Rib Sprain


A rib sprain or also know asĀ  a costovertebral joint sprain is one of the most common conditions seen by osteopaths. As some of you may have seen in the recent Australian Open, Victoria Azarenka took a medical time out during a crucial point after complaining she had severe chest pain and couldn’t breath. This caused a lot of controversy.

Was she truly complaining of these symptoms or was she choking under pressure. All I can say is if these symptoms were true then a rib sprain could be the cause.

Most people find it hard to believe that we can injure our ribs so easily, but did you know that your ribs move with every breath we take. A pair of ribs attach to each vertebrae in the upper back (thoracic spine) via the costovertebral and costotransverse joints on either side of the spine. These joints are protected by strong connective tissues and cartilage.

During certain movements of the rib cage and spine, such as twisting and bending, may cause pulling or compressive forces on the costovertebral joints. If these forces are excessive and beyond what the joint can withstand, injury to the costovetebral joint may occur. This may involve damage to the cartilage or the connective tissue surrounding the joint. Furthermore, the position of the rib may shift and if left untreated can lead to more of chronic problem.

Causes of Rib Sprain

  • Chronic mechanical overloading of the supportive structures of the upper back, neck and shoulder (including muscle, fascia, ligaments and facet joints). This can lead to muscle fatigue and micro-trauma of these tissues causing low or high grade inflammation in areas of strain.
  • Most commonly caused by poor and sustained poor postures.
  • Commonly presents in those spending extended periods of sitting and working on desks and computers; athletes that require excessive arm movement and load such as dancers; or those that require to have a sustained arm posture such as hair dressers.
  • It is theorised that drooping of shoulders, head and neck as a result of stress and other psychological issues may also contribute
  • Pregnancy and recent weight gain.
  • Sedentary lifestyle and obesity
  • Poor bra support.
  • Long history of general poor posture
  • A history of other conditions or injuries that may have been poorly managed which can cause compensatory postural changes
  • Trauma such as sleeping awkwardly, a fall, heavy lifting, or whiplash may also cause the sprain
  • Pre-existing conditions such as some arthritic conditions or degenerative diseases.

Rib Spain Symptoms

  • Generally there will be a slow onset of upper back/shoulder pain.
  • In some cases there may be a sudden acute and sharp pain in the upper back which can cause some shortness of breath.
  • Pain may be exacerbated by deep breathing.
  • The ache will commonly be constant and become worse with certain movements or sustained shoulder use.
  • The pain is often worse towards the end of the day (when the tissues become fatigued).
  • You may get some referred pain either in the front or side of the chest (usually following the path of the rib).
  • You may also experience an increased regularity of headaches (mainly due to postural strain through the neck).

How to Treat Costovertebral Joint Sprain

Your osteopath will take a past medical history and perform a through physical examination to determine the cause of the postural strain. Your osteopath will also screen for other potential causes that may require referral to a specialist.

Generally the cause is multi-factoral and requires a dynamic treatment based on the patient. An important aspect of treatment is to work through causative factors with the patient and devise a management plan to reduce repeat incidences.

Sprain of the Rib Management

  • Lifestyle and ergonomic/work adjustments are most commonly prescribed if the cause is postural strain.
  • Referral to a specialist for imaging if indicated (if suspected other causes such as disc injury, degenerative, congenital, or fracture etc.).
  • A short course of pain reliever or anti-inflammatory medication may assist (as prescribed by your doctor or pharmacist).
  • Stretching and strengthening exercises will be prescribed based on your needs.

Got a sprained rib? Make an Osteo appointment with Mosaic Health Today.


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