The ribs are an important part of posture and an important anchor for many muscles of the spine. Restricted rib joints can manifest as localized pain, or, in the case of intercostal neuritis, pain the follows the ribs around to the sternum. Sometimes there is even pain with breathing which can mimic a heart attack or pulmonary conditions.
Twelve pairs of ribs articulate with each of the twelve thoracic vertebrae. Each rib connects to 2 vertebral levels with 3 small synovial joints as well as a ligament that connects to the disc between the two vertebrae. The top seven ribs attach to the sternum with costal cartilage. Often a restricted rib will feel like it is protruding slightly.
In addition to moving during breathing, the ribs are an attachment point for many muscles including those for the neck (scalenes), low back (quadratus lumborum), and chest (pectoralis minor). With three joints per rib and all the muscular attachments, there is plenty that can go wrong with the ribs. When rib motion becomes restricted, their lack of movement can cause all those muscles to become irritated, resulting in pain that is difficult to identify.
Rib dysfunction is the term used by chiropractors to describe a mechanical problem affecting the joint between the rib and the thoracic spine. Upper rib dysfunction and associated muscle spasm can cause what is called a ‘Thoracic outlet syndrome’, which can cause impaired blood flow and irritate the nerves traveling down the arm causing numbness in the arm and hand. This kind of problem is often caused by poor side sleeping posture.
The upper ribs also work in tandem with the shoulder and shoulder blade (scapula). Full shoulder movement requires the scapula to glide over the ribs, called scapulothoracic movement. Rib dysfunction can cause restricted scapular mobility with pain on shoulder movements. Poor scapulothoracic movement can lead to rotator cuff injuries and should be evaluated when rehabilitating any shoulder injury.
The chiropractic examination is first aimed at ruling out serious medical problems. It is then followed by a detailed examination of the joints and muscles. The aim of the treatment is to restore the movement, reduce pain and reduce the muscle spasm. This is done using a variety of different ‘hands on’ techniques and exercises. Proper chiropractic adjustment to the ribs usually allows patients to breathe easier, reduce pain associated with the area, and improve posture.
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