RIB TISSUE PAIN

Although there are many different causes of rib pain that will in no ways respond to my TISSUE REMODELING TREATMENT (costochondritis, osteoporosis, fracture, etc), there are many people whose rib pain can be effectively treated by what I do in my clinic. If you are interested in meeting a couple of these folks, take just a couple of minutes to watch THESE TWO VIDEOS.  Between these two individuals, there was nearly a decade of Chronic Rib Pain prior to their experience here.

Although rib problems are not typically dangerous like a ruptured disc can be (unless you happen to shatter them in a terrible accident), rib pain can be severe to the point that people think they are dying.  I frequently see patients who come to me after getting an air-evac ride to the hospital, and then ending up being run through several days worth of cardio tests that cost more than the house they are living in.  Their conversation with their cardiologist frequently goes something like this:

Thank Goodness Mr Jones!  We have run every conceivable test — many of them several times over.  We cannot seem to find a single thing wrong with you.  Everything appears to be just fine.  You are as healthy as the proverbial horse, and your heart is just about perfect.”  

But doc, why am I still having the same pain that I came in here with in the first place?” 

(deer-in-the-headlights look) “That is a great question Mr. Jones.  Be sure and ask your family doctor when you see him later this week.” 

If you think I am over-exaggerating, you would be wrong.  I see at least two patients a month (often more), who have been through an almost identical scenario.  Don’t get me wrong; I don’t want people showing up in my office in the middle of a heart attack.  But something is rotten in Denmark when it takes several days, a $20,000 helicopter ride, and the better part of a hundred grand to (incorrectly) tell someone that there is “nothing” wrong with them.

ANATOMY OF THE RIB CAGE

To understand some of the most common causes of rib pain, we have to understand a little bit of anatomy (see the picture at the top of the page).  There are typically 12 pairs of ribs that make up the “rib cage”.  As you already know, the rib cage surrounds and protects several organs (chiefly the lungs).  All ribs attach to the spine, and the “Thoracic Spine” is the 12 vertebrates that the ribs attach to.  In the front, ribs (or more correctly, the rib cartilages) attach to the sternum or breast bone.  The lowest two or three ribs are said to “float” because they do not have a bony or cartilage attachment in the front. 

An important fact to remember is that ribs move.  I know that ribs feel like they are anchored to the spine, but trust me — they move.  You can feel this simply by putting your hands on your ribs and breathing deeply.  When ribs do not move properly, not only can it hurt (sometimes terribly), it almost always hurts specifically to cough, breathe, sneeze, laugh, hiccup, etc. 

I frequently see patients who have ribs “out”.  The technical term for this condition is SUBLUXATION.  In a nutshell, “subluxation” means bones or joints that are either misaligned or not moving properly in relationship to each other.  One of the beauties of subluxated ribs is that they usually respond to adjustment immediately.  When they do not, I start to think of FASCIAL ADHESIONS that could be restricting rib motion and causing pain. 

Another fact that people may not be aware of is just how much “tissue” attaches to ribs.  Much of this is fascia, although there are ligaments, tendons, and muscles as well.  Let’s look at a few pictures of the tissues that attach to ribs.

Rib Tissue Pain

The thing that I want you to see here is just how many tiny muscles (muscle tendons) attach to the rib cage.  Also notice the muscles that actually run between the ribs.

Rib Tissue Pain

This picture, as opposed to the previous, is from the front.  Again, notice how the rib cage as well as the individual ribs are completely covered with muscles and tendons.

Rib Tissue Pain

Notice not only the muscles that attach directly to the rib cage, but look at the amount of fascia.  This fascia runs from the pelvis to the skull and attaches to ribs along the way.  And remember….. Fascia is arguably the single most pain-sensitive tissue in the entire body!

Rib Tissue Pain

A great picture of the relationship of the fascia and associated musculature of the abdominal muscles, to the rib cage.

Rib Tissue Pain

Serratus Anterior Muscle. Notice how this muscle covers the entire lateral rib cage.

Rib pain is common.  Dog common.  Just yesterday I treated a woman who had torn a rib fascia while coughing.  she is a tough gal, but her pain was about as severe as anything that I see in my clinic.

Rib tissues can be injured in a variety of ways.  Coughing and sneezing are a couple of common ones.  Throwing is also a fairly common way to injure these tissues (especially throwing something really heavy like a chunk of firewood).   As you can imagine, rib injuries are common in sports.  Not only are they found in contact sports like football, but they are also found frequently in baseball, softball, and even golf (swinging a bat or golf club can tear rib tissues and put even the “heavy hitters” on the D.L.). 

