What's Causing This Chronic Rib Pain?

by Celeste Cooper, RN Health Professional

Have you wondered why your ribs hurt? Do you feel as if you can’t take a deep breath? These are important questions to address.

Things to consider

Our rib cage protects many important organs, supports the upper body, and assists with breathing. That’s why it’s imperative to see your doctor first to rule out any serious medical problems. Once that is done, there other things to consider that could be causing your rib pain.

Small, intricate muscles between our ribs allow our rib cage to expand and relax when breathing. When inflammation or restriction of movement affects any part of the rib cage, it causes pain and guarding. Usually, that’s not a bad thing. Guarding can reduce pain and give the ribs time to heal. But it also results in shallow breathing, and possibly poor oxygenation. That’s why it’s important to consider these questions.

  • Has the pain lasted more than three-six months?

  • Does it hurt more when you move, sneeze, cough, or take a deep breath?

  • Have you sustained an injury?

  • Have you recently had a cold or other respiratory infection?

  • Have you changed your level of physical activity?

  • Are you spending too much time in one position?

  • Do you have other symptoms?

  • Do you have a chronic illness that might contribute to the pain?

The pain could be costochondritis or myofascial pain from trigger points in the muscles between the ribs.

What is costochondritis?

Costochondritis is inflammation of the rib cage. Possible causes are injury, infection, or virus. It is not a chronic condition unless it is the result of an underlying chronic disorder.

Generally, treatment is conservative with over-the-counter analgesics, such as ibuprofen or acetaminophen, topical analgesics, ice for the inflammation, and heat to relax the muscles.

Myofascial trigger points

Myofascial trigger points, also called muscle knots, are a common cause of intractable and unusual aches and pains. However, they are under-diagnosed. They cause restriction of movement and pain. You can usually feel the knot by pressing on the painful area, unless it is located underneath the rib or in a chest muscle that is radiating pain to the ribs.

Examples of things that can cause trigger points:

  • Overworking the chest muscles, such as weight lifting or rock climbing. Don’t laugh, athletes develop TrPs too.

  • Improper breathing.

  • Poor posture.

  • Static body positions.

  • Putting an unequal workload on the muscles, such as carrying a heavy purse or backpack.

  • Poor sleeping posture or bedding.

  • Anatomical deformity that causes asymmetry, such as scoliosis.

Treatment of trigger points involves restoring the muscle fiber involved to its normal resting state.

  • Warm up first, maybe a warm shower or heating pad, and take a few deep breathes to make plenty of oxygen available.

  • If you can feel the painful knot, apply 70-80 percent pressure for 30-60 seconds several times a day. A Thera Cane can be particularly helpful in reaching your back and sides.

  • Practice breath work, such as Qi Gong.

  • Regularly stretch the intercostal muscles, all of them, not just the area that hurts. For instance, you can feel the back ribs restriction when breathing into yoga “child’s pose.” Don’t miss the side rib area; provide a stretch by doing a side bend to the left, bringing your right arm over your head as you breath into it, then alternate sides.

  • Use care not to overstretch, which can cause rebound.

Chronic rib pain can be difficult because, like it or not, the ribs of an adult are going to move 16-20 times a minute with respiration. But, by paying close attention to perpetuating factors and the other things mentioned here, we can minimize or even eradicate pain.


Celeste Cooper, RN
Meet Our Writer
Celeste Cooper, RN

Celeste Cooper, R.N., is a freelance writer focusing on chronic pain and fibromyalgia. She is lead author of Integrative therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and the Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain book series. She enjoys her family, writing and advocating, photography, and nature. Connect with Celeste through Twitter @PainedInkSlayer.