Rib joint problems in the side

How are your ribs attached and where does the pain come from?

At the back, each rib is connected to the spine by two joints. The costovertebral joint connects the head of the rib to the thoracic vertebrae, the costotransverse joint connects the rib to the transverse process of a vertebra. At the front, most ribs are connected via cartilage to the breastbone or to the rib above. If a rib joint becomes stiff or irritated, you often feel it as pain radiating along the rib to the side.

People sometimes talk about a ‘rib out of place’, but a rib almost never actually dislocates from its joint. It is usually a movement restriction or irritation of the joint and the surrounding capsule. This often develops from a sudden twisting movement, lifting in a twisted position, an awkward sleeping position or heavy coughing. Sitting hunched forward for long periods and a stiff mid-back also increase the risk of problems.

Forms of rib joint problems

• Blocked rib joint: a suddenly developing, sharp pain next to the spine that radiates along the rib, often after a twist or after sleeping.
• Overloaded rib joint: a nagging pain that develops gradually from prolonged sitting, one-sided work or sport with a lot of rotation.
• Slipping rib syndrome: an overly mobile lower rib that slides over the rib above, with a click in the side.
• Stiff rib joints: with wear or an inflammatory disease of the spine, the rib joints become stiffer, so the ribcage expands less when breathing.

Typical symptoms of an irritated rib joint

The pain from a rib joint often follows the course of the rib. These symptoms are common:

• Pain next to the spine that runs like a band along the rib to the side.
• A stabbing pain when breathing in deeply, sighing or yawning.
• Pain when twisting the trunk or turning over in bed.
• Pain when lying on your back or on the affected side.
• A click or shifting feeling at the bottom of the ribcage.
• A local tender spot next to the spine or on the rib.
• The feeling that you cannot breathe in fully.

Are you suddenly short of breath, do you have chest pain radiating to the arm or jaw, or are you coughing up blood? Call 112 straight away. Do you have severe, cramping pain in your flank with blood in your urine, fever or nausea, or night pain that does not ease with a change of position? Contact your GP, as the cause may then lie in the kidneys or other organs. After a fall or blow to the ribs with severe pain, also see your GP first.

Slipping rib syndrome: the clicking lower rib

Slipping rib syndrome is a lesser-known cause of pain in the side. Ribs 8, 9 and 10 are not directly connected to the breastbone at the front, but via cartilage and connective tissue to the rib above. If this connective tissue is too lax, for example after a fall or due to hypermobility, the cartilage can slide over the rib above. This causes a click and a sharp pain at the lower edge of the ribcage, often when bending, twisting or getting up from a chair. The diagnosis is often made with the hooking test, in which the lower rib is gently pulled forward. Physiotherapy here focuses on trunk stability, posture advice and tape.

Mobilising and offloading: treatment at De Fysio Man

A rib joint is a joint and therefore often responds well to manual therapy and targeted exercises. Treatment is useful if the pain when breathing or twisting does not ease after a few days, or if a rib seems to lock up again and again.

Treatment of the rib joints

• Explanation of the rib joints and why the pain spreads along the rib to the side.
• Manual therapy with gentle mobilisations of the rib joints and the thoracic vertebrae.
• Lateral rib breathing to restore the movement of the ribs when breathing.
• Rotation and extension exercises for the mid-back within the pain limit.
• Tape to support the ribcage, especially with a slipping rib.
• Advice on sleeping position, sitting posture and lifting without twisting.

The 4 keer T method

For rib joint problems, we also use the 4 keer T method at De Fysio Man. This method focuses on the connective tissue (fascia) around the joints and combines testing, triggering and taping, among other things. This improves the mechanics of the rib joints, so they move smoothly again when breathing and twisting.

Rib joint problems and intercostal muscle problems

Rib joint problems and problems of the intercostal muscles are very similar, because both cause pain when breathing and twisting. If the pain is mainly between two ribs on the side and tensing the trunk hurts, it is more often intercostal muscle problems. A blocked rib joint can also make the intercostal muscles tense up more, so both problems occur together. We list the different causes of pain in your side on the page about side complaints.

Recurring rib joint problems

If a rib keeps locking up, the mid-back is often structurally too stiff or the back is loaded one-sidedly. For recurring problems, we work on the mobility of the thoracic vertebrae and the strength of the back and shoulder blade muscles. Are you younger than 45 and, in addition to rib pain, do you have low back pain with morning stiffness that lasts longer than half an hour and improves with movement? Then discuss this with your GP, as it may fit with ankylosing spondylitis (Bechterew’s disease).

How we work at De Fysio Man

1. Intake and assessment

We discuss where the pain starts, how it developed and when it increases. With spring tests, we assess the mobility of the rib joints and thoracic vertebrae, and we look at your breathing and posture. We rule out a cause in the heart, lungs or kidneys as far as possible.

2. Tailored treatment plan

You receive a plan with manual therapy, exercises and advice for work, sport and sleep.

3. Breathing in smoothly again

We guide you until you can breathe and twist without pain again and you know how to prevent a rib from locking up again.