Rib and Thoracic Pain: Causes, Red Flags and What May Help

Sharp pain which is felt around the ribs or between the shoulder blades brings a particular kind of worry with it because most people’s first thought is that it is to do with their heart. As an experienced chiropractor I can say that rib and thoracic pain is not something to brush off lightly and this page will help you tell the difference between a musculoskeletal problem and a more serious clinical one.

Most musculoskeletal rib and thoracic pain comes from the joints, muscles and ligaments of the mid-back rather than anything more serious, but knowing which is which is important. This page covers both what usually causes rib and chest pain and just as importantly, the signs that mean you should seek medical help instead.

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What is rib and thoracic pain?

 

The thoracic spine is the mid-back section between the top of your shoulder blades running down to just above your lumbar spine (lower back) and it’s where your ribs attach to your spine at small joints called costovertebral joints.

Pain here may come from one of a few sources: irritation of those costovertebral joints, strain in the intercostal muscles that run between your ribs or pain referred from the thoracic spine itself into the chest wall.

If your pain sits lower in your back, in the lumbar region, my back pain guide is likely to be more relevant. Another possible cause of rib pain could be shingles, which is caused by the Varicella Zoster virus, it lies dormant in the nerve roots after you have had chicken pox. It often affects the thoracic nerves T3 – T12 which wrap around the chest and upper abdomen like bands around the rib cage.

What Causes Rib and Thoracic Pain

Prolonged poor posture, particularly hunching over a desk or phone, can be a contributor to rib and thoracic pain, these positions place a sustained load on the joints and muscles of the mid-back. A single awkward movement, an unaccustomed twist, reaching awkwardly or lifting something unevenly, can strain the intercostal muscles or irritate a costovertebral joint. A new or unfamiliar mattress or a bad nights sleep over time could trigger pain. Forceful or prolonged coughing can do the same thing, as can minor trauma such as a knock to the chest or a fall. Referred pain from the thoracic spine, where irritation of the joints or discs in the mid-back is felt around the chest wall rather than the back itself, is also common.

image of a mans body locating rib and thoracic pain with the image of a spine and rib cage

Common causes of rib and thoracic pain

Symptoms of Rib and Thoracic Pain

Patients usually describe symptoms as a sharp, localised pain that gets noticeably worse with specific movements, twisting, reaching overhead or taking a deep breath and a pain that eases with rest or a change in position. Pressing directly on the sore spot, between the ribs or along the spine, often reproduces the pain, which is a useful sign it’s coming from the musculoskeletal structures rather than an internal organ. It’s frequently one-sided and can feel worse when lying on the affected side at night.

In patient terminology, many people describe all of this simply as pain between the shoulder blades. That interscapular ache commonly comes from the thoracic facet joints, from the costovertebral joints where the ribs meet the spine or from the rhomboid and mid-trapezius muscles lying over them. It is frequently put down to a muscle knot when the joint underneath can be the real source.

One thing I always check is whether the pain is actually coming from the neck. The lower cervical spine refers pain into the area between the shoulder blades far more often than most people expect, and someone can have a persistent mid-back ache with no neck symptoms whatsoever. It is a common reason why treatment aimed only at the sore spot does not settle it, and it is why I examine the neck even when the complaint sits squarely between the shoulder blades.

Clinically, these presentations go by several names depending on the exact structure involved. Costochondritis, inflammation where the ribs meet the breastbone, can be a cause of sharp, localised chest wall pain, sometimes with visible swelling in a related condition called Tietze syndrome.

Pain originating more from the spine itself, sometimes called thoracic facet joint pain or thoracic spondylosis, tends to sit further back and can radiate around the ribcage.

Intercostal neuralgia describes nerve-related pain between the ribs, distinct from simple muscular strain, though nerve-related rib pain is less common than mechanical causes.

If you are local to Bournemouth and want to talk things through about any rib or thoracic pain you may be experiencing then do please get in touch.

Leslie Budzynski Chiropractor at his desk in his treatment room at Bournemouth Chiropractic explains how chiropractic may help you to find out more about your rib and thoracic pain Bournemouth

Your Chiropractor Explains How Treatment May Help

What tends to help rib pain most is combining hands-on care with movement advice and addressing any postural or breathing patterns which are contributing to the problem. A systematic review of non invasive treatments for musculoskeletal thoracic spine and chest wall pain found that a broader, multimodal programme, combining manual therapy, soft tissue work, exercise and advice, led to more patients reporting meaningful improvement than a single education session alone.[1] Every plan is individualised: someone whose pain flares with a specific rotation movement needs a different focus to someone whose pain is worse with sustained sitting posture. Most musculoskeletal thoracic pain settles within a few weeks with appropriate care, though recurrent postural strain can take longer to fully resolve if the underlying habits don’t change too. We talk lifestyle and routines through and discuss achievable goals for adaptations and change.

It’s an area where it’s referenced medical evidence is more limited than for back or neck pain. The same review found the overall research quality was sparse and where manipulation alone was studied against placebo, it produced a statistically significant but clinically small short-term improvement in pain, rather than a dramatic one.[1] That’s why the medically evidenced multimodal approach above, rather than manipulation in isolation, is the more realistic expectation and why sticking with the process of care matters as much as any single hands-on treatment visit.

