The What?
– Rib pain, specifically the upper part can be felt in two main areas, posterior (back) and anterior (chest). Upper rib pain is usually felt as either a sharp or deep dull pain on the inside of the scapula (shoulder blade) or it can be a sharp or dull pain just to the side of the sternum (chest bone). In both cases the pain can be worsened with deep breaths, coughing, pulling, twisting to or sleeping on the painful side.
The Why?
– Rib pain in the upper region has a few main causes that I see on a regular basis which includes: Excessive twisting of the upper body, doing activities that require a pulling motion especially one side dominant, sleeping all the time on the same side, or in some cases from a bad cough. In all these cases there is some degree of the rib being dislodged and subluxated (go out of place).
The How?
– There are a number of methods used at preventing, reducing and eliminating upper rib pain.
Home prevention
1) Avoid always sleeping on the same side- When sleeping all the time on the same side, the joints of the ribs become chronically stretched and loosen due to the weight of the other half of the body. Ideally sleeping on the back would be the best position since it would equally distribute the weight of the upper body. However, alternating sides can be a good alternative by allowing each side to get equal rest.
2) Avoid excessive twisting and one sided pulling- Repetitive twisting (eg. reaching to the back of the car) can cause increase stress of the upper rib joints and lead to the bone going out of place. To avoid this make sure to turn your hips fully with your upper body to reduce stress.
Repetitive or excessive pulling on one side of the body (eg. vacuuming) can cause the muscles of the rib region to overwork and pull the ribs out of place. A good way to prevent this is to remember to alternate between hands with regular activities
Home treatment
3) Ice/heat– Ice in the first day or two helps to numb pain and reduce some muscle spasming. Using either a cold pack, gel pack or even a bag of frozen vegetables for 10-15 minutes can help reduce pain. Allow for at least an hour break in between icing sessions.
Heat after the first couple days provides a better method for healing and relaxing the muscles around the area. Using a hot pack, hot water bottle or heating pad for 10 minutes will help decrease muscle tension and spasms. It is important to remember to wrap multiple layers of towel to prevent skin burns. Even if the heat source does not feel hot, long sustained heat can cause damage to the tissue
4) Compression- A good way for people to deal with pain associated with breathing and coughing is to apply a light compression to the ribs using a tensor bandage (Ace wrap). This helps prevent excess movement of the rib which can cause irritation and sharp pain when taking deep breaths. Apply very lightly to avoid restricting breathing.
5) Ball on the wall- One way to self massage a pesky spot on the back is to use a ball against the wall. Using a ball (eg. Tennis ball) placed against the wall, lean back onto the spot that causes pain and roll the ball around while applying your body weight to massage the area.
Treatment
6) Chiropractic adjustment- the quickest way to alleviate rib pain, is an adjustment to put the rib back into place. While this treatment can be quite intense and painful, the adjustment only lasts a split second. Most people will feel immediate relief of the area. Usually, a few adjustments are required to keep the rib in place.
7) Massage- Treating the muscles and tissue surrounding the rib will help reduce pain and prevent future episodes.
Dr. Alex Murray
