You cough, sneeze, or laugh and may have felt a pop in your back. Shortly after you start to have a sharp pain in the mid back, little off midline.

Eventually you may even start to have pain wrapping around your side. No position is comfortable, breathing hurts, and forget about laughing! You ice it, put heat on it, take Advil, but nothing is helping at all! You go to the ER or your chiropractor and they say “you have a rib out”. You may think this is very common, but you will soon learn that this is extremely rare to the point that it’s never been seen outside of severe trauma. Rib pain in general is common though, about 20-30% of chest pain is musculoskeletal in origin. Different types of rib pain include: costochondritis, slipping rib syndrome, intercostal neuralgia, and intercostal strain. This blog will only be focusing on costovertebral joint dysfunction in Columbus since that is the most common.

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I Have A Rib Out?

First and foremost we need to go over “rib out” diagnosis and what’s meant by “ribsn coming out”. Costo- means rib and vertebral- means vertebra (spine), so costovertebral joint means where the rib attaches to the spine. Ribs cannot dislocate outside of a serious trauma. In fact, a scholar search of costovertebral joint dislocations resulted in just a few case studies which were all from a severe trauma and all required rib fractures to occur. Sneezing, coughing, laughing, movement, etc., cannot dislocate a rib. The reason for this is because of our natural anatomy.

Below shows a picture of your back, you can see all the ribs are in front of a very strong bony prominence of the spine called “transverse process”. The second picture shows a downward view of the thoracic spine, you can see how each rib is lodged in place creating the joint. Around each one of these joints is a very strong and tight band of ligaments called the joint capsule. Furthermore, there’s also tendons from intercostal muscles and spinal muscles reinforcing these joints.

In order for one of these ribs to dislocate, it would have to completely fracture the transverse process of the spine or tear all the muscles, tendons, and ligaments attaching to them. In which case, this is an emergent referral NOT a chiropractic adjustment fix.

A review study on CT scan imaging of patients after thoracic traumas revealed a range of potential thoracic injuries diagnosed by radiologists. Considering the severity of the traumas described in this paper, not one patient was ever radiologically diagnosed as having a “displaced rib” or a “rib subluxation”. With how rare this is, we should never hang our hat on this diagnosis. In conclusion, rib subluxations have been described, identified and treated for over a hundred years, yet there is still a lack of any scientific evidence supporting the existence of such a phenomenon.

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SO, WHAT IS IT!?

Now this does not mean these joints can’t become painful. In fact, it’s very common for these joints to become irritated. This is called “costovertebral joint dysfunction”. This means that the joint of the rib and spine becomes irritated or restricted in movement due to inflammation, muscle spasms, minor trauma (coughing, sneezing, laughing, falling), nerve irritation, or even restricted movement in the thoracic spine (mid back). When these joints become painful, they can surely bring on some intense pain making it feel like they’re “out”. The reason for this is because ribs are never at rest, they move with every breath you take! Commonly, pain can travel around following the rib and even to the front of the chest. Each rib carries a nerve with it, this is the cause of referral type pain! When palpating (feeling) for the rib that is “out”, commonly there is a lump around the area of pain. Mistakenly, this is thought to be the rib in question being out. In actuality, it is the muscle guarding and spasm with associated inflammation, not the rib.

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CAN WE HELP!?

So, now that we know our ribs don’t pop out, or at least easily, what can we do to help!? Luckily, chiropractic works great with rib type pain. When these joints become “stuck” they can cause a great amount of pain, so adjusting these areas for movement will help. With adjustments, soft tissue work may be needed as well for the residual muscle spasms. We can further advance our treatment with rehab by practicing breathing into the painful side. Like a sore ankle compensating the way we move, we can compensate for our breathing patterns when we have a painful rib.

If this sounds like you, make an appointment and let us help you!!!

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Why Are We Different?

We truly care about you which is why we NEVER make you sign up for any mandatory treatment plans, will not sell you anything extra unless you request it, and make you the center of care with your goals in mind. We offer multiple variations of adjusting patients, full rehab area to accommodate for anyone's needs, and additional therapies such as massage, dry needling, and cupping!

Citations:

Browning, J. R. S. (2021). Evidence-Based Evaluation & Management Of Common

Spinal Conditions. Jam, B. (2015). Ribs don’t Sublux, Ribs don’t “go out”...so what’s going on? Retrieved 2015.