Rib and Back Pain

If an individual is having pain in the front of their body and/or having difficulty breathing, the natural assumption is that they must have injured their ribs in some manner.  However, in many cases issues with the thoracic spinal area can cause as many symptoms in the front of the body as it can in the back.  If you are having pain in the middle of your body, front, back or perhaps both, read on to learn more about what could be causing your pain and more importantly, how to find solutions.

Rib/Thoracic Spinal Anatomy

The thoracic spinal area is located in the mid-back and consists of 12 vertebrae bones with a rib connected on either side of each vertebra.  In the front of the body, the top 7 ribs connect to the breastbone.  Ribs help to protect essential organs such as the heart and liver, along with the lungs and kidneys as well.  Ribs also play a vital role in our ability to breathe, lift, and lower,  thereby allowing the functions of inhalation and exhalation to occur.  Near the top of the thoracic spinal area resides the neck (cervical) part of the spine.  The area directly beneath the thoracic region of the spine is known as the lumbar portion of the spine.  Many muscles involved in shoulder and arm movements, along with rotational movements near the waist are connected in the thoracic portion of the spine.  Of course, the cervical and lumbar area also have many muscles involved in the movement of the spine as well.  All of these spinal portions, along with the ribs in the front make for a very complicated region of the body with regard to breathing, movement, and nerve impulses.


There is a multitude of injuries that can occur throughout the rib/thoracic area.  Some individuals incur injuries in these areas through a vehicle accident or fall.  Others might have some type of contact sports injury or they may have significant issues in the cervical and/or lumbar area which puts additional strain on the thoracic region of the spine as it attempts to pick up the slack.


A patient may have a wide range of symptoms that don’t necessarily pinpoint where the actual issue is stemming from.  Even if an individual has a normal rib cage, they may have difficulty breathing if they are having mid-back muscle spasms, as mid-back pain and extreme muscle tightness can prevent a person from drawing a full breath.  They may have pain or tenderness with simple movements such as carrying a bucket or sneezing, or experience shortness of breath from light activity.  In other cases, patients actually do have a rib problem.  Perhaps they experienced a fractured or broken rib or they may have a condition called “costochondritis”, a condition characterized by inflammation where the ribs connect to the breastbone.


For patients exhibiting rib and/or thoracic spinal pain, a doctor will review all of a patient’s symptoms and will most likely take an X-ray to determine where the pain is coming from.  For those with suspected thoracic issues, a doctor may order an MRI to help them make an accurate diagnosis.  If the issue is muscular in nature or due to a herniated or bulging spinal disc, a doctor will often write a prescription for physical therapy treatment for their patient.

Physical Therapy Solutions

Physical therapists will first provide their patients with a complete evaluation to determine the extent of the injury.  Initially, they will most likely provide pain-relieving measures including heat therapy, ultrasound, and gentle manipulation of the thoracic spine if necessary.  Next, they will introduce stretching exercises designed to increase movement and flexibility such as “threading the needle”, “thoracic windmill” or “child’s pose”, a popular yoga movement.  Eventually, they will follow with strengthening exercises for the mid-body and surrounding areas including the abdominal core muscles, the glutes, hamstrings, and scapular muscles, all of which act as stabilizing muscles.  Exercises might include using a kettlebell and/or doing ab planks or bracing.

If you would like more information about how to regain your mobility and strength after a rib or thoracic spinal injury, please contact us at 570-208-2787 or email us at cawleyptfrank@gmail.com.

Written by Dr. Heather Marsico DPT

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