FOR MORE INFORMATION ON PAIN CAUSED BY A PROBLEM WITH, OR INJURY TO RIB TISSUES, CLICK.




62 responses to “RIB TISSUE PAIN

  1. Alex Ardizzone

    In April of 2013 I was lifting the hood of my car, when I could feel something pull on the my right side rib cage,X-ray showed nothing, it hurts most when I lay down to go to sleep at night. After awhile the pain subsides. It’s been over a year & the pain is still the same now as it was when it first happened. What can I do for relief?? I’m 72 now & have enough pain without this new pain.

  2. Debbie

    Hi dr russ,
    For almost 8 years i had ct, mri n xrays, echos showing nothing significant. Well mri showed a vertebrae with a small nodule. But no relationship apparently.
    The pain i have under upper left rib is off the scale coming and going, when i sit quietly theres no problem. As soon as im upright it starts from tightness then inflames, if i carry v light shopping its triggered. Deep breathes trigger. A walk in park triggers. Its so debilitating and im sure my other muscles compensating this and starting to also have problems. I think my physio may have made a break through she found a spot almost on the rib which she said was muscle, but id say bullseye. The pain on soft touch was like electric shock. What do you advise ? Is there a cure i cannot face another 8 years of this im exhausted with it. General docs have sent me all over the place but dont put pieces together if its complex and no quik answer. V frustrating.

  3. Tessa Belk

    Hello Dr. Russ,

    Lately I have been having really sharp pains in my ribs. It’s usually in one place, lower right part of rib cage, but it can happen other places.
    It’s sharp and feels like someone’s stabbing me. It can feel so bad that I have to hunch over and stop breathing. It goes as quick as it comes.
    It’s not a constant pain, it’s more random. One of my attacks can last from a few seconds to a couple minutes.
    It’s been happening since May. My friends think it’s indigestion, but I’m not so sure…
    I’m 18 years old, 125 lbs, 5′ 6″, female, rarely active.
    The past two days, I felt the same pain, but it was moved to my spine.
    Any ideas? I don’t wanna go to the doctor if I don’t have to.

    Thank you,
    Tessa

  4. Jazz Selby

    Are you in england?

  5. Jane Crowe

    Dear Dr. Russ,

    I fell onto my back during gymnastics three days ago. After it happened I had some dull pain under my left breast/rib cage area. The pain has gone away but when I sneeze, I have sharp pain in that area. The pain does go away after a few minutes. I do not have any pain when coughing or laughing or any other body movement. Could this be a bruised rib or something?

  6. janet

    Hi Dr. Russell

    I have had dull pain in my lowest right back ribs. I guess it’s flank pain. The area of the pain is about as big as a fist, but is not really tender the the touch. However; it I push around in there it starts to ache afterwards. It started in January 2014 after a terrible cold. I have tried chiro, massage therapy, had a bone scan, xrays, blood work, and nothing is found wrong. Also, no treatment has made it better.

    But this pain doesn’t go away and in fact, it is getting a little worse. It’s still a dull pain but more constant now.

    Do you have any suggestions for me?

    Thanks, Janet

  7. Marlene

    Dr Russell Thank you for all you knowledge . Just reading these posts has helped me in having a better understanding of what may be happening in my case. I lifted a rather large piece of furniture ,felt a sharp pain ( like a lightning bolt , knife ) lower back ,two bottom ribs ,right side . Touching the ribs where it hurts feels like there is a marble stuck in between the ribs ( ligaments ,tendons,muscles ? ) I can move around without constant pain ,just not doing anything to aggravate it any more. I did go to the Chiropractor ,three times I might add ! I have also gone to see Kinesiologist, who told me without even feeling the area in between my ribs that my pubic bone was out and it was not a rib .. Go figure ! I truly feel for all you folks , hurting and suffering just trying to fine the right cure and help. I realize if you have found your way here you are in good hands .
    Once again Thank You Dr Russ ;+)

  8. Kristin Vestrheim

    Dr Doctors.
    For the last 4 weeks I have had a stabbing pain below my left breast in the rib area. It last from seconds to minutes. It can not be reproduced by movement, breath or touch, but is seems somewhat worse when I have been sleeping sitting up with my 5 week old on my chest. Could this pain be rib/muscular in nature?

    • Hello Kristin,

      Could be a tissue thing, but usually there will be a certain movement or position that causes pain. The common denominator with rib pain is that it can be severe in the absence of any sort of objective findings.

