Something we commonly hear is “I think my rib is out”, but what does that really mean? Is your rib really popping out? How does it happen? What can I do for it? Conditions involving ribs are very painful and often times it is hard to find a comfortable position. Even something as simple as breathing becomes a painful task, and unfortunately we can’t just not breathe. In order to better understand what is happening we have to look a little deeper into anatomy and biomechanics.

Rib Anatomy & Biomechanics

I promise not to bore you with too much anatomy, but it will help to understand what is going on. Typically each human has 12 ribs on each side and attach on the vertebra (back) and the sternum. The first 7 ribs are considered true ribs since each rib attaches directly to the sternum. Ribs 8-10 are considered false ribs because they indirectly connect to the sternum via cartilage, this helps for increased mobility during breathing. Finally ribs 11 and 12 are called floating ribs since they only attach at the vertebra and do not attach to the sternum. The rib attachments on the vertebra are surrounded on the front by the radiate ligament and the inside by intra-articulate ligament between the rib head and the vertebra, both pictured below. It also articulates with the transverse process, which is a bony extension off of the vertebra.

 Radial Ligament (Left) and Intra-articular Ligament (RIght)

Radial Ligament (Left) and Intra-articular Ligament (RIght)

 Rib articulation with the vertebra (back).

Rib articulation with the vertebra (back).

When we breathe, the ribs need to be able to move. The ribs move along two different planes, moving like a pump handle and bucket handle. The sternum and ribs on the front move like a pump handle, while the outer portions of the ribs moves like a bucket handle during breathing, which allows for proper expansion during breathing.

No Parking Zone

The reason for going over anatomy is we can see the ribs are protected by ligaments and other structures to prevent them from “popping out”, and that movement is vital for normal rib function during breathing. So my rib isn’t popping out? Odds are probably not, more likely is your rib is parked (restricted) and not wanting to move during breathing and other activities. The sharp pain during breathing is due to the ribs being restricted and not being able to move like they need. Things that cause rib dysfunction can be attributed to falls, trauma, twisting in an awkward position, and poor breathing.

 A. Show proper rib motion during breathing with the diaphragm dropping down and the pump handle motion. B. Shows the motion of the rib cage during chest breathing. The rib cage shifts straight up and doesn't allow for proper rib motion. We can also see the diaphragm doesn't expand not allowing for full utilization of the lungs. (Image: iptnpt)

A. Show proper rib motion during breathing with the diaphragm dropping down and the pump handle motion. B. Shows the motion of the rib cage during chest breathing. The rib cage shifts straight up and doesn't allow for proper rib motion. We can also see the diaphragm doesn't expand not allowing for full utilization of the lungs. (Image: iptnpt)

Yes, there is a right and wrong way to breathe. It is really common now a days to breathe primarily from our chests and recruit accessory muscles. What happens when we breathe from our chest is we lift the whole rib cage straight up, not allowing for the proper bucket handle and pump handle motion  which can lead to restriction developing.

Hit the Gas

In order to restore proper mechanics of the rib, we have to get it moving again. Most people with rib dysfunction respond well to adjustments because it helps to restore proper motion of the joint allowing for the bucket handle and pump handle motions. The goal of treatment is not only to get you out of pain and restore motion, but to help prevent the issue from coming back again. Unfortunately, people with rib dysfunction commonly have reoccurring episodes, so we have to find the underlying causes. One thing that is seen in individuals with reoccurring rib dysfunction is chest breathing. On top of the adjustment and increasing thoracic mobility, we also must address breathing. We have to start training ourselves to use the diaphragm during breathing instead of accessory muscles to help allow the ribs to move properly.

 One adjustment to help restore rib motion.

One adjustment to help restore rib motion.

 A drill to practice breathing into the abdomen and no the chest.

A drill to practice breathing into the abdomen and no the chest.

TROSS

At TROSS we strive to provide our patients with the best care possible. We have additional training in a variety of techniques to continue to provide our patients with the most up to date care. Our doctors have training in a variety of adjusting and manual therapy techniques, as well as rehabilitation to not only get you out of pain but keep you moving pain-free. If you have any questions or would like a complimentary consultation contact TROSS today! TROSS proudly serves the Cottleville, St. Peters, St. Charles, O’Fallon, and St. Louis area!

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