Costovertebral joint sprain (Rib sprain)

By Steven Tran –Sydney CBD Chiropractor

First of all Ribs don’t go out… so what is actually going on?

There are several joints in the spine such as intervertebral joints, costotransverse joint, etc. In the thoracic spine, the ribs articulate with both the body of thoracic vertebrae and the transverse processes, the joints that are formed here are called costovertebral joint and costotransverse joints.

Rib subluxation or ribs “going out” is described as a partial dislocation of a rib usually occurring at the costovertebral and/or the costotransverese joints. Despite the lack of any evidence, healthcare providers have regularly proclaim rib subluxation as a common clinical occurrence found in patients with unilateral thoracic pain that radiates to the chest wall.

What may actually be happening is that the supportive ligaments around theses joints (costotransverse, intertrasnverse and radiate (costovertebral) ligaments) are sprained and stressed. Following a major or minor trauma (such as over reaching for an item or sneezing) of a local ligament, local inflammation and local muscle spasms (such as the erector spinae) occurs in the attempt to stabilise the costovertebral and costotransverse joints.

What causes costovertebral joint sprain?

• Sudden acceleration / deceleration injuries
• Blunt trauma to chest and spine
• Overuse or misuse – excessive bending, lifting, arching, reaching or twisting movement.
• Forceful or excessive coughing
• Poor posture (stooped)

The signs and symptoms of costovertebral joint sprain?

• Pain on one side of the spine and rib cage + pain that radiates from mid back around the chest wall
• Mimic pain of cardiopulmonary origins  (chest pains)
• Pain with deep breathing, sneezing and coughing
• Tenderness to palpation over the costovertebral joint
• Muscle spasms around the injured joint

What you can do right now for costovertebral joint sprain?

• Avoid forward flexion, lateral flexion and posterior extension of the spine

• Initially, ice treatment should be tried at home. This will help in reducing pain and swelling. 10 minutes once in every hour

• Exercises: (these exercises should be performed under the supervision of a health practitioner initially)

1. To perform the shoulder blade squeeze exercise, you should sit or stand tall keeping your back in straight line. Then squeeze the shoulder blade (both shoulder blades together) as hard as you can and also to the maximum pain-free limit. Hold this position for at least five seconds and then release it. Start with10 reps and 3 sets, repeat 2-3 times in a day.
2. To perform the thoracic rotation exercises, you should lie down on a flat surface on your back and bend both the knees. Then lower the knees slowly to one side making sure that the shoulders and feet are in contact with the surface of the floor. Then repeat the same to other side with of 10 reps and 3 sets, repeat 2-3 times in a day.

What will a health practitioner do to help with my rib pain:

• Education as to how to protect spine from future injuries
• Education on what needs to be done in case of injuries in future
• Adjustments / Mobilization
• Soft tissue releases
• Dry needling
• Rib taping to compress and stablise the costovertebral joint.  
• Rehab

What’s the recovery time of a costovertebral joint sprain?

The recovery time of a costovertebral joint sprain may vary from patient to patient depending on compliance with treatment plan. With ideal treatment and rehabilitation, patients typically take two-three weeks to recover from the injury.

It is important to note, however, that injured tissue takes approximately six weeks to restore the majority of its strength in ideal healing conditions. To prevent injury recurrence, care must be taken when returning to activity during the healing process. Unsure when you can return to activity? Speak to a health professional to find out more.

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