Back Rib Pain During Pregnancy: When to DIY v. Virtual Physical Therapy

Why do I have sharp back rib pain during pregnancy - especially on the right side?

During pregnancy, there is a natural expansion, or flaring, of the rib cage to create more room for the growing baby and that expansion can sometimes cause sharp back rib pain. Not exactly what you signed up for, right?

Why does it feel like your “rib popped out”? Typically rib issues during pregnancy occur because of internal pressure. This pressure can change the orientation of the rib, causing the rib to become stuck in a rotated position. While the right side is slightly more common because the pressure from your rib can push the liver higher, back rib pain can pop up on either side anytime during your pregnancy.

“We’ve seen moms with back rib pain who are afraid they won’t be able to push when the time to deliver comes and that’s never something a mom should have to worry about. But if you nip it in the bud, there’s a lot you can do to help relieve the pressure or slow the progression. The goal is to provide more comfort for a patient’s growing belly so women can deliver more confidently and safely when the time comes.” - Dr. Sarah Clampett, PT, DPT

For most pregnant people, back rib pain usually goes away after the delivery if they’re able to address the root cause of the pain early on. For others, back rib pain may sometimes linger postpartum.

More on Medical News Today about causes of rib pain like gallstones and UTIs during pregnancy.

When to DIY for back rib pain relief - and when you should get a physical therapist on Zoom pronto

Without a doubt “don’t wait” scenarios

The truth is rib pain during your pregnancy unfortunately will rarely go away on its own. That’s because it’s either a trauma injury or your own natural rib flaring. In either scenario, it’s not a time to mess around. Back rib pain can progress quickly so don’t wait more than 2-3 weeks to get care. A physical therapy treatment plan can help relieve pain from your upper back and shoulder right away or at the very least can slow the pain significantly to ensure both a safe pregnancy and delivery for you and your child.

Coughing, Sneezing, or Breathing

DIY - If applying light to moderate pressure to the affected rib (this is called a “self-split”) improves the pain when you cough or sneeze, then you’re managing as well as expected on your own. Props to you!

Physical Therapist - If you feel a sharp pain in the back of your rib every time you inhale, cough, or sneeze, it’s time to schedule a virtual physical therapy appointment ASAP. Unfortunately, back rib pain can escalate quickly if you wait too long to get treatment. A women’s health physical therapist can work with you on a treatment plan from your own home to slow the progression of back rib pain. The goal here is to bring the intensity down to a 3/10 on the pain scale so it doesn’t escalate to a 9/10 when it’s time to deliver.

Sleeping

DIY - If you’re not waking up from your back rib pain that’s a win. You may not need to seek a healthcare provider yet.

Physical Therapist - If you’ve googled “how to sleep with rib pain during pregnancy” then let’s get you some professional help. There are tons of reasons why getting a good night's sleep while pregnant, especially in the mid-second or third trimester can be hard to come by - but back rib pain doesn’t need to be one of them! With a few mindful sleeping techniques to safely compress the affected rib, you will be able to greatly improve your sleep quality.

Sitting

DIY - If the pain subsides on it’s own or when you change positions, your pain is likely temporary and may have been caused by gas or bloating. What can we say, it happens.

Physical Therapist - If it feels like your rib “popped out permanently” this is known as a posterior rotation and you should consult a physical therapist. During pregnancy, there is a natural expansion, or flaring, of the rib cage. Because the growing baby pushes the abdominal organs upward the ribs naturally flare to create more room. It becomes a problem though when your rib joints are either too stiff or too mobile and get stuck in that rotated position. It’s incredibly common and should be addressed quickly because a permanent rotation can quickly become intensely painful during other activities like breathing or sleeping–things are already hard enough when you’re pregnant, so it’s important that neither be disrupted!

Walking

DIY - If your back rib pain doesn’t limit your ability to walk for as long as your heart desires then you’re in the clear.

Physical Therapist - If you begin to feel pain while taking regular breaths on your walks, that’s a sign your joints are crying out for help. The good news is, there is lots you can do to alleviate the pressure and nip back rib pain in the bud so you can continue light exercise throughout your pregnancy. Added bonus - staying active helps with labor and recovery!

Household Activities (i.e. bending, lifting, etc.)

DIY - If your back rib pain hasn’t limited your ability to do household tasks like bending to get in the car or raising your arms to get dressed, then keep calm and carry on.

Physical Therapist - We’re all in favor of listening to your body and delegating as much as you need to during your pregnancy. If your back rib pain becomes excruciating while doing load-forward activities like chopping, doing the dishes, laundry, picking things up - or while performing any other job, you should seek a physical therapist telehealth appointment right away. Some of us have partners or parents to get extra household support from, while others of us don’t. No matter what your support-system looks like, feeling like your “rib popping out” is not something you have to soldier on with and can be significantly improved through physical therapy.

Getting Dressed

DIY - If the pain does not affect your clothing choices (like pullover sweaters, bras, pants, etc.) then do your thing!

Physical Therapist - If however, you experience a sharp pain that gets progressively worse over time or the pain under your bra line remains after you’re finished getting dressed, that’s a sign things may get worse. Showing you how to safely do things like getting dressed when you’re pregnant without progressive and excruciating back rib pain is what virtual women’s physical therapy is made for. Your physical therapist can see you in your home setting and make recommendations or modifications to move around pain free.

The Takeaway on Back Rib Pain During Pregnancy

Back rib pain can happen early on and increase during pregnancy as your body naturally makes room for change - however, that doesn’t mean you have to live with it!

Moving more mindfully is an effective method to reduce and slow back rib pain early on so you can confidently stick to your birth plan. And hopefully, focus on enjoying your pregnancy!