Rib Pain in Back: When the Rib Joints Are the Problem

Rib pain in the back may develop when movement or strain irritates the joints that connect your ribs to the thoracic spine. The pain often starts beside the spine and may travel around your rib cage. Since several conditions can cause similar symptoms, identifying the exact source is essential for proper treatment.

At Total Orthopedics & Sports Medicine, our specialists first identify whether your symptoms are related to a rib joint or another musculoskeletal problem. After confirming the source of your pain, we develop a treatment plan based on the affected structure and your symptoms. Our goal is to reduce your pain, restore comfortable rib and upper-body movement, and help you return to normal activities. Call 855-321-6784 to book your appointment.

What Causes Back Pain Around the Rib Joints?

Back pain around the rib joints can result from sudden twisting, heavy lifting, repetitive upper-body movements, or sitting in poor posture for extended periods. These activities can place excessive stress on the joints and irritate the surrounding tissues. As irritation progresses, even routine movements may begin to worsen your pain.

Here are some other common causes of back pain around the rib joints:

1. Direct Injury or Trauma

A fall, a sports collision, or a direct blow can injure a rib or the tissues that stabilize its attachment to the spine. The force may stretch supporting ligaments or disturb normal joint movement. As these structures become irritated, pain may worsen when you rotate your upper body, cough, or take a deep breath. More significant trauma can also cause a rib fracture, so persistent pain after an injury needs proper evaluation.

2. Intercostal Muscle Strain

The intercostal muscles extend between your ribs and help with the movement of your rib cage during breathing. Sudden twisting, strenuous exercise, heavy lifting, or repeated coughing can strain these muscles. This strain may cause localized tenderness and pain that worsens when you breathe deeply or move your upper body. Since these muscles surround the ribs, the pain may feel similar to a rib joint problem.

3. Joint Degeneration

The joints where your ribs connect to the spine can gradually wear down with age. These changes may reduce smooth joint movement and lead to stiffness or discomfort. You may notice more pain after long periods of inactivity or repeated upper-body movements. Degenerative changes in nearby areas of the thoracic spine can also contribute to your symptoms.

4. Persistent Coughing

Frequent coughing repeatedly forces the rib cage to expand and contract. This repeated loading can strain the ribs, intercostal muscles, and their surrounding attachments. In some people, forceful coughing can even contribute to a rib fracture. For example, in a 2024 study of 90 patients, researchers found 154 cough-related rib fractures, mostly in ribs 4 through 9.

5. Thoracic Spine Conditions

Pain near the ribs does not always originate from the ribs themselves. Problems in the thoracic spine, particularly the facet joints, can produce pain in the same area. In fact, researchers used controlled diagnostic blocks to evaluate patients with chronic thoracic pain. Results showed that the facet joints were responsible for pain in 34% of participants. Therefore, identifying the exact source of pain is essential for an accurate diagnosis.

6. Slipping Rib Syndrome

Slipping rib syndrome develops when the cartilage supporting the lower false ribs becomes unstable, resulting in abnormal movement. According to a 2023 review, this abnormal movement most often affects ribs eight through ten. As the affected rib moves, it can irritate the nearby intercostal nerve and surrounding tissues. As a result, you may feel sudden, sharp pain along the lower chest region or upper abdomen, sometimes accompanied by a clicking or popping sensation.

7. Rib Joint Dysfunction

Rib joint dysfunction occurs when the joints connecting the ribs to the spine become irritated or do not move properly. Because these joints connect the ribs to the spine, irritation can cause upper back pain around the rib cage. Pain in this area often increases when movements such as twisting, reaching, or deep breathing stress the irritated joint. In some cases, discomfort may also spread from the spine toward the side of the right rib cage.

8. Costochondritis

Costochondritis develops when the cartilage connecting the ribs to the breastbone is inflamed. The condition is more frequently reported in women and commonly affects adults aged 40 to 50. Although the exact cause is often unclear, the resulting symptoms can resemble other causes of chest pain. In particular, costochondritis can mimic cardiac pain, making it difficult to distinguish the source of the pain during the initial evaluation.

Which Rib Joints Can Cause Pain in Your Back?

The costovertebral and costotransverse joints may cause back pain when they are irritated, strained, or injured. These joints connect the ribs to the thoracic vertebrae and help guide rib movement. When either joint is affected, pain may develop near the spine and worsen with movements involving the rib cage.

