Also called: Costovertebral joint dysfunction; a rib out; costotransverse joint pain
Exercise strongly helps
Stretch
Massage
Strength
Sharp one-sided pain beside the spine, worse on a deep breath or a twist. Each rib meets the spine at two small joints that have to glide with every breath - and when the mid-back stops rotating, those joints take the movement instead.
How common: Musculoskeletal causes account for 10-30% of non-cardiac chest pain and rib joints are a large share of it; commonest in desk workers, new lifters, and after a coughing illness
What it is
Every rib attaches to the spine at two small joints, and both of them glide with each breath and each rotation. They are designed to move constantly and in small amounts.
When the thoracic spine loses rotation - which it does in almost everyone who sits - those joints are asked to supply movement they were not designed to lead. They become irritable, and the resulting pain is characteristically sharp, one-sided, close to the spine, and provoked by a deep breath or a twist.
What it feels like
- Sharp, well-localised pain beside the spine, usually on one side
- A catch on taking a deep breath
- Worse twisting, reaching or rolling over in bed
- Sometimes referring around the ribcage toward the front
- A strong urge to have it clicked, with brief relief afterwards
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.
- Loss of thoracic rotation
- The thoracic spine is built to rotate and is held still for hours. The rotation it gives up is taken by the rib joints, which are designed to follow rather than to lead.
- Sustained flexed postures
- Sitting rounded holds the rib joints at one end of their range for hours. They stiffen there and object when asked to move.
- Shallow breathing
- A full breath moves every rib joint. Breathing only into the upper chest removes that constant gentle mobilisation for most of the ribcage.
- An awkward sudden movement
- Reaching behind into a car, a violent sneeze, or lifting something at an angle can irritate a joint acutely, usually on a background of stiffness.
- Weak mid-back musculature
- The muscles that control the thoracic spine and ribcage are rarely trained. Without them the segments move poorly and unevenly.
- Prolonged coughing
- A persistent cough loads the rib joints repeatedly and is a common precipitant of a first episode.
- Carrying loads asymmetrically
- A bag on one shoulder, or repeated one-sided lifting, loads one side of the ribcage disproportionately.
- Repeated manipulation without changing anything
- Clicking relieves briefly and does not restore the rotation or the strength. People who rely on it alone tend to need it repeatedly.
- Other causes wearing the same disguise
- Shingles before the rash appears, a rib stress fracture, and referred pain from the chest or abdomen can all produce similar pain. New, severe or unexplained thoracic pain is worth having assessed.
Who tends to get it
- Desk workers and drivers with stiff, flexed thoracic spines
- Cyclists and rowers, who spend long periods in thoracic flexion
- Anyone who has had a prolonged cough
- People who carry loads on one side habitually
- Anyone with a history of the same problem, which recurs readily
What makes it worse, and what settles it
Makes it worse
- Long unbroken periods sitting rounded
- Shallow upper-chest breathing
- Twisting under load before the mid-back is moving well
- Relying on manipulation alone without building rotation and strength
- Continuing a cough untreated
Settles it
- Thoracic rotation and extension mobility work, done little and often
- Deep breathing into the lower ribs, which mobilises the joints from the inside
- Mid-back and scapular strengthening so the segments are controlled
- Massage and soft tissue work along the muscles beside the spine
- Breaking up sitting hourly, which is the largest single input
What actually helps
The short version: Each rib meets the spine at two small joints that have to glide with every breath. When the mid-back stops rotating those joints take the movement instead and turn irritable - which is why the pain is sharp, one-sided, and worse on a deep breath or a twist
Strength work: Back: Traps: Middle; Back: Traps: Lower; Back: Rhomboids; Back: Spinal Erectors; Core: Diaphragm; Shoulders: Serratus Anterior
Stretching: Back: Mid-Back; Trunk: Rotation & Side Bend; Spine; Chest
Massage: Back: Upper Back; Back; Chest - along the rib line, and never a percussive tool directly on the spine
Also worth doing: Breathe into the sides and back of the ribcage rather than the top of the chest; rotate the mid-back several times a day; a manual therapist can often settle one quickly
What the evidence says: The honest summary is that this is common, benign once the frightening causes are excluded, and settles with movement of the thoracic spine. Manual mobilisation gives fast relief; the mobility and breathing work is what stops it coming back.
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…
Chest pain with breathlessness, sweating, or radiation to jaw or arm; fever with a cough; pain after a fall in anyone with thin bones; a band-shaped rash - none of those are rib joints
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
Acute episodes usually settle within one to three weeks, and consistent thoracic mobility and strength work substantially reduces recurrence over six to twelve weeks. It is one of the more reliably recurrent problems if nothing changes about the sitting and the breathing. New, severe or persistent thoracic pain - particularly with a rash, with fever, with weight loss, or in anyone with osteoporosis or a cancer history - needs proper assessment rather than mobility work.
Prevalence basis: Non-cardiac chest pain series in primary and emergency care
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.