      Sincerely,
      Dr. Russ

  9. Debra McKinnon

    I was searching the internet because I am having weird things as well, at the sternum and ribcage. I have twinges, not really pain, that happens quite often, and it comes and goes, but when I am having a flare up or whatever you want to call it, the twinges happen all the time. It starts at my sternum and goes through to my back.

    I recently went to the chiropractor, he mentioned I had some ribs out of place. But, this weird thing has been happening to me, a few months ago, I was in the gym and doing pullups for my abs. I got a horrible pain under my left ribcage, almost like something was poking out from under my ribs, it was intense to where I had to push on my ribcage to help the pain. Last night it happened again. I was working in the yard, twisted just the right way and the pain was horrible. I could hardly breath and had to push in on my rib cage real hard and I swear, it felt like something was poking out.

    Should I see a doctor or does this sound like the rib cage problem? I am normally very healthy and very active.

    • Hello Debra,

      Sounds like it may very well be subluxated ribs. I would try a different chiro and see what happens. Does not really sound like a tissue thing to me, but impossible to say for sure without looking.

      Sincerely,
      Dr. Russ

  10. Melissa

    Dr. Schierling,
    I’ve had this pain on my front right side under or in my ribs for over a year now. It hurts on the bottom of my rib cage going up underneath. If I find the right ribs, it hurts to push on them. I have been to 5 different Drs., had 3 separate ultrasounds, a HIDA scan, and a CT scan. And they can’t find anything. So they put me on this medicine called Amitriptyline, I’m guessing to deaden the pain. I’ve only been on it for about 5 days but I’m still not really seeing a difference. Although they did say it’ll take about 2-3 weeks to take effect. I’m concerned they think it’s organs that’s bugging me and I think it’s just my ribs. What do you think?

  11. Manny Medina

    Im sorry if my writing bad but im in pain.. im only 25yr old n everyday since my back injury.. I get muscle cramps on my back, ribs, butt, hips, legs and under my feet.. if there any way I could get some example in how to stretch. . Cuz I hate taking 7 different meds daily.

  12. Matthew Knepper

    Hello Dr. Schierling, exactly one year ago I was playing softball and threw a ball while on one foot, I felt like something ripped out around my rib area it hurt so bad I hit the ground. After just a minute or two I felt fine, threw the ball again and it again put me on the ground. I would not experience any pain except when I threw the ball it felt like on rib was getting caught on another and kinda clicking off and on it. The season ended and eventually I wasn’t throwing anything and had no problems. 3 weeks ago (a year later) I was throwing the ball and didn’t have the sudden initial injury type pain, but the feeling of something moving returned. It is painful every time I throw and even more so uncomfortable it feels very weird. When I move certain ways in the shower for example I feel it. Any diagnosis doc? Being that I don’t seem to have any broken bones can I wrap it to try and hold whatever it is in place so I can throw? Thanks so much for any help!

    • Hello Matthew,

      Hello Matthew,

      My best guess is that this is not merely a rib subluxation (a rib out of place). This problem sounds like a tissue problem to me. Wrapping might help but wrapping carries with it other problems. One is that it can cause pneumonia because it does not let the rib cage expand.

      Sincerely,
      Dr. Russ

  13. Dana Tilley

    This was a very interesting article and I am wondering if it applies to my situation. I had bariatric surgery 4 weeks ago. Shortly after surgery I started having back pain on my left side. The doctor attributed it to left over gases that are used during surgery. The pain diminished but was still severe (liking getting stabbed in the back) when I hiccuped, coughed, or sneezed. Yesterday I ate something that did not sit well and I ended up throwing up. When I got up this morning, my left side and back are extremely painful and when I hiccuped it made me scream. Any insight you could give me would be appreciated.

  14. Cecilia

    Hello, I am a 23 year old female. I’ve had rib pain for a year and some now. Originally 3 ribs were displaced, fixed, and seemingly healed. Now I am suffering left shoulder and rib pain. The rib pain is just right under my left breast. What could it be? Sleeping on it agitates it…

  15. Amani Suleiman

    Hi

    I am having a terrible pain in my sternum and the side of ribs near it. Happened after me giving birth (normal delivery). Pain for two years now, I did an xray several times, ct scan, and bone scan, all are normal. Heart echo normal, and breast examination came back normal, what is wrong with me, I feel hopeless.

  16. Howard Ramsey

    I fell out of tree and broke my back they took my 12th rib out on left side to do surgery back is fine but the left side right above my hip is severe pain i tried several pain Dr. but nothing has helped and it is getting worse.

  17. Thiyagarajan

    Hai,

    My entire back spinal and low hip attached ( muscle + bone ) together. I can’t bend my back. I can’t sit properly. If my legs slip, while walking my spinal gives too much pain.

