Is it a Rib Problem or a Heart Problem?

Rib pain can be very painful. Due to its ability to ‘mimic’ anything from the chest pain of a heart attack to the pain of pneumonia, a true rib problem can be difficult to diagnose.

I frequently find myself finding rib problems that a patient had no idea they had. While everyone knows that they have ribs in their body, many don’t understand their function. Ribs are the least studied bones within our bodies. Why? Perhaps because there are so many of them perhaps? Or is it due to the fact that they make complex joints with other bones in the front and the back of the body, making it difficult to isolate and research them? I think it’s a bit of both.

Ribs are long, flat bones which are also curved. The ribs are aligned in such a way that they form a cage. The rib cage is a protective organ in itself because it houses the human heart and lungs. The rib cage has 12 ribs on each side that are attached directly or indirectly in the front of the body to a flat chest bone called the sternum. The ribs are attached to the spinal bones in the back. This sort of attachment makes the rib cage very strong. It is able to withstand many forces such as jumping, running, etc. Despite its strength, it is also very flexible.

Why Do Ribs Never Stop Moving?

The ribs never stop moving. Regardless of whether you are active or still, awake or asleep, there is something that you never stop doing – breathing!

With every breath, the lungs expand and push against the ribs which cause the ribs to move outward And of course, the exact opposite occurs when you exhale. There are also small muscles in between each rib contract that contract and draw the ribs in and out. Just like other joints and bones in the body, the ribs are prone to problems.

One of the common problems is misalignment – the bones get out of their proper position. The ribs can shift ever so slightly from their connecting joints and that can push on a nerve ending causing exquisite pain. Explaining it like someone stabbing you with a knife would be no exaggeration. Rib pain, as mentioned above, commonly mimics the pain from a heart attack.

Here’s a common scenario: A patient with pain from a rib experiences severe pain in the mid-back region, near the shoulder blade, with radiation to their jaw, shoulder, or upper arm. The pain can also be in the chest. Due to the constancy of the pain, the patient rushes to the ER where investigations are done for heart issues but everything comes back negative. The patient is sent home with pain relievers that help temporarily and the pain returns once the effects of the drug have worn off.

Why Does Misdiagnosis Occur?

I have met patients who have been living with rib pain for weeks and even years. Slight rib misalignments are not detected on Xrays or MRI’s so it is the skill of the clinician that is needed to diagnose the problem correctly.

Unfortunately, traditional practitioners are not well trained in diagnosing rib pain and the result is a lot of misdiagnosing needless drugs, and needless suffering. Another common symptom is that patients may have difficulty breathing. They commonly report that taking a deep breath brings on the pain. They may also have problems in rotating their torso or midsection. Forward or backward bending may be painful too.

I have seen patients assume compensatory postures to accommodate long-standing rib pain. The patient may tilt to the side or slouch, all in an effort to avoid the pain. Patients sometimes perceive that something is ‘out of place, but they think it’s their back and not their ribs. They try various rotatory movements to try to reduce the pain but it’s not successful.

Others might go to massage therapists to reduce the tension in tight muscles, thinking the pain is coming from there. This too is unsuccessful long term.

A Proper Diagnosis is Critical

Here at Root Cause Physical Therapy, we specialize in getting to the root cause of WHY the body is giving you symptoms. Masking a symptom with a drug for temporary relief or treating secondary problems is just not going to resolve the real underlying problem permanently.

As a doctor of physical therapy, I am trained to detect rib problems during my initial evaluation of my patient. Performing a comprehensive history, pertinent orthopedic testing, and manual muscle testing is all done in an effort to understand which rib is posing the problem.

What Does Treatment Consist Of?

Once the problematic rib or ribs is identified, my initial treatment consists of pain management and the release of the associated muscle tension. This is very important because the patient needs to relax and that is difficult when the pain is severe.

Once the pain and muscle tension is taken care of, then, the misalignment can be corrected through specific muscle mobilization techniques, performed by a qualified physical therapist, or a chiropractic adjustment by a doctor of chiropractic.

Once I am satisfied that the correction has been achieved, I proceed to teach the patient-specific exercises to maintain the muscle strength along the ribs. This will hopefully prevent further misalignments from occurring along the rib cage.

In certain chronic cases where the problem tends to recur, the issue may be due to ligament laxity or looseness. Such patients tend to gain benefit from our clinical nutrition department that gets to the root cause of the lax ligaments very successfully. A ribbed belt can provide nice support in the interim as it keeps the ribs stable through external support.