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Rib pain can be separated into two different categories: traumatic and non-traumatic. The importance of ruling out non-musculoskeletal causes of chest pain/discomfort cannot be overstated, especially those that necessitate immediate treatment, such as ischaemic heart disease. Rib pain can involve the costovertebral, costochondral, and costosternal joints as well as the various attachments of muscles, cartilage, ligaments, and tendons.

Traumatic rib injuries:

  • Are a result of a certain force placed onto the chest cavity causing direct trauma to structures underlying and can result in a fracture of one or more ribs or subsequent bruising and strain of ligaments/muscles in the surrounding tissue.

Non-traumatic rib injuries:

  • Are a result of a condition causing musculoskeletal pain, rheumatic diseases or a systemic non-rheumatological condition

Traumatic: Injuries tend to accompany bruising and swelling as well as pain when breathing and lying on the affected side. A chest deformity may be seen, people have can difficulty sleeping, they can also experience discomfort with movements that require a change in intra-abdominal pressure such as coughing and sneezing.

Non-traumatic: Localised ribcage pain on movement, difficulty sleeping and sometimes pain when taking a deep breath, coughing or sneezing.



  • Risk factors can include being in a motor vehicle accident with a blunt impact to the chest, contact sports, and being diagnosed with osteoporosis/osteopenia subsequently having a fall with impact around the trunk, back and chest area.
  • Life-threatening injuries from chest trauma e.g., a punctured lung, are also possible, so it’s important if you have had a traumatic incident that you visit your closest emergency centre.


  • Thoracic costovertebral joint dysfunction: localised pain 3-4 cm from the midline around the costovertebral joints.
  • Lower rib pain syndrome: Tender areas on the costal margin that cause pain in the lower chest or abdomen that is reproduced by pressure.
  • Pregnancy-related rib pain: Occurs when your muscles and ligaments soften and become more flexible due to the hormone’s relaxin and progesterone during pregnancy. This suggests that the bones of the rib cage may move a little more than they usually do, which can be uncomfortable.
  • Costochondritis: (inflammation of the costochondral joints) Sometimes brought on by strenuous upper body activity, such as weightlifting, or by excessive coughing.
  • Rib Subluxation: Common people to experience this can suffer with Ehlers-Danlos syndrome (EDS), a hypermobility syndrome where people experience joint pain as they can move excessively into ranges causing issues with movement.
  • Elevated first rib: Is where the first rib is elevated and can press on underlying structures causing pain/discomfort. This can fall into the traumatic category if there is a whiplash type mechanism, although it is seen when there has been a lot of overhead movement of the shoulder and/or sleeping with the arm overhead.

Some other common non-traumatic causes:

  • Rheumatic diseases such as: fibromyalgia, rheumatoid arthritis, axial spondylarthritis (including ankylosing spondylitis)
  • Pain referring from thoracic spine/costovertebral joints
  • Sternalis syndrome

Management and Treatment

Your Physiotherapist will complete a thorough subjective and objective assessment. From here, your Physiotherapist in conjunction with your treating GP may organise for imaging to be completed to rule out any fractures or disruption to internal structures.

Traumatic: Treatment will be based on presenting symptoms and include

  • Pain management
  • Rest/ice
  • Protective padding/bracing
  • Exercises to improve posture
  • Joint mobilisation (usually following completion of fracture healing)
  • Soft tissue release
  • Strength and flexibility exercises
  • Prevention of localised lung collapse through breathing exercises
  • Taping techniques
  • Gradual return to activity


  • Joint mobilisations and glides
  • Soft tissue release to the intercostal musculature
  • Strength and flexibility exercises
  • Exercises to improve posture
  • Taping/bracing for extra support
  • Advice regarding activity modification and self-management


  1. Bascom R, Dhingra R, Francomano CA. Respiratory manifestations in the Ehlers–Danlos Syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 2021;187(4):533-548. doi:10.1002/ajmg.c.31953.