    Past 5 Years i have this problem. I try to contact a doctor, he priscribed “muscle reflex “. such a medicine is not supporting well.

    I need your suggestion about my disease.

    Around 3 years back I feel pain in lower Spinal, but day by day this pain reached all over my back.

  18. Nichole Hassemer

    I fell straight on to my pelvic bone after being tripped roller skating last night. The only pain I had yesterday was near and around my tailbone when sitting down and getting up. Today when I woke up, I started having neck muscle pain, pain in the muscles covering the lower half of my ribs,and headaches that seem to fad in and out within seconds. I’m wondering if these could be all linked to falling on my tailbone.

  19. Larry Thompson

    I hurt my back playing in a softball tournament three years ago. Over swung and at the immediate time did not bother me. On my way home however, my upper right back under the scapula started in with back spasms that literally took my breath away. I went to the doctor and was given muscle relaxers (getting rid of the spasms) and sent to my physical therapist. I probably went to the therapist for 3 – 4 weeks where she said she could feel a knot deep in the tissue. She did ultrasound on it and massaged it with her elbow but never did completely get rid of the problem. It did feel better after applying pressure in the area and rolling her elbow around but it would always come back fairly soon. I have visited her a few different occasions over the three years for some temporary relief but never getting it resolved for good. It flares up often and hurts to cough or sneeze real hard. It is beginning to be more and more annoying as it flares up during simple daily routines as well as the more exertive routines. I’m tired of the issue and only wish that I could figure out what the problem is so that I can get rid of it for good. Any help would be fantastic! Thanks!

  20. Cayce

    Dr. Schierling,
    For the past almost 3 years now, I have had a terrible chronic pain under my left breast. This pain comes and goes frequently throughout th day. Though I haven’t found many specific things that aggravate it, it always seems to be worse in the evening and when I am wearing a supportive bra (the pain is right were the bottom of the bra sits) which just seems to dig into the area of tenderness. I’ve been to several chiropractors who can’t seem to put their finger on it, and I am currently doing acupuncture (which seems to half take away the pain at times). The area is very tender to the touch and I need a solution to get rid of this chronic pain! Do you think this could be the answer to my problem?

  21. PeterGilmore

    I rolled over after showering 3 months ago and started getting severe spasms in my left upper rib on the back side. The spasms moved to the right side a week later and I am in and out of pain that moves from left to right. The spasms are gone but the tightness and soreness remains 3 days a week I have tried various techniques including dry needle therapy with minimal results. And to complicate matters I am paralyzed and wheelchair bound but at this point they still believe it’s a strain. Does this sound like a strain? thank you for any responses.

  22. Tracie

    I have a bulging muscle or vein that started out as a sore/ bruised rib. It runs from under my left breast to the bottom if my rib. It pops out when i stretch my arm/side up. I am getting worried! I am calling for a doc apt tomorrow, but was wondering if you could speculate on what you think it could be.

  23. Fakiha

    I have had a bad blow to the left side, just below my rib cage 3 years ago while doing Karate. Ever since, whenever I turn or stretch my body to the right, a painful lump appears on the left side just below the rib and I have to stretch my body for the lump to disappear. I have experienced severe pain and have done all the tests possible to find out a cure for this problem. None of the specialist have a solution and advised that I need to live with this problem. I do not believe that so please advise as to what type of specialist I should visit.

    • Sounds like it’s probably Fascial Adhesion.

      Sincerely,
      Dr. Russ

      • Bonnie

        Dear Dr.
        Thanks for this forum. I’m having a simular situation. Mine started 6 or 8 weeks ago. Minor pain in upper left Rib. Didn’t think too much of it as we are preparing to move and I’ve been packing and such. About 3 weeks ago I took my dog to the beach and carried a heavy bag along with being dragged down the beach by her. Haven’t been the same since. My back hurts, ribs hurt, sides hurt. In the mean time I’ve been packing, up and down… Last week got a massage and its been even worse. I’ve pretty much been in bed since. The pain subsides when I lay down with the heating pad but as soon as I get up to move around the pain is so intense that I am almost convinced to go to the emergency room. And I’m terrified of hospitals. I went to see a acupuncturist and was told my liver is clogged causing spleen and pancreous issues and am on herbs and enzymes. Has helped on the short term but when I get up and moving again here comes the pain. And it’s bad. Mostly in the rib area. Thing is, it doesn’t hurt to breathe. No shortness of breath. I have no nausea. I don’t know what to do. I’m trying to pack since we have to be out of our house next week and I’m afraid because I’m not sure if there is something seriously wrong with me. What do you think?

