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The Gist: What is Rib Pain during pregnancy?

Also known as: “I popped a rib out”

Rib pain is the pain often felt on one side of your rib cage caused by too much or too little movement of one or more ribs.

You may experience pain that wraps from the mid back to the sternum that is sharp, achy, or intense in nature. You likely feel stiffness in the mid back and ribs, and you may have pinpoint tenderness in one spot. It may hurt to take a deep breath, so you may be taking shallow breaths instead. Standing for prolonged periods of time or using your arm may also be difficult. 

The anatomy of Rib Pain

You have 24 ribs total, 12 on each side. The ribs articulate with the thoracic spine and form costovertebral joints. You have muscles between the ribs called your intercostals. The ribs are responsible for protecting the organs in your chest, but they must also move as you breathe. 

Rib pain is often caused by a dysfunction in your costovertebral joint. The joint is either too mobile, which causes the rib to move too much, or too stiff which limits the ability of the rib to move appropriately while breathing. Sometimes, the rib will be too mobile and then may get stuck in the wrong position. 

Who gets Rib Pain? When does it occur for women?

During pregnancy, there is a natural expansion, or flaring, of the rib cage. This is because as the baby grows, it pushes the abdominal organs upward and the ribs flare to create more room. This expansion changes the way the ribs articulate with the spine, which makes the joints more vulnerable. 

Furthermore, during pregnancy and breastfeeding, a woman’s hormones change, which can affect the laxity of the joints, including the now vulnerable costovertebral joints. The joint is typically injured due to an overpressure on the rib from inside the body. This pressure can come from increased intra abdominal pressure, like a cough or sneeze, which can alter the position of the rib in relation to the vertebrae. This pressure can also come from something more physical, like a kick or punch from the growing baby, which can also alter the posture of the rib. 

Typically, rib dysfunctions arise during the second half of the pregnancy as the baby and belly are getting bigger, and it is often seen on the right side due to the location of the liver in the abdominal cavity. It usually goes away after you deliver, but some patients may have lingering rib pain postpartum. 

The Origin Way: Physical therapy for Rib Pain

When assessing your rib pain, we will begin by looking at your posture and the way you breathe. Our treatment plans often include different manual therapy techniques for your mid back and ribs, exercises to improve your postural strength and mobility, and strategies to optimize breathing patterns and posture. Taping techniques are often used to help rib pain as well. 

How long does it take? 

Unfortunately, it is hard to provide a typical recovery timeline with rib pain as we breathe thousands of times per day, which can exacerbate symptoms. Some patients respond within a couple visits, while others may have lingering symptoms.

What to expect in the future

Typically, once your rib pain has subsided you will not have a flare up unless there is some aggravating event like another pregnancy or a lot of coughing. If your rib pain does return, you will have the exercises and strategies to address it. However, if those do not work, you should return to physical therapy for a few visits to expedite the healing process.

Additional Reading and Sources

Strunce, Joseph B, et al. "The Immediate Effects of Thoracic Spine and Rib Manipulation on Subjects with Primary Complaints of Shoulder Pain." The Journal of Manual & Manipulative Therapy, Journal of Manual & Manipulative Therapy, Inc., 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2813499/.

Baitner, A C, et al. "Spontaneous Rib Fracture during Pregnancy. A Case Report and Review of the Literature." Bulletin (Hospital for Joint Diseases (New York, N.Y.)), U.S. National Library of Medicine, 2000.

Shah, Shalini, et al. "Pain Management in Pregnancy: Multimodal Approaches." Pain Research and Treatment, Hindawi, 13 Sept. 2015, www.hindawi.com/journals/prt/2015/987483/.

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