Although both joints support rib movement, they connect different parts of the rib to the spine. The costovertebral joint connects the head of each rib to the vertebral body. In contrast, the costotransverse joint connects the rib to the vertebra’s transverse process. Because these joints connect to different parts of the vertebrae, the location of pain may vary depending on the affected joint. For example, costovertebral joint irritation may cause localized pain near the spine, while costotransverse joint pain may extend outward along the rib.

What Are the Symptoms of Rib Joint Back Pain?

Rib joint back pain may feel like a localized dull ache or sharp pain along one side of the upper or middle back. The discomfort may spread around the rib cage and become more noticeable with certain movements. Some people may describe it as a sudden, sharp pain under the right rib cage and in the back, especially when twisting or bending.

Here are some other associated symptoms you may experience:

• A feeling of tightness around the rib cage
• Severe chest pain when getting in or out of bed
• Muscle spasms around the painful area
• A clicking or popping sensation
• Pain that interferes with sleep
• Difficulty taking a full breath comfortably

You may also experience pain with chronic coughing, discomfort with deep breathing, or symptoms that worsen when you lie on one side. Although these symptoms may suggest rib joint involvement, they do not confirm the exact source of your pain. Similar pain patterns can develop from the muscles, thoracic spine, or other structures around the chest. To determine the exact source of your symptoms, schedule a consultation at Total Orthopedics & Sports Medicine.

Why Does Rib Pain Get Worse With Deep Breathing?

Rib discomfort can get worse with deep breathing because each deep breath expands the rib cage and increases movement at the rib joints. If a joint or nearby tissue is irritated, this added movement can place more stress on the sensitive area. As a result, you may feel intense pain as you inhale deeply.

Common causes of rib pain that worsen with deep breathing include:

• Intercostal muscle strain: Chest expansion stretches the injured muscles between the ribs.
• Rib fracture or bruise: Deep breathing moves the injured rib, which can increase pain around the damaged area.
• Costochondral irritation: Chest expansion can strain the rib-cartilage junction.
• Thoracic spine problems: Certain spinal conditions can cause pain that becomes noticeable with rib movement.
• Pleurisy: Inflammation around the lungs can cause sharp pain during inhalation.
• Persistent coughing: Repeated coughing can strain the ribs, muscles, and surrounding tissues.
• Pneumonia: Lung inflammation can cause sharp pain with deep breathing.

Which Movements Can Trigger Rib Joint Pain?

Twisting your torso, bending sideways, reaching overhead, and pushing or pulling can trigger rib joint pain. These movements change the position of the rib cage and place additional stress on an irritated joint. As this stress increases, the irritated joint may become more painful during movement.

In addition, a study of 15 patients with costotransverse joint inflammation examined movements that can place stress on these joints. Researchers found that repeated shoulder movements and twisting of the thoracic spine may contribute to inflammation. Similarly, raising your arm while taking a deep breath may increase movement at the ribs’ attachment to the spine. Activities that repeatedly expand the chest may also irritate an already sensitive joint.

A Common Movement Pattern in Patients With Persistent Back Rib Pain

At Total Orthopedics & Sports Medicine, we often see patients who have gradually modified everyday activities because certain movements repeatedly worsen their rib back pain. For example, you may start turning your entire body instead of twisting, avoid reaching overhead, or limit lifting to prevent movements that repeatedly increase your pain.

Over time, these adjustments can begin to interfere with movements you once performed without a second thought. During your evaluation, our doctors assess which movements reproduce your pain and how they affect your daily activities. Then, we use these findings to plan treatment based on the movements you are struggling to perform comfortably.

We continuously monitor these movements throughout your recovery and adjust your treatment plan as your mobility and comfort improve. Consult our specialists to restore movement affected by persistent rib pain.

Can Rib Pain Spread to Your Shoulder Blade?

Yes, rib pain can spread toward the shoulder blade when the joints connecting the ribs to the spine are irritated. Because these joints are located beneath the muscles of the upper back, irritation in this area can produce pain that is felt around the shoulder blade. As a result, you may experience aching, tenderness, or sharp pain along the inner edge of the shoulder.

How Can Arthritis Affect the Ribs in Your Back?