If rib and thoracic pain is causing you discomfort and getting in the way of things you would rather be doing, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

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Or call for a chat on 01202 937568

Red flags: when to seek medical attention first

Most rib and thoracic pain is musculoskeletal and not dangerous, but chest pain has a small number of serious causes that need to be ruled out first. Call 999 immediately if you have chest pain along with any of the following: a heavy, crushing or squeezing sensation rather than a sharp, localised one, pain spreading to your arm, neck, jaw or back, breathlessness, sweating, nausea or feeling faint or pain that isn’t affected by movement, posture or breathing.[2][3] Coughing up blood or sudden severe breathlessness also need immediate emergency attention.[2] Pain between the shoulder blades that comes on suddenly and severely, especially alongside chest pain, breathlessness, sweating or feeling faint, should be treated as a medical emergency and not as a musculoskeletal problem.

If your pain is clearly made worse with specific movements or breathing, reproducible when you press on the area and you don’t have any of the symptoms above, it’s far more likely to be musculoskeletal and a chiropractic assessment can be your next step. If you’ve been checked over and it’s confirmed as musculoskeletal, I’m happy to help you get to the bottom of what’s causing it.

Your First Visit: How to Book In

If your GP or A&E has ruled out anything serious and you come to me with rib or thoracic pain, the first full visit to my chiropractic clinic involves a detailed medical history, a physical assessment to reproduce and localise the pain and an explanation of what’s likely to be causing your rib pain before we agree a plan together.

Frequently Asked Questions

Chiropractic care may help with mechanical rib and mid-back pain, once anything more serious has been ruled out. The thoracic spine and rib joints are a common source of this kind of pain and manual therapy and exercise are reasonable conservative options to consider. At my Bournemouth clinic, careful assessment comes first, because chest and rib pain always needs screening.

The ribs move with every breath, so a joint or muscle problem in that area is often felt more with deep breathing, coughing, or twisting. This pattern usually points to a mechanical cause rather than a lung or heart problem, but I still screen for those possibilities before starting any care.

Most cases improve within a few weeks with appropriate care and activity modification. Pain linked to ongoing postural habits, such as prolonged desk work, can take longer to fully resolve unless those habits change alongside treatment.

Based around my Clinic procedures in Bournemouth I have written a helpful guide to how long your recovery may take, how many treatment sessions you may need and the associated estimated costs involved. A helpful read for you.

Musculoskeletal rib pain is usually reproduced by movement, breathing or pressing on the specific spot and it tends to be sharp and well-localised. Pain that is crushing, spreading to the arm or jaw or comes with breathlessness or sweating is different and needs emergency assessment. If in any doubt, treat it as urgent.

Chest pain can occasionally be cardiac, which is why it’s always worth ruling out first rather than assuming. Pain that’s heavy or crushing, spreads to your arm, neck, jaw or back, or comes with breathlessness, sweating or feeling faint needs a 999 call.[2][3]

Whatever may be behind your rib, thoracic or chest pain, come and find out

There are a lot of possible causes behind rib, thoracic and chest pain and the right first step is always a proper assessment. If that's getting in the way of your day-to-day activities, then I'd happily see you to find out whether chiropractic may help you. During a free 15 minute consultation I can offer advice about how much chiropractic could help you and from there you can book a full consultation, examination and treatment where I'll take a full medical history and conduct a thorough examination and answer your questions about what is going on.

One important note: if chest pain is ever severe or crushing or comes with breathlessness, sweating or pain spreading to your arm or jaw, treat it as an emergency and call 999 first.

Rib and thoracic pain are conditions I see often here in Bournemouth and Poole.

In many of the cases, chiropractic care is a very well-tolerated option and I'll explain clearly whether it's likely to help in your particular case. If I think you'd be better served by your GP, a specialist or another practitioner, I'll point you in the right direction. Either way, you'll leave knowing more than when you arrived.

There's no pressure and no obligation, just come in, get assessed and let's find you a way forward.

The first step is just a conversation. Call or message me, whatever's easiest and we'll take it from there.

References and Further Reading

References

[1] Southerst D, Marchand AA, Cote P, Shearer HM, Wong JJ, Varatharajan S, et al. The effectiveness of noninvasive interventions for musculoskeletal thoracic spine and chest wall pain: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. J Manipulative Physiol Ther. 2015;38(7):521-531. doi:10.1016/j.jmpt.2015.06.001

[2] NHS. Chest pain. nhs.uk/symptoms/chest-pain/

[3] NHS. Symptoms of a heart attack. nhs.uk/conditions/heart-attack/symptoms/

[4] Cloward RB. Cervical discography: a contribution to the etiology and mechanism of neck, shoulder and arm pain. Ann Surg. 1959;150(6):1052-1064.

[5] Slipman CW, Plastaras C, Patel R, et al. Provocative cervical discography symptom mapping. Spine J. 2005;5(4):381-388.

Medical Disclaimer:  The information on this website is provided for general informational purposes only and does not constitute medical advice. It is not a substitute for professional diagnosis, treatment, or guidance from a qualified healthcare practitioner. If you are experiencing pain or any other health concern, you should seek advice from your GP or another appropriately qualified clinician. Chiropractic treatment may not be suitable for everyone. Leslie Budzynski DC will assess your suitability for treatment at your initial consultation and will refer you to another healthcare professional where appropriate. Treatment outcomes vary between individuals. No guarantee of results is made or implied.

Practitioner: Leslie Budzynski D.C. | Doctor of Chiropractic | GCC registration: 00043 | BCA membership number: 0072

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