Getting to the Bottom of Rib Cage Pain

rib cage pain

For physically active people, pain in and around your rib cage can be a real nuisance, slowing you down during daily activities and keeping you awake at night. Because you can see and feel your ribs beneath your skin, you may not think of them as having muscles and connective tissue. But your ribs are held together and supported by soft tissues that can become stiff, inflamed and painful.

Function of the Rib Cage

Your rib cage plays three important roles within your musculoskeletal system::

  • Your ribs provide a rigid protective “cage” that safeguards your heart and lungs.
  • Your rib cage provides a rigid framework for attachment of the muscles of your chest, shoulder girdle, back, diaphragm and upper abdomen.
  • Your rib cage plays an important role in respiration, expanding and contracting as your respiratory muscles, including your diaphragm, work to help you breathe.

Rib Cage Anatomy

Your rib cage defines your body’s thoracic region, and includes your sternum, your 12 thoracic vertebrae and 12 pairs of ribs. All your ribs attach to your thoracic vertebrae — T1 to T12 — at the back of your upper body. In the front, ribs one to seven attach with cartilage to your sternum. Ribs eight through 10 attach to the cartilage of the seventh rib, while ribs 11 and 12 attach only to the vertebrae, with their distal ends floating freely.

rib cage image

The thoracic cage has five sets of muscles that work to expand and contract the thoracic cavity as you breathe. They include the external, internal and innermost intercostal muscles found in the spaces between the ribs, the subcostal muscles found in the lower portion of the thoracic wall, and the transversus thoracis muscles that attach from the back of the lower sternum to costal cartilage of ribs 2-6.

In addition, the pectoralis major and minor, the serratus anterior and the scalene muscles make up part of your thoracic wall. Fascia, a strong sheath of connective tissue, runs all the way from the pelvis to the skull, attaching to the ribs along the way. Injury to fascia is often responsible for rib cage pain.

Symptoms of Rib Cage Pain

Pain in the thoracic region is often caused by stiff, inflamed or injured soft tissue, and it can manifest in a number of ways.

Common symptoms include:

  • Chest pain when breathing
  • Rib pain
  • Being unable to take a deep breath
  • Pain when lying on the affected side
  • Pain that feels like a side stitch you might get while running
  • Pain in the ribs or chest when retracting your shoulder blades
  • Rib cage pain when reaching behind your back

Causes of Rib Cage Pain

Your ribs are designed to be mobile, opening and closing with each breath. However, when soft tissues are injured or abused, your ribs can become rigid, compressed, and deformed, causing pain and impairing fluid movement. Soft tissues of the rib cage can become injured in multiple ways. Some of the most common causes of rib tissue pain include:

  • Coughing and sneezing
  • Throwing heavy objects
  • Contusions from contact sports
  • Swinging motions in sports like tennis, golf and baseball
  • Lack of physical activity that reduces mobility
  • Inflammation
  • Stress
  • Heart disease
  • Rib fractures
  • Rib subluxation (misalignment)
  • Tears or adhesions of the fascia

Other serious conditions can cause rib pain, including an infection or a heart attack.

The Role of Fascia in Rib Cage Pain

Fascia is a dense sheet of tissue made of protein fibers that binds and supports your bones, muscles and vital organs. Fascia is often at the root of chronic rib pain.

Fascia is armed with six times as many sensory neurons as any other body tissue, except the skin. Fascia forms a sort of internal webbing that helps your body’s muscle systems communicate with each other.

Healthy fascia is supple, able to twist, slide and glide beneath your skin like a thin sheet of rubber. When fascia becomes stiff, its nerve endings are suppressed, bringing discomfort throughout your body and sending pain signals to your brain.

Fascia is made of collagen fibers that need to remain supple, so they can glide over and around muscles and other surfaces throughout your body. Dysfunction of the fascia in the thoracic region can cause pain and stiffness, and inhibit the ability of your rib cage to move freely during breathing.

Promoting Healthy Fascia

After extended periods of inactivity like a long day sitting at your desk, a road trip or a good night’s sleep, your muscles may feel stiff and cramped. That stiffness is often caused by parts of your fascia that wrap around your muscle fibers, which are normally elastic and flexible, sticking together.

If you have ever watched a cat getting up from a nap, you will notice that the first thing they do is stretch, releasing fascia fibers and restoring mobility. Gentle stretching before you get moving in the morning, or after a long period of sitting, slowly pulls muscles and connective tissues apart, reducing stiffness and preparing your body for movement. Moving around and even massaging tight areas periodically throughout the day can improve circulation, warm up tissues and keep your fascia from locking up.

Fascia can also become inflamed, twisted and bound up from being active. Repetitive motions, overtraining during sports and exercise and other prolonged physical activities can cause overuse injuries to fascia tissues, resulting in pain and limited range of motion. Giving your body ample time to recover between activity sessions can reduce rib cage pain caused by damaged fascia.

A nutrient-dense diet and adequate hydration can also help to keep muscle and fascia tissues pliable by reducing inflammation and providing the necessary fluid and nutrients for healthy cell formation and function.


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Myofascial Release Therapy for Rib Pain

Adhesions can develop in your fascia, causing it to stick or snag instead of gliding. Because the tissues throughout your body are interconnected, adhesions in one area can affect tissues in other areas. Tight and injured tissue in the thoracic region can interfere with breathing and affect mobility throughout your upper body.

Considering the number of muscles, bones, nerves and connective tissues that converge at the thorax, and the number of attachment points for soft tissue, pain in the rib cage often causes tightness and misalignment in the back as you compensate for rib cage pain. Once tightness in the rib cage is released and the ribs are freely moving, pain and tension in the back is also relieved, and healthy breathing is restored.

Myofascial release therapy Is a highly specialized manual therapy that stretches and softens the fascia and relieves adhesions. Physical therapists use myofascial release techniques to help eliminate rib cage pain and restore healthy fascia.

Rib Pain Treatment in NYC

Pain in the ribs requires specialized treatment from a skilled practitioner. The thorax and ribs are not commonly treated in conventional medicine unless the patient has been injured or feels like a rib is locked up. In most cases, if a rib itself is injured, the patient is reluctant to be touched in that area.

The skilled chiropractors at NYDNRehab know how to work with painful muscles and fascia of the rib cage, to release adhesions and prevent the buildup of scar tissue. You don’t have to live with rib pain. Contact NYDNR today, and get rid of rib cage pain so you can get back to doing the things you love.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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