporting event, fall, or car accident
- Tenderness along the rib cage
- Inflammation may also be present in some cases
- Pain spanning from back to front
- An ongoing ache in the back that worsens during activity
- Shooting pains
- Burning or stabbing sensation
- Pain radiating down the leg
Why Rib Pain is Often Mistaken for Back Pain
The rib cage and middle back not only occupy the same spot in the torso, but have other strong bonds, as well. Having such a tight anatomical relationship usually results in referred pain, or the concept of dysfunction in one area affecting the other. That interdependence frequently makes pinpointing the exact cause of pain in the back in ribs hard to pin down.
Here are the three points where the two join together:
Nerves. The spinal nerve in the thoracic vertebrae winds around the front of the chest as the intercostal nerve.
Joints. The ribs attach to each vertebrae via two joints, the costotransverse and costovertebral joints.
Muscles. A strain in the intercostal muscles surrounding the rib cage can spread to the back and around the ribs.
What Causes Rib Pain?
Middle back and rib pain symptoms overlap at times. Yet what causes rib pain typically arises from a number of specific factors
Intercostal muscle strain. The intercostal muscles wedge between each rib. They move when you breathe. But repetitive exercise (like swinging a golf club), a sudden twisting motion, an injury to the chest wall, or even a forceful cough, can overly exert the muscles and make breathing difficult. An intercostal muscle strain is the most common type of rib cage trauma.
Costochondritis. An inflammation of the cartilage connecting the ribs to the breastbone, costochondritis causes sharp pain in the chest and ribs that can travel to the back. But diagnosis and treatment often focus on the back as the source of pain. There is no definitive cause, but the condition largely affects women over 40.
Rib joint dysfunction. A lesser known cause of rib pain, slipping rib syndrome develops when one of the lower ribs dislocates and presses on a nerve beneath it. The rib slips out of position and you may hear a clicking or popping sound in the rib. Symptoms include tenderness and pain along the rib and trouble breathing. Often hard to diagnose, slipping rib syndrome can be caused by a fall, injury, or poor posture.
Trauma or injury. Rib fractures are quite common, with about 30 percent of people who suffer a blow to their chest breaking at least one rib. The trauma can result from a car accident, serious fall, or a hard impact while playing contact sports.
Thoracic spine issues. Due to the tight bond between the middle back and the ribs, any issues in the thoracic spine, such as herniated disc or arthritics, may eventually progress from the back to the ribs.
Postural stress. Upper back and rib pain can also be due to slouching over a desk for long hours, or rounding your shoulders to look down at your devices. These positions can overload the ligaments, muscles, and joints of the spine. As a result, the joints connecting the ribs to the middle spine can become restricted or irritated.
When Rib Pain Signals Something More Serious
Mild muscle strain around the ribs usually heals in a few days with at-home treatments and rest. If symptoms become ongoing and more severe, see a medical professional.
- Difficulty breathing
- Chest pain with sensations of pressure and tightness
- Fever or infection symptoms
- Intense pain after trauma
- Shortness of breath
- Pain in the neck and shoulders
Treatment for Rib Pain
Conservative treatment for rib pain successfully reduces discomfort and improves mobility. And you can perform many of these therapies at home.
Rest and Activity Modification
- Rest for a few days and avoid aggravating movements
- Gradually return to more strenuous activity
Pain Management
- Alternate between ice/heat therapy to reduce pain and promote healing
- Try over-the-counter pain relievers (ibuprofen, naproxen, and acetaminophen) or stronger medications prescribed by your doctor
- Hold a pillow as you breathe to lessen pain
Physical Therapy
- Mobility exercises, but be careful not to overstretch or overextend the joints
- Practice proper breathing techniques
- Correct posture to prevent strain on the upper back
Manual Therapy
- Massage to release tension in the intercostal muscles
- Passive manipulation to improve joint mobility
Exercises and Prevention Tips
Try these exercises to keep your thoracic spine healthy and strong. Work with a physical therapist to help you perform the exercises correctly and at a comfortable pace. Avoid doing too much too soon to prevent overuse injuries.
Improve Mobility & Breathing Exercises
- Thoracic spine rotations (seated spinal twist, cat cow)
- Diaphragmatic (belly) breathing exercises to strengthen your diaphragm
Strengthen Supporting Muscles
- Core stability and strengthening (side plank, abdominal crunches)
- Upper back strengthening (bridge, scapular squeeze)
Fix Seated and Standing Posture
- Arrange your workstation ergonomically with the monitor even with your line of vision. Buy a chair that supports your back and keeps your feet on the floor. Position your elbows at 90 degrees to the keyboard
- Take frequent breaks to stretch your legs and engage your muscles
- Practice good posture. Don’t slouch!
When to See a Specialist
Rib and back pain can be a minor and temporary nuisance. But be aware of signs you may require a thorough medical evaluation.
- Pain lasting more than a few weeks
- Pain interfering with breathing or movement
- Recurrent pain episodes
- Unclear source of pain. Is it coming from the back or the ribs?
How New York Bone & Joint Can Help
New York Bone & Joint Specialists have extensive experience in treating orthopedic conditions in every part of the body, including the ribs and the spine. Our physicians follow a multi-step process to diagnose your pain.
- Perform a comprehensive evaluation of how your rib and spine mechanics work together
- Identify the root cause instead of treating only the symptoms
- Create a personalized treatment plan
- Focus on restoring full movement and preventing a recurrence
- Recommend conservative therapy as the first line of treatment
Get Ready to Move Freely Again
Rib pain is often mistaken as a back problem, and that can delay effective treatment. The team at New York Bone & Joint possesses the expertise and commitment to determine where the cause of your rib or back pain lies. Early treatment can quickly reduce pain and lead to better mobility. Contact us today if your rib pain is holding you back from living your best life.
FAQs
What causes rib pain?
A number of factors can cause rib discomfort. A strain in the intercostal muscles wrapped around the rib, displaced joints in the lower ribs, or a forceful impact to the torso can all lead to rib pain. But a hard cough can also damage the rib cage.
Why does rib pain feel like back pain?
The two structures are close anatomically. More than that, your rib cage is attached to the thoracic spine through a network of nerves, joints, and muscles. Any dysfunction or damage within the ribs or back may be felt in both areas.
What is the best treatment for rib pain?
The cause of the rib pain dictates treatment. But in most cases, rest, physical therapy, breathing exercises, and gentle stretching can resolve the discomfort.
When should I see a doctor for rib pain?
See a doctor if you experience severe pain that doesn’t go away in a few days or you cannot move freely. Ongoing breathing issues or intense pain after injury also demand immediate medical attention. An orthopedist can make an accurate diagnosis and prescribe appropriate treatment.
Can poor posture cause rib pain?
Yes, it can. Prolonged sitting, slouched posture, and bending your head down to view your tech devices strain the muscles, ligaments, and joints in the spine, and that can be felt in the ribs.