      • Hello Bonnie,

        It’s really hard to say what’s going on here. Doubtful it is “serious” but again; hard to say. Does not really sound like something Tissue Remodeling would help.

        Sincerely,
        Dr. Russ

        PS Let me know if someone solves it.

  24. Erin

    Thank you for this article and the beautiful illustrations. You have described my life! Except for the fact that I have been dealing with fascia pain for 3 years and what I have told multiple doctors that I think are rib subluxations. I have other health issues as well which cause me chronic pain. But this pain! Oh. It is mainly thoracic mid to right side being the worst but is on both sides and lumbar. You can feel the fascia crunching under your fingers as you massage in this or that pain relieving cream which barely reaches it. But is crippling pain. I can’t do activities with my arms in front or over my head at all or lift anything. It’s awful. I am at a loss for what to do. The doctors here just give pills.

  25. Jeff

    I dislocated the 4th, 5th, and 6th ribs on my left side around 4yrs ago. I have found, since then, that if I turn a certain way or stretch my arms all the way back like I’m yawning and really stretching out, I get a breath-taking pain that shoots all the way into my left shoulder. Also, I’ve injured the same spot 2 additional times from very minimal contact and it’s very painful each time. Does this ever heal???

  26. chris

    HI, i fractured a few ribs on the job last Thanksgiving. Ever since I have been on workers comp. I have been seeing a Doctor that has run CAT scans,MRIs, and X Rays. Long story short ,its almost been a year and Im still having some very bad pains at my L4 and L5. It almost feels like my ribs are going to come out of joint at anytime. Is this Hyper-extended joints, or facia damage? I need answers, because my doctors don’t seem to have very much knowledge about this. Subluxation and Fascia damage definitely sounds like the Culprit. Who can I get to verify this for my law suit? Please help. If i don’t get answers ,I will be told I’m fine .I’m not fine!

    • Hello Chris,

      Unfortunately, when it comes to Fascial Injuries / Adhesions, your scenario is the norm. Out of sight, out of mind. Since most Fascia cannot be imaged well, your problem / pain is blamed on anything and everything other than what is really causing it.

      Dr. Russ

  27. Andrew

    This is a very good info. I have pain around my ribs for two years now, mostly including under the ribs. The myotherapist initially said it was an external oblique thing but could not treat the problem. All scans are perefectly normal. My reumatologist cannot find anything wrong. I visisted a guy who is a sensitive craniosacral therapits and he feels this is a ligament / fascia problem in the area. Unfortunately, not many specialists can treat this and physios where I live cannot understand what I am talking about…
    So, info like this give sme a clue of where to try to find out a problem which stays with me for 2 years now…

  28. Brian

    I’ve had a pain under my armpit at my rib for 2 weeks. Figured it was muscle strain. But always think something worse. Thanks for the info. I will go to a doctor if the pain gets worse, but it is getting better. First time with rib strain so feared the worst.

  29. Natasha

    Thank you for this insight. I recently had my 3rd child and my body just went wacky on me! I felt as if I was dying or about to! Anxiety didn’t help. I been having a lot of pain in my chest and 1st it was my stomach that was out of place due to my acid reflux that was full blown. I was constantly grabbing my breast area and under arm pits for the pain to go away. Pain going from left yo right side of my arm pain in my jaw…so yes I thought I was having heart attack. I’ve been going to chiro. Massage and holistic healing to figure out what the heck was going on. Also had a mini in office ekg and everything normal. I would constantly check my heart beat and it was always in good range. So finally my holistic chiro is putting me back in order moved my stomach back, and now moved most of my ribs back in place still have some ways to go but at least I’m not going crazy anymore!! I live in Oahu Hawaii do I wish I could see you but its a bit far…lol but thank you for your website, it really helped me understand my body and I’m not going crazy!
    Aloha from Hawaii – Tasha

  30. Barbara

    Thank you for helping me understand how easily the ribs and muscles attached to the ribs can be injured…I go to a very good Chiropractor who has explained it to me but seeing it here in your wording has put my mind at ease. I was trying to start up a stubborn leaf blower almost 2 years ago and noticed my left side near my ribs was very sore after constantly pulling the long string that starts the blower. I must have pulled it hard about 30 times. Didnt feel the pain till a day later and since have had a constant dull pain in the left side of my ribs and muscles. Sometimes I guess my adjustment is just right and the pain is gone but as soon as I proceed with my normal activities and exercise it comes right back dull nothing major and I can actually reproduce the pain with certain movements. Anyway that you for the explanation above it was a great help in calming my nerves that I have worried about this for the past 2 years!!!!

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