Quinci Herll, Chiropractic Intern
ACHOO! Ouch, I sneezed so hard my rib went out of place, time to call my chiropractor! A "rib out of place” is a fairly common condition presenting to a chiropractic office, but what does this really mean? When the ribs are not properly moving and out of their usual position, it can cause sharp, pinpoint pain. This pinpoint pain can either be on the front or back of the rib cage. Thankfully, a painful rib can be easily treated without drugs or surgery!
Anatomy
The rib cage is made of 24 ribs in total, 12 on each side. The ribs connect to the sternum on the front and to 12 thoracic vertebrae on the back. The rib cage protects vital organs such as the lungs and hearts and assists with breathing. When you take a breath in, the ribs move up and out. The opposite happens when you breathe out; the ribs move down and in. Intercostal muscles are present between the ribs and assists with their motion while breathing.
When a rib “goes out of place”, it is usually not a true dislocation. If a rib were to fully dislocate, it would be an emergency room situation. The heads of each rib attach to the thoracic vertebra, creating the costovertebral joints. These joints are limited to a small degree of gliding and rotation of the rib head. When a rib “goes out of place”, it means that these joints are no longer moving properly and the surrounding musculature tightens up. This lack of movement can cause severe pain, making it hard to breathe, lift, and twist.
Causes
What causes lack of movement of the rib joints? Sometimes patients will recall the exact incident the injury occurred while other times it may have a more insidious or unknown onset. Patients often report their rib being out following an illness due to aggressive sneezing and coughing. We also commonly see "ribs out of place" after air travel - reaching under the seat in front of you can be a trigger as well! The ribs and intercostal muscles are closely related to the respiratory system. When the respiratory system is not functioning properly, the intercostal muscles have to work harder, causing improper rib motion. Lack of rib movement can also be caused by poor posture or repetitive movements. Poor rib movement is also common during pregnancy. When the baby grows, it can put pressure on the ribs or the baby can even kick them. During pregnancy, the body releases a hormone called relaxin that loosens and relaxes muscles, joints, and ligaments to prepare the body for delivery. This hormone sometimes causes the ribs to expand to make more room for the baby, causing pain and lack of proper rib movement.
Treatment
Chiropractic care is a great first step for a rib that is not moving properly. A chiropractor will adjust the full spine from neck to low back, paying special attention to the thoracic spine and ribs. By adjusting the costovertebral joints, the rib head can return to the correct position and move properly again. When ribs are not moving properly, the intercostal muscles can become strained. Chiropractors can perform soft tissue techniques such as Graston and cupping to the area to increase blood flow and decrease healing time. Laser therapy can also be beneficial in speeding up recovery time by promoting the healing process and relieving inflammation. Chiropractors can also apply KT tape to the ribs to provide support and decrease pain. Patients can expect to experience relief after just one adjustment. Chiropractors will likely recommend a few followup appointments to make sure everything is still moving properly.
When ribs are not moving properly, it can cause intense pain. This can be a scary experience for people who are not aware what is going on. Did I break or tear something? Am I having a heart attack? Thankfully, a "rib out of place" can be treated conservatively, despite how painful it may be. An adjustment and soft tissue work will bring back proper motion to the ribs and calm down the surrounding musculature. Incidentally, if you or your chiropractor are worried that a rib is actually broken or fractured, it is easy to order an X-ray to be confirm.
Quinci Herll is a chiropractic student from Northwestern Health Sciences University in Bloomington, Minnesota, completing her internship at Washington Park Chiropractic. She is passionate about athletes, pediatrics and perinatal care. She enjoys educating patients on the power of chiropractic and helping others achieve their health and fitness goals.