Hi everyone, in today’s blog we will be looking into rib pain and specifically pain associated with the area where the rib joins the thoracic spine, this is known as a costovertebral joint dysfunction.

To understand this particular joint dysfunction, it’s important to be familiar with the anatomy. The costovertebral joint is found in the thoracic region of the spine. These joints are made by the connection of the head of the rib to the vertebral column. The head of the rib will align with its corresponding vertebrae and the inferior portion of the vertebrae above.

Surrounding the joint are ligaments which include:

· The Intra-articular ligament – which attaches to the intervertebral disc to the ridge between the 2 facets of the head of the rib.
· Radiate ligament – which is formed by 3 bands that connect the rib head to the vertebral bodies.

Muscles that either innervate or lie over the top of the costovertebral joints include the erector spinae group, multifidus, rotatores, intercostals, serratus posterior inferior, rectus abdominus, and the diaphragm. These muscles act on the ribs and thus the costovertebral joint to expand the rib cage and allow breathing to occur.

The actual amount of movement in the costovertebral joint is very small, however, it has a high frequency of movement due to the rib’s involvement in breathing.

The movement is a gliding motion, in an up-and-down fashion, to increase the volume of the thorax and allow inspiration and expiration.

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We use the analogy of a bucket handle to describe the rising expansion of the ribs during breathing.

A Costovertebral joint dysfunction occurs when there is damage to the connective tissue that surrounds the joint and occurs most commonly when there is a sudden or spontaneous movement involving bending or twisting through the thoracic spine, e.g. turning quickly to look behind you when reversing a car.

Injury can also occur when there is an impact, which forces the joint through a greater range of movement than its normal capacity, for example, a sporting injury or car accident.

Other potential causes include:

· Lifting a load with poor technique or lifting and twisting at the same time.

· An imbalance (tightness vs weakness) between musculature in the thoracic region

· Work that requires repetitive bending, twisting, or lifting

Costovertebral joint dysfunctions typically happen very quickly and as such are usually associated with a sudden pain in the upper back and rib while actively bending, twisting, lifting, or arching. This is then followed by muscle spasm, pain and stiffness that occurs after the activity and may not be felt until the next morning.

Symptoms are generally felt on one side of the spine and rib cage, frequently with muscle spasms and restriction in movement of the injured joint. There may also be a referral of pain around the affected rib and into the chest.

Accompanying symptoms include:

· Pain and restriction on deep breathing as the joint attempts to expand

· Decreased range of motion through the thoracic spine

· Tightness through the chest

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· Inability to stand upright

· Pain on coughing, sneezing, and twisting.

Costovertebral joint dysfunctions can be treated, very effectively, by conservative Physiotherapy, Chiropractic, and Remedial Massage treatment.

Treatment will consist of an initial rest period from any aggravating movements. During this phase your therapist will help alleviate pain and restore movement by mobilizing the thoracic vertebrae and corresponding rib, releasing soft tissue to alleviate surrounding muscle spasms, and providing education as to how to protect the spine from future injuries.

After the pain and inflammation subside, gentle mobility exercises including side bending movement and twisting motions are recommended in order to keep the joint mobility intact, prevent joint stiffness, and improve the ability to deep breathe.

Once full and pain-free mobility has been regained your therapist will prescribe a progressive program of stretching, strengthening, and core stability exercises to maintain your flexibility and minimize the risk of reoccurrence in the future.

Due to the sudden and acute nature of the mechanism of injury, Costovertebral joint injuries can be hard to predict and thus prevent. However, here are 3 tips you can employ to minimize your chance of sustaining a Costovertebral joint injury:

1. Ensure you are lifting loads with the correct technique. Especially if you are lifting repeatedly. Avoid twisting through the spine when lifting. Change direction with your feet.

2. Stretching can be beneficial to avoid future muscle spasms. Please be mindful that to ensure you are doing the correct stretches we recommend you seek guidance from one of our qualified practitioners.

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3. Give your upper back some support by strengthening the muscles that assist in stabilizing and supporting a healthy posture. Such as this shoulder blade squeeze.

So that’s a brief overview of how costovertebral joint dysfunction can occur and how to avoid it. If you have questions or comments, feel free to e-mail us at [email protected] and we will happily answer them for you.