Also called: Rib fracture recovery; cracked rib; breathing exercises after a rib injury
Exercise strongly helps
Breathing
Stretch
Massage
Every breath moves the fracture, so people breathe shallowly to avoid the pain. That collapses the base of the lungs and stops mucus clearing - and pneumonia is what actually harms older people with broken ribs, not the fracture.
How common: Rib fractures are in about 10% of all trauma admissions and are the commonest chest injury after a fall in older adults; pneumonia follows in nearly 1 in 5 older people with even one or two broken ribs
What it is
Ribs heal by themselves in about six weeks and there is no fixing or strapping to be done in most cases. The fracture itself is rarely the problem.
The problem is what the pain does to breathing. Shallow breathing means the small airways at the base of the lungs collapse and secretions are not cleared, which produces atelectasis and then pneumonia. That complication is what causes the deaths and hospital admissions associated with rib fractures in older adults, and it is largely preventable with pain control and deliberate deep breathing.
What it feels like
- Sharp pain at one point on the ribcage, reproducible on pressing
- Severe pain with deep breathing, coughing, laughing and sneezing
- Breathing deliberately shallowly to avoid it
- Pain rolling over in bed and getting up from lying
- Bruising over the area, sometimes appearing days later
What causes it
Most people have more than one of these at once, and they feed each other. Read the
list looking for the two or three that sound like your week rather than for the one
true answer — the ones that describe you are the ones worth acting on.
- Pain-limited shallow breathing
- Deep breaths hurt, so people avoid them. The lung bases are then never fully inflated, which is exactly the condition in which small airways collapse.
- Suppressed coughing
- Coughing is what clears secretions and it is agonising with a broken rib. Retained secretions in poorly ventilated lung bases is the direct route to pneumonia.
- Inadequate pain control
- Under-treated pain is the main modifiable cause of the whole cascade. Adequate analgesia is not comfort care here - it is what allows the breathing that prevents pneumonia.
- Age
- Rib fracture complications rise steeply with age. Reduced respiratory reserve, weaker cough and more comorbidity all contribute, which is why older adults with rib fractures are treated more cautiously.
- Multiple fractures
- Each additional fractured rib increases the risk of complications substantially. Three or more, particularly in an older adult, is a different clinical situation.
- Existing lung disease
- COPD, asthma and any condition reducing respiratory reserve raises the risk of the shallow-breathing complications considerably.
- Smoking
- Impairs the clearance of secretions and reduces respiratory reserve, both of which matter here specifically.
- Strapping or binding the chest
- Historical treatment, now avoided because it restricts breathing further and increases the pneumonia risk. It is still sometimes suggested.
- Prolonged immobility
- Lying still worsens lung ventilation and secretion clearance. Sitting upright and moving is protective.
- Osteoporosis
- A rib fractured from a minor fall or a cough indicates thin bone, which should prompt a bone density assessment - the fracture is a signal, not just an injury.
Who tends to get it
- Older adults, in whom complications are far more likely
- Anyone with three or more fractured ribs
- People with existing lung disease or who smoke
- Anyone whose pain is not adequately controlled
- People who fractured a rib from a minor fall or a cough, which suggests osteoporosis
What makes it worse, and what settles it
Makes it worse
- Shallow breathing to avoid pain, which is the whole mechanism of harm
- Avoiding coughing, which retains secretions
- Strapping or binding the chest, which restricts breathing further
- Lying flat and still for long periods
- Under-treating the pain, which drives all of the above
Settles it
- Adequate pain relief, taken regularly so deep breathing is possible - this is the treatment
- Deliberate deep breathing exercises, ten deep breaths every hour while awake
- Supported coughing - hugging a pillow against the ribs - so secretions are cleared
- Sitting upright and moving about rather than lying still
- Getting bone density assessed if the fracture followed a minor fall or a cough
What actually helps
The short version: Every breath moves the fracture, so the body breathes shallowly to avoid the pain. Shallow breathing collapses the small airways at the base of the lungs, mucus is not cleared, and pneumonia follows - which is what kills older people with broken ribs, not the fracture. The ribs heal by themselves in about six weeks
Strength work: Core: Diaphragm - deep slow breaths to full inspiration, ten every hour while awake, with a hand or pillow held against the sore side; Chest: Intercostals later; Walking from day one
Stretching: Chest; Trunk: Rotation & Side Bend; Back: Mid-Back; Spine - gentle, within pain, from the second week, to stop the whole ribcage stiffening
Massage: Back: Upper Back; Neck - the muscles that guard around the injury; nothing over the fracture
Also worth doing: Take the pain relief regularly so you can breathe deeply - this is the one injury where painkillers are the treatment; cough with a pillow hugged to the chest; sleep propped up; do not strap or bind the chest; no lifting or contact for six weeks
What the evidence says: Deep breathing, incentive spirometry, early walking and effective pain control are the standard of care for rib fractures precisely because pulmonary complications are the danger; a randomized trial found incentive spirometry reduced pulmonary complications after rib fractures, and spirometer volume is used to identify who needs closer care.
The names above are the Targets qFIT tracks —
the Muscle Guide explains what each one does, and
Quick Add switches on the Exercises you
already have.
The qFIT routine for this
Ready-made routineBreathing & Ribcage
qFIT already has this one built. It runs massage first, then stretching, then
strength — the order that works on a body that is already sore — and every
activity in it carries the reason it is there.
The button below opens your Checklist with this routine already selected, so instead
of your whole list you land on just its Categories, Targets
and Exercises, each with its checkbox, ready to tick as you work through
them.
Have more than one problem? Tick yours under My Problems on
My Profile and your Checklist's Routine list gains
Recommended for my problems — every routine for the problems you picked, merged
into one. Your picks stay private; that filter is the only thing they feed.
Get it checked if…
Breathlessness at rest, fever, coughing up blood or discoloured sputum, or pain that suddenly worsens - pneumonia or a collapsed lung; three or more broken ribs, or any rib fracture in someone over 65, usually needs hospital assessment
And whatever the body part: chest pain or unusual breathlessness on
exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and
unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or
one calf that is swollen, warm and painful. Any of those, stop and get assessed.
How it usually goes
Ribs heal in about six weeks and pain usually settles substantially by four. The outcome is determined by whether pneumonia is avoided, which is determined by pain control and deep breathing rather than by anything done to the ribs. Increasing breathlessness, fever, coloured sputum or worsening rather than improving pain needs prompt medical review. A rib broken by a cough or a minor fall should prompt an osteoporosis assessment.
Prevalence basis: Trauma registry data; rib fracture management scoping reviews
Others the same routine covers
These share the Breathing & Ribcage routine, so the work is the same. If one of them also
sounds like you, that is a reason to expect more from it, not less.
This is general information, not a diagnosis, and it cannot examine you.
If it matches you, use it to ask better questions of a clinician rather than to replace one.