Arthritis can restrict movement in the rib-to-spine joints and increase irritation in the affected area. As the joint surfaces and surrounding tissues degenerate, you may develop stiffness, tenderness, or ongoing discomfort in the affected area. These changes may also increase pain with rib movement during routine activities and breathing.

Here are the main types of arthritis that can affect the rib-to-spine joints:

• Osteoarthritis: Cartilage wear can make the rib-to-spine joints stiff and painful during movement.
• Rheumatoid arthritis: Inflammation within the rib joints can cause stiffness and discomfort during rib movement.
• Ankylosing spondylitis: Inflammation can gradually stiffen the rib-to-spine joints, reducing normal chest expansion.
• Psoriatic arthritis: Swelling and irritation at tendon and ligament attachment sites near the ribs can cause tenderness and discomfort.
• Reactive arthritis: An immune response after certain infections can trigger inflammation in joints, including those connecting the ribs to the spine.

Can Osteoporosis Increase the Risk of a Rib Fracture?

Yes, osteoporosis can increase the risk of rib fractures by weakening the bones and reducing their ability to handle everyday stress. This condition is increasingly common with age, affecting a significant proportion of adults aged 65 and older. As bone mineral density decreases, even a minor fall, forceful cough, or other low-impact stress may cause a rib fracture.

Can a Rib Injury Cause Back Pain Without a Fracture?

Yes, a rib injury can cause rib and back pain without a fracture. A sudden impact or forceful movement may strain the rib joints, cartilage, or surrounding muscles, leading to acute pain or tenderness. You may also notice discomfort with breathing, coughing, or upper-body movement as the injured tissues recover.

In fact, a review of chest trauma in athletic medicine reports that many chest injuries involve simple contusions and muscle strains rather than severe traumatic injuries. These minor injuries can still cause pain even when the rib itself is not fractured. Moreover, the pain can extend toward the back when the injured rib joints and nearby tissues are stressed during normal chest and upper-body movement.

When Does Back Rib Pain Need Urgent Medical Attention?

Sudden or severe pain in the rib area requires prompt medical evaluation, especially when accompanied by trouble breathing, chest pressure, fainting, or weakness. These symptoms may be associated with heart or lung problems, gallbladder infections, or other conditions affecting the structures within the chest. In such cases, seek immediate medical attention instead of waiting for the pain to improve.

Here are other warning signs that may require urgent evaluation:

• Sudden onset of back or chest pain
• Pain spreading toward the shoulder, arm, jaw, or abdomen
• Stabbing pain that rapidly worsens
• Sweating, nausea, or unusual lightheadedness
• Coughing up blood or developing a rapid heartbeat
• New confusion or difficulty staying awake
• Severe pain after a major injury
• Signs of a blood clot, such as sudden swelling in one leg

How Does Joint Pain Differ From a Muscle Strain?

Joint pain is typically felt around the affected joint, while a muscle strain causes pain within the injured muscle. Besides that, muscle pain often increases when the muscle is stretched or contracted. In contrast, joint pain may worsen when the affected joint is stressed during movement.

The following factors can also help distinguish between joint pain and a muscle strain.

Joint Pain	Muscle Strain
May cause joint stiffness	May cause muscle weakness
Can produce clicking or grinding	May cause swelling or bruising
May involve joint swelling	Often develop after sudden, forceful muscle use
Pain may stay around the joint	Pain usually follows the injured muscle
May develop with gradual joint wear	Often improves as the muscle heals

Can a Pinched Nerve Cause Similar Symptoms?

Yes, a pinched nerve can cause similar symptoms when pressure or irritation affects a nerve near the thoracic spine. The pain can extend along the nerve pathway from the spine toward the chest or back. You may also notice tingling, numbness, or burning sensations along its path.

Because the affected nerve travels through the chest wall, nerve irritation can cause pain that travels in a band-like pattern around the torso. The symptoms may also become more noticeable with movements that place pressure on the nerve or surrounding tissues. This overlap can make it difficult to determine whether the pain is coming from a nerve or a rib joint.

How Is the Source of Your Back Pain Diagnosed?

