Rib joint pain, known in the medical fraternity as the costovertebral pain, causes a dull ache in the mid-upper back that can sometimes refer to the front of the chest wall. The pain is aggravated by deep breaths, coughing, movements of your back or rib cage and occasionally neck movements. You might experience any of the following conditions:
- Pain across the upper mid back – often near the joint itself where the ribs attach to your spine
- Pain which radiates to the front of the chest wall, sometimes into the shoulder and arm or along your rib
- Pain with deep breaths, forceful coughing, sneezing or laughing
- Tenderness on palpation over this joint or along the back of the rib
- Tightness in muscles between the spine and shoulder blade
- Pain which is aggravated when moving your chest from side to side
Costo means rib and vertebral refers to the vertebra of the spine, which is where the name of this condition comes from. We have twelve ribs on each side, 10 of which join onto the sternum at the front. What you may not have thought about before is that your ribs also attach to your spine at the back. The joints where your ribs attach to your spine are called the costotransverse joints.
Take a look at this birds eye view picture of one spinal segment in the middle back.
You can see from the picture that the rib attaches to the side of each vertebra through two joints; the costotransverse and the costovertebral joint. Costovertebral pain can come from either of these joints and the ligaments and muscles surrounding it.
What causes costovertebral joint pain?
Anything that puts compression or torsion force through the costovertebral joint can potentially cause pain. Sometimes this could be through a specific forceful incident such as:
- Acceleration/deceleration injuries such as a car accident
- Blunt trauma like falling on your chest or back
Other times there might not be a specific “moment in time” incident but may be caused from repetitive movements like when your trunk and rib cage are rotated or overstretched for long periods of time, such activities can include:
- Repetitive reaching with your hands e.g. painting a high wall or ceiling
- Chopping wood
- Athletes with sports with repetitive throwing or upper body twisting movements e.g. cricket, baseball, rowing.
- Vigorous coughing or sneezes thanks to illness
How does physiotherapy help?
Physiotherapists are the best healthcare professionals to treat this condition. At Fixio Sport Physio we will take a detailed history and do a complete and thorough physical exam focusing on your symptoms and any contributing factors that may be aggravating the pain. Because the pain is around your midback and side we will also do a thorough differential diagnosis to rule out other conditions such as fractures, muscle strains, cardiac conditions, lung problems and renal conditions.
After we give an accurate diagnosis of costovertebral joint pain, we will come up with a treatment plan tailored to your needs. This will involve manual techniques such as
- Mobilisation of the costovertebral joint
- Rotational glide over the rib
- Thoracic joint mobilisations
- Soft tissue massage techniques such as deep friction and trigger point release around the surrounding muscles
- Manipulations when indicated
- Dry needling
This treatment will reduce stiffness and improve muscle function in the area to help unlock your movement. We’ll also focus on specific exercises therapy to prevent recurrence, such as:
- Wall push ups with integrated correct core and shoulder blade positioning
- Chest Rotation exercises while seated
- Shoulder blade strengthening and postural exercises.
These exercises will be designed based on any imbalances identified during the assessment and will help create long lasting pain free function.