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Back Pain in Ribs

Understanding This Symptom

Experiencing thoracic spine and rib pain? Learn more about what could be causing this and the treatment options that can provide lasting relief.

Back pain in the ribs can be a common and often debilitating condition, causing discomfort and limiting mobility for many individuals. The pain can range from mild to severe and may be caused by various underlying conditions.  Understanding the many causes of rib and back pain is important and can assist in securing an accurate diagnosis.  Treatment options vary depending on the underlying cause and severity of symptoms.

What Can Rib And Back Pain Feel Like?

Persistent pain in the ribs that does not respond to conservative therapy can be an indication that there are problems within the musculoskeletal system. Consider it a warning sign that warrants further attention.  Patients with thoracic spine and rib pain have several different symptoms that include:


Pain may be abrupt in onset or insidious.  It can feel like a sharp, stabbing pain or a dull aching pain in the upper back.


Swelling associated with back pain in the ribs can vary in severity depending on the underlying condition or injury. In general, swelling in the back ribs may present as a noticeable bulge or bump on the affected area, or as an area of redness or inflammation around the injured site.


Bruising associated with back pain in the ribs can occur due to trauma or injury to the area, such as a fall or direct blow to the rib cage. The bruising may appear as a discoloration of the skin around the affected area, ranging from red or purple to yellow or green as it begins to heal.

Bruising associated with other conditions, such as inflammation of the rib cartilage (costochondritis) or a herniated disc, may also cause discomfort or tenderness around the affected area, and may limit movement or cause difficulty breathing.

Difficulty Breathing

Difficulty breathing associated with back pain in the ribs can be a serious symptom and may indicate a potentially life-threatening condition. In some cases, the pain and swelling associated with rib injuries can make it difficult to expand the lungs and take deep breaths, leading to a feeling of shortness of breath or difficulty breathing.

Origin Of Rib And Back Pain 

Rib and back pain can be debilitating.  Rib pain can be broadly classified into two categories.

Pain Of Musculoskeletal Origin

Muscles allow us to do everything we enjoy: running, cycling, and walking. Muscles can be injured, causing pain and dysfunction, referred to as pain of musculoskeletal origin.  Acute muscle pain is abrupt in onset and typically sharp and stabbing.  Acute muscle pain can last a few days to weeks. Pain that lasts over three months is referred to as chronic.

Pain Due To Underlying Medical Conditions

Not all pain is of musculoskeletal origin.  The thoracic cavity contains many important structures that can become injured, diseased, or degenerate, causing pain.  Examples of medical conditions that can cause rib and back pain include pneumonia, kidney stone, urinary tract infections,  heart ischemia, intercostal neuralgia, and pleurisy.

 9 Common Causes of Rib And Back Pain

It is important to realize that numerous other causes can cause pain in the ribs and back. The 9 most common include:

1. Poor Posture

Poor posture is increasingly common due to excessive screen time on cell phones and computers.  This can lead to several complications which include rib, and thoracic spine pain, joint and disc degeneration, and head forward posture.

2. Muscle Strains

The thoracic spine and ribs have many small and large muscles that provide support and movement. Examples include the intercostals, trapezius, rhomboids, and latissimus dorsi. A muscle strain is commonly called a pulled muscle and occurs when the muscle is injured through direct or indirect trauma (1).  Pain, swelling, and restricted movement are the common symptoms of muscle sprain.

3. Ligament Sprains

Ligaments are thick pieces of connective tissue that connect bone to bone.  They provide important stability for the ribs and thoracic spine. A sprain involves the overstretching or tearing of the ligaments. Ligament injuries are common, and approximately 17 million injuries per year in the United States (2)

4. Joint Injury or Dysfunction

Three important joints can cause thoracic spine and rib pain. Injury can occur to these joints and is most commonly due to trauma, degenerative changes, and ligament laxity.  The three joints are:

Thoracic Facet Joint

A facet joint is a small paired joint on the backside of the spine that provides important stability, facilitates the transfer of loads, and supports spinal motion (3).  They are present in the lumbar, cervical, and thoracic spine and are susceptible to injury, which can cause thoracic spine and rib pain.

Costotransverse Joint

Costotransverse Joint

One of two important joints is formed by the rib head and the thoracic spine.  It is important in the bucket handle and pump-handle motion of the ribs, which facilitate respiration. 

The joint is surrounded by a capsule and supporting ligaments, all of which are prone to injury and can cause back pain in the ribs. The referral pains of the different costotransverse joints have been established (4).

Costovertebral Joint

The costovertebral joint is formed by the rib head as it joins the vertebral body, forming a joint.  Like the costotransverse joint, it is surrounded by a capsule and supporting ligaments, all of which are susceptible to injury.

5. Organ Dysfunction

The thoracic cavity is full of structures that can become injured or diseased, thereby creating thoracic spine and rib pain.  Examples include the heart, lungs, liver, spleen, and kidneys. Heart attacks, GI reflux, and pneumonia can all cause back pain in the ribs.

6. Infection

Infection in the muscles, bones, thoracic discs, and organs can cause back pain in the ribs.  Herpes Zoster, AKA Shingles, is a viral infection that can cause severe, unrelenting burning pain.  It is typically associated with a red rash that can progress to fluid-filled blisters that are painful

7. Osteoarthritis

Osteoarthritis is the most common form of arthritis and can occur in the thoracic discs, facets, costotransverse and costovertebral joints causing back pain in the ribs.

8. Scoliosis

Scoliosis is a sideways curve of the spine.  It can occur in the cervical, thoracic, and lumbar spine.  The abnormal curve can put excessive pressure and wear and tear on thoracic discs, facets, and costovertebral joints, causing thoracic spine and rib pain.

