Rib and Chest Wall Pain: Costochondritis, Rib Joints and When to Worry
Rib and Chest Wall Pain: Costochondritis, Rib Joints and When to Worry
Quick summary
- Any new chest pain must be assessed for heart and lung causes first. If you have chest pain with breathlessness, sweating, nausea, or pain spreading to the arm, jaw or back, call 000.
- Once serious causes are excluded, chest wall pain is common. Costochondritis, inflammation where the ribs join the breastbone, is a typical example (Proulx & Zryd, 2009).
- Musculoskeletal rib pain is usually reproduced by pressing on the sore spot, deep breathing, twisting or particular movements.
- Most cases settle with time, relative rest from aggravating activities, gentle movement and breathing exercises.
Pain in the ribs or the front of the chest can be frightening, and it is right to take it seriously. This article explains why heart and lung causes must be ruled out first, and then how the more common musculoskeletal causes behave and how they are managed.
Chest pain: rule out the serious causes first
Call 000 immediately if you have chest pain or pressure with any of the following:
- shortness of breath, sweating, nausea, dizziness or fainting;
- pain spreading to the arm, neck, jaw or back;
- sudden severe pain, or pain with coughing up blood;
- a feeling that something is seriously wrong.
See your GP promptly for any new or unexplained chest pain, especially if you have heart disease risk factors, a recent illness, fever, or a recent long flight or surgery. A chiropractor is not the first port of call for undiagnosed chest pain. We screen for these signs at every visit and refer when needed.
Common musculoskeletal causes
Costochondritis
Costochondritis is inflammation of the cartilage where the ribs join the breastbone (sternum). It usually causes sharp or aching pain at the front of the chest, often on one side and over more than one rib. The pain is typically reproduced by pressing on the area and can be worse with deep breaths, coughing or certain movements (Proulx & Zryd, 2009). It is generally self-limiting, though it can take weeks to months to settle fully.
Rib joint irritation at the back
Each rib also attaches to the spine at the back through small joints. When these become irritated, often after twisting, lifting, a coughing fit or a long period of awkward posture, pain can be felt beside the spine and may wrap around the chest wall. It is often sharper with deep breaths, rolling over in bed or rotating.
Muscle strain
The muscles between the ribs (intercostals) and around the chest can be strained by heavy lifting, sport, persistent coughing or sudden twisting.
Rib injury
A fall, sports collision or significant blow to the chest can bruise or fracture a rib. Severe pain after trauma, or pain with breathlessness, needs medical assessment.
Clues that pain is musculoskeletal
- It is reproduced by pressing on a specific spot.
- It changes with movement, posture, twisting or deep breathing.
- It followed a specific activity, strain or coughing illness.
These clues are helpful, but they do not rule out other causes on their own. That is why a medical check comes first for new chest pain.
What helps
- Relative rest: reduce the activities that clearly aggravate the pain for a while, without stopping moving altogether.
- Gentle breathing and mobility: slow, comfortable deep breaths and gentle rotation help keep the rib cage moving.
- Heat and pain relief: heat packs and simple pain relief, as advised by your GP or pharmacist, can ease symptoms.
- Hands-on care: for rib joint irritation at the back, gentle mobilisation and soft tissue work may help some people breathe and move more comfortably, alongside exercise.
- Gradual return to load: reintroduce lifting, sport and upper body training progressively.
Rib pain that's been checked by your GP and is still bothering you?
We assess the ribs, upper back and breathing mechanics and build a plan to help you move and breathe comfortably again.
Frequently Asked Questions
How do I know if chest pain is my heart or a rib?
You can't safely tell on your own. Any new chest pain, especially with breathlessness, sweating, nausea or pain spreading to the arm or jaw, needs urgent medical assessment. Call 000 in an emergency. Once heart and lung causes are excluded, musculoskeletal pain is usually reproduced by pressing on the area or by specific movements.
How long does costochondritis last?
Costochondritis is generally self-limiting, but it can take several weeks to a few months to settle fully. Reducing aggravating activities and gentle movement usually help.
Can a chiropractor help with rib pain?
For rib pain that has been medically cleared and is musculoskeletal, such as rib joint irritation at the back or muscle strain, gentle mobilisation, soft tissue work and exercise may help some people move and breathe more comfortably.
Why does my rib hurt when I breathe in?
Deep breathing moves the ribs and the joints where they attach to the spine and breastbone. If these joints or the surrounding muscles are irritated, breathing in can be painful. Pain with breathlessness, fever or after an injury needs medical assessment.
References
- Proulx, A.M., & Zryd, T.W. (2009). Costochondritis: Diagnosis and treatment. American Family Physician, 80(6), 617–620.
This article is general information, not a diagnosis or a substitute for individual advice from your health professional.
