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Lower Rib Pain with Deep Breathing – A Case Report

Injury to the bone and/or muscle can cause pain.

Injury to the bone and/or muscle can cause pain.

John Doe came to Cole Pain Therapy Group for evaluation of lower rib pain that began after playing touch football with his kids over the weekend. He had not had any previous pains like this, and there was a sharp pain at his rib with deep breathing. It also felt like a catch when he bent or rotated away from the pain.

Examination of the chest and ribs didn’t reveal any heart or lung problems. Upon close examination of the area of pain, it was apparent that movements which stretched the ribs apart cause more pain. There was stiffness at the mid-back, which did not allow the ribs to move normally.

The ribs move like a bucket handle during deep breathing, which requires motion at the spine/rib junction.

The ribs move like a bucket handle during deep breathing, which requires motion at the spine/rib junction.

The rib pain was from a strain of the muscles between the ribs. The stiffness at his mid back and rib cage was a predisposing factor resulting in an imbalance of movement.

The treatment consisted three sessions of thoracic spine manipulation and manual therapy. The spinal manipulation restores appropriate mobility between each vertebra, and manual therapy at the injured muscle improves the pain and facilitates healing. His symptoms resolved as the area healed over the next 10 days.

The muscles and ribs of the chest wall are responsible for about 45% of chest pain in people who seek non-emergency doctor evaluation. (Eur J Gen Pract. 2009) It is important that physical examination rules out other underlying problems including heart attack, heart disease, and anxiety. When it is found that it is a muscle and joint problem that’s causing the pain, improving how the area works by applying manual treatment, is the best option.  Thoracic spine manipulation is effective for decreasing pain and increasing range of motion (J Man Manip Ther. 2009).

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