Sticky Ribs

Rib pain is a pretty prevalent musculoskeletal complaint, but the cause of it can seem elusive and so we often claim to be an innocent bystander. It can present as a tension or stiffness, usually between the shoulder blades, and can progress to a sharp stabbing pain. It often begins after some incidental movement like reaching for a bottle of shampoo in the shower, or the famous “woke up with it” phenomenon. In all likelihood, it was brewing for a bit longer, it just wasn’t registering on our radar yet. So let’s try to uncover the mystery and take a look at what’s up with misbehaving sticky ribs. 

We usually have 12 paired ribs - remember the body is always allowed to make its own rules so sometimes we have a bonus set and sometimes we can be missing a set. Our ribs (“costals” in medical terms) each have little joints where they meet (“articulate”) with the vertebrae of our spine. The ribs are made of bone at the back and sides and then become cartilage as they wrap around to the front. The first 6 ribs each have their own joints with the sternum in the front, while the cartilage for ribs 7-10 merge together as the “common costal cartilage” which meets the sternum in one joint on each side. Finally, we have the 11th and 12th ribs, which are known as the “floating ribs”. These little guys don’t have a big cartilage portion and don’t attach at the front. We’ve got a tonne of muscles that attach to, between, and near the ribs so I’ll spare you the list. Finally, the diaphragm is a large, flat muscle that looks like a dome on the bottom of the rib cage. Its movement helps create pressure differentials in the lungs so that air will rush into the lungs as we breathe in and be “squeezed out” as we exhale.   

When we look closely, if someone is breathing with the correct pattern, we will see the entire rib cage expand (360 degrees) as the ribs move slightly out, on the inhale and then relax back in on the exhale. Now what the heck happens when a rib goes “out”? Well for starters, barring significant trauma with fractures, let’s just clarify that the rib hasn’t gone anywhere. When a rib joint gets stuck it can sometimes feel like it’s sticking out. Remember those joints we have between each rib and the spine? Those are the ones that usually get stuck. Without having it’s regular motion each breath, there is a bit of swelling that builds up in the joint and then, in an effort to protect the inflamed area, some muscles around that joint contract or spasm - this combo makes the rib feel like it’s sticking out compared to the others around it. 

The severity of symptoms can range quite substantially from mild discomfort to excruciating pain. Sometimes when we turn our head we can even feel it pull into the angry rib. Sometimes it’s painful when we take a deep breath (as the irritated joint tries to move but can’t), and sometimes it seems almost constant. One reason the shoulder blade zone is vulnerable is because we spend a lot of time sitting at desks and typing on keyboards, with a posture that looks more like a curled forward T-Rex than a human. If we aren’t at desks all day, we likely are still doing a lot of tasks with our arms in front of us (driving, cooking, holding devices, caring for children etc), all of which puts a load on that area between the shoulder blades. 

I’ll let you in on a little secret though, there’s also another, lesser known cause of these sticky ribs. And that cause, is emotional stress. We know mechanically (and logically), one of the main jobs of the ribcage is to protect the heart and lungs…did you catch that? The HEART and lungs. When we endure a tough sudden emotional blow like a loss, or even a prolonged period of emotional stress (maybe some fear, anxiety, sadness, etc) our body naturally tenses around our heart to protect it. In doing so, when we inhale, we don’t expand much through the area near the heart and those rib joints can become stuck and swollen because they are missing out on the thousands of mini mobilizations that they would normally get with each breath. 

So we can take anti-inflammatories, use ice and heat, and we can go to the chiropractor, physio or massage therapist… But sometimes, we may also need to acknowledge that perhaps, the cause isn’t entirely mechanical. And that means, the fix might not be entirely mechanical either. If you have had treatment and the symptoms come right back or they need to pull out all the stops and smash it to get it move, then my suspicion for the cause being not entirely mechanical goes up. Certainly, there is a time and place to have that sucker moved “back in”, but we also need to respect what the body is saying. So that means rather than wishing the practitioner would get more aggressive with treatment, we may actually need to take a little step back and respect that our body might not be ready to let go just yet. It might still be trying to protect our heart. 

The body will usually move and release quite nicely when it feels like it is safe to do so. When it doesn’t feel safe, it will put up a fight as it tries desperately to do its job and protect us. If we’ve had our emotional defences dialled up lately, even though the “threat” or event may have passed, we still need to convince our body that it’s safe to let go now. We can do this by brining some awareness to our breath in the sore, stuck area. Because our defence mechanism is subconscious, we’re going to really need to consciously focus on expanding those tight spots out as we breath in. By doing this, we use our breath and conscious awareness to help convince the rib that it’s ok to move again, restoring the rib’s normal motion. Because the force comes from within, this practice can feel safer and encourage the body to drop its high alert defence mechanisms and release (when it’s ready), without rebounding right back again. Relaxation strategies or meditation combined with the breathing may offer an added benefit to help our body reset a bit quicker. 

So for sure, pay attention to the mechanical loading you place on the area, get some treatment, and do the stretches you’ve been given, but if you’re not progressing or are wracking your brain about what might have happened to cause this pain, check in with yourself. Reflect a little on how your emotional self has been doing. It’s quite possible that focusing on breathing into that area and adding a little patience and self-compassion might just be the missing ingredients in the secret sauce for curing those sticky ribs.