Have you ever had a sharp stabbing pain, that’s barely out of reach, just inside or underneath your shoulder blade? Believe it or not, you may be bothered by a rib. As always, check any persistent problem with your doctor, but if everything checks out medically, it may help to learn about this little-talked-about area.
First, some anatomy. Both men and women have 12 pairs of ribs. They are attached to the spine by special joints that help support the ribs and rib cage. The ribs then bend around the body to the front and 10 pairs attach to the sternum (breastbone) or cartilage attached to the sternum. The 2 lower pairs are called “floating” because they don’t attach to anything in front.
To get a sense of your rib cage, run your hand down the back of your neck until you come to a vertebra that tends to stick out, at about the top of a shirt collar. The location is typically at or near the end of your neck vertebra (called C7) and the beginning of your mid-back vertebra (named T1). This is the height at which the first rib comes off the spine. The first rib actually courses around to the front of the body underneath the neck and shoulder muscles and sneaks underneath the collarbone. The rest of the ribs follow suit, horizontally bending from back to front under the arm and all the way down the side of the body. Between each rib are 3 layers of muscles that help the ribs move as you breathe.
Ribs also must accommodate to your different body positions. For instance, if you bend to the left, the ribs squish together more on the left as the spine allows the body to bend that way.
Confusion often occurs when chiropractors, osteopaths and manual physical therapists talk about a rib being “out.” To explain this concept, we need to clarify that the rib doesn’t literally “pop out.” The term usually refers to the rib not being in synch or not moving in coordination with the other ribs. This can happen if the attachment of the rib at the vertebra has tightened or become slightly stuck and misaligned.
The muscles between the ribs can also go into spasm because of postural abnormalities or injuries, and prevent the surrounding ribs from moving properly.
Sometimes you can feel some of these problems, especially if they are in the front ribs that are more accessible to your reach. Start with your fingers on your sternum. Now slide off the sternum and place 1 or 2 fingers in the “groove” between the ribs. This groove is where the intercostal muscles are located. See how far you can slide your fingers out to the side. You may feel the groove between the rib get narrower or difficult to follow. Most people have some imbalances, but these are frequently painless. It is usually excessive rotational stress (like raking) or excessive overhead activity that starts to irritate the ribs, especially when postural imbalances are present.
Another way ribs can sometimes be irritated is from tests like mammograms. A person can sometimes be left with residual musculoskeletal pains associated with rib dysfunctions after having this very necessary test. Other tests in which arms are positioned overhead while you lie on your back for extended periods can cause similar problems.
So remember, after your doctor has checked out that nagging pain and everything looks ok medically, a manual therapist skilled in rib problems may be able to help you.