9. Fibromyalgia

Fibromyalgia is a chronic condition characterized by pain, stiffness, and tenderness in the muscles, tendons, and joints of the body.  The pain is typically widespread and can involve the thoracic spine and ribs.

What You Can Do For The Pain

Treatment options for back pain in the ribs vary depending on the underlying cause and severity.  That is why securing an accurate diagnosis is so important.  For example, the treatment of thoracic spine and rib pain arising from scoliosis is different than pain due to an infection.  When appropriate conservative therapy should always be the first line of treatment. Treatment options include:


Rest is essential in allowing the affected area to heal, including avoiding certain activities that may cause pain or aggravate the condition.


Applying heat can reduce inflammation, increase blood flow and alleviate pain.

Posture Improvement

Improving posture and spinal alignment can reduce thoracic spine pain and rib pain.


Over-the-counter medications such as Ibuprofen, Advil, and Naproxen can effectively relieve rib pain.  These medications should be avoided as they have significant side effects.

Oral Steroids

Steroids are powerful anti-inflammatory agents that reduce swelling and pain. Steroids have significant side effects and may make the underlying condition worse, and for these reasons should be avoided.

Physical Therapy

Physical therapy can help to strengthen the muscles around the affected area, improve flexibility, and alleviate pain.

Chiropractic Care

Chiropractic adjustments can help to realign the rib and surrounding structures, which may help alleviate pain.

Steroid Injections

When conservative treatment options and medication fails, some patients may be referred for a steroid injection. Injections in the thoracic region can not be performed by your PCP or local orthopedic doctor as these are complex injections with significant risks including the collapse of a lung.


Orthobiologics are the use of naturally derived substances in the treatment of common orthopedic conditions.  Examples include PRP and bone marrow concentrate.   To learn more about orthobiologics please click on the video below.

Getting the proper diagnosis is crucial in treating back pain in the ribs because different underlying conditions or injuries can cause similar symptoms of pain in the back, making it difficult to determine the specific cause of the pain without a proper diagnosis. For example, pain in the back ribs could be caused by muscle strain, a rib fracture, a herniated disc, or a pinched nerve.

Each of these conditions may require different treatment approaches, and treating the wrong condition may result in the worsening of symptoms or further injury.

At the Centeno-Schultz Clinic, we are experts in the evaluation and treatment of thoracic spine and rib pain. Board-certified, fellowship-trained physicians review your symptoms, aggravating and alleviating factors, past medical history, past surgical history, and current medications to determine the best regenerative treatment option. 

PRP has concentrated platelets that are rich in growth factors that are vital to initiate and accelerate tissue repair and regeneration.  Bone marrow concentrate which contains stem cells can potentially accelerate tissue repair, thereby reducing pain and increasing function.

Get The Best Treatment For Your Rib And Back Pain 

Thoracic spine and rib pain can be a common and debilitating condition.  The pain can be caused by several underlying conditions that include poor posture, muscle strain, ligament sprain, joint injury, organ dysfunction, infection, osteoarthritis, scoliosis, and fibromyalgia.  Symptoms may include pain, swelling, bruising, and difficulty with breathing.  Securing an accurate diagnosis is critical for the best clinical outcomes.

At the Centeno-Schultz Clinic are experts in the evaluation and treatment of rib and thoracic spine injuries and the use of orthobiologics. We are committed to securing an accurate diagnosis so that an effective treatment plan can be created. 

All injections are performed under x-ray and or ultrasound guidance.  Why? To avoid serious and potentially life-threatening complications such as a collapse of a lung.  Unlike the pain clinic across town or the stem cell clinic that popped up last month in the mall.  To learn more, please click below.

If you or a loved one continue to have back pain in your ribs that have not responded to conservative therapy, oral medications, or physical therapy, please schedule an appointment to learn about regenerative options.  Find a lasting solution for your thoracic and rib pain.  Make an appointment today

Doctors that Can Help You Understand Your Upper Back Pain

Thoracic Spine Physician and Expert

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate and PRP for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI).

1.Maffulli N, Del Buono A, Oliva F, Giai Via A, Frizziero A, Barazzuol M, Brancaccio P, Freschi M, Galletti S, Lisitano G, Melegati G, Nanni G, Pasta G, Ramponi C, Rizzo D, Testa V, Valent A. Muscle Injuries: A Brief Guide to Classification and Management. Transl Med UniSa. 2014 Sep 1;12:14-8. PMID: 26535183; PMCID: PMC4592039.

2.Wu F, Nerlich M, Docheva D. Tendon injuries: Basic science and new repair proposals. EFORT Open Rev. 2017 Jul 27;2(7):332-342. doi: 10.1302/2058-5241.2.160075. PMID: 28828182; PMCID: PMC5549180.

3.O’Leary SA, Paschos NK, Link JM, Klineberg EO, Hu JC, Athanasiou KA. Facet Joints of the Spine: Structure-Function Relationships, Problems and Treatments, and the Potential for Regeneration. Annu Rev Biomed Eng. 2018 Jun 4;20:145-170. doi: 10.1146/annurev-bioeng-062117-120924. Epub 2018 Mar 1. PMID: 29494214.

4.Young BA, Gill HE, Wainner RS, Flynn TW. Thoracic costotransverse joint pain patterns: a study in normal volunteers. BMC Musculoskelet Disord. 2008 Oct 15;9:140. doi: 10.1186/1471-2474-9-140. PMID: 18922181; PMCID: PMC2587465.

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