Doctors evaluate your pain pattern, rib and spinal movement, tenderness, and other risk factors to identify the source of your upper or mid-back pain. They may examine specific rib joints, compare movement on both sides, and check whether applying pressure to a particular area reproduces the pain. They may also recommend the following tests while diagnosing the pain source:

• X-ray
• CT scan
• MRI
• Dynamic ultrasound
• Bone scan
• Nerve conduction study
• Electromyography (EMG)

However, doctors select the appropriate test based on the findings from your examination. For example, imaging may be used when doctors need to assess a suspected fracture, spinal condition, or other structural problem. Current American College of Radiology guidance also states that uncomplicated thoracic back pain typically does not require imaging. But persistent symptoms or red flags may require further evaluation.

Can a Diagnostic Injection Confirm the Pain Source?

Yes, a diagnostic injection can help determine whether a specific rib joint is contributing to your pain. A physician injects a local anesthetic into the suspected joint to temporarily block pain signals from that area. If the injection reduces your usual pain, it may indicate that the joint is causing your symptoms.

The extent of pain relief can also help determine whether the targeted joint is contributing to your symptoms. For example, complete relief may suggest that the joint is the main source of pain. On the other hand, partial relief may indicate that another structure is also contributing to your pain. Similarly, little or no relief may suggest that the targeted joint is not the main source of your pain.

How Do Doctors Treat Back Pain From a Rib Joint?

Doctors first recommend rest, activity modification, anti-inflammatory medication, and targeted exercises to reduce irritation and restore comfortable movement. If initial treatment does not provide relief, they may recommend targeted injections or other procedures. But the specific treatment approach depends on the underlying cause, severity of pain, and response to initial care.

Here is how different treatment options may help reduce rib back pain and improve movement:

• Pain relievers: Over-the-counter NSAIDs can relieve costochondritis pain.
• Heat therapy: May reduce muscular tension and improve comfort.
• Ice therapy: Helps limit swelling after an injury.
• Strengthening exercises: Build support for the spine and rib cage.
• Breathing exercises: Maintain comfortable chest and rib movement.
• Rib/thoracic manipulation: May improve mobility in stiff rib and thoracic joints.
• Nerve pain medication: Helps control chronic pain from irritated nerves.
• Targeted injections: Deliver medication directly to an affected rib joint.

If these treatments do not provide lasting relief, doctors may recommend radiofrequency ablation. It uses controlled heat to reduce pain signals carried by nerves around the affected joint. As a result, patients may experience pain relief and improved comfort with movement. In fact, a systematic review and meta-analysis found Level III evidence for radiofrequency neurotomy in managing chronic thoracic facet joint pain. Similarly, a 2024 case report reported three months of pain relief after radiofrequency ablation for costotransverse joint pain.

Which Rib Joint Problems May Need Surgery?

Severe rib instability, symptomatic slipping rib syndrome, and structural damage to the rib or its supporting tissues may require surgery. Doctors may recommend surgery when these problems cause significant pain or abnormal rib movement despite nonsurgical treatment. Depending on the problem, surgery may stabilize or repair the affected structures.

When Can You Safely Resume Normal Activity?

You can safely resume normal activity once you can move, bend, twist, and breathe deeply without increasing your rib pain. You should also regain normal strength and movement before returning to more intense activities. As your pain improves, you can return to normal activity in the following stages:

• Begin with daily activities: Start with walking, dressing, and other light household tasks.
• Increase activity gradually: Slowly increase activity periods while monitoring for any increase in pain.
• Add light exercise: Begin gentle mobility and low-impact exercises once daily activities feel comfortable.
• Begin light lifting: Start with light loads and increase the weight only when you can lift comfortably.
• Resume strenuous activities: Return to heavy work or sports only when the necessary movements no longer increase your symptoms.

Note: Recovery timelines vary depending on the cause and severity of your rib pain. If you have a fracture, significant injury, or ongoing symptoms, consult your doctor before returning to strenuous activities.

Get the Right Diagnosis for Rib Joint Back Pain at Total Orthopedics & Sports Medicine!

Rib joint back pain can be difficult to distinguish from pain caused by nearby muscles or spinal structures. You may also assume the pain will improve on its own or that pain near the ribs must originate from the ribs. But similar rib and back pain can result from several different underlying problems.

At Total Orthopedics & Sports Medicine, our doctors assess the location and pattern of your rib pain to identify the source of symptoms. We also assess how breathing, twisting, posture, and rib movement affect your symptoms. But if the physical examination does not clearly identify the source of your pain, our doctors may use imaging or targeted diagnostic tests. Call 855-321-6784 or visit our clinic to schedule a proper evaluation.

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