Costovertebral Joint Sprain

Injuries > Upper Back & Chest > Costovertebral Joint Sprain

(Also known as Sprained Costovertebral Joint, Costovertebral Joint Dysfunction, Costovertebral Joint Injury, CV Joint Sprain)

What is a costovertebral joint sprain?

The spine comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the discs centrally (figure 1). These joints are designed to support body weight and enable spinal movement. Each vertebrae in the upper back (thoracic spine) also connects to each rib via the costovertebral joint on either side of the spine.

Each costovertebral joint comprises of smooth cartilage which lies between the bony joint surfaces cushioning the impact of one bone (the rib) on another (the vertebrae). Strong connective tissue also wraps around the bony ends providing support to the joint.

During certain movements of the rib cage and spine, stretching or compressive forces are placed on the costovertebral joints. If these forces are excessive and beyond what the joint can withstand, injury to the costovertebral joint may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. This condition is known as a costovertebral joint sprain.

Causes of a costovertebral joint sprain

Costovertebral joint sprains typically occur during excessive bending, lifting, arching or twisting movements. They may occur traumatically or due to repetitive or prolonged forces.

Signs and symptoms of a costovertebral joint sprain

Patients with a costovertebral joint sprain may experience a sudden onset of upper back and rib pain during the causative activity. However, it is also common for patients to experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms are typically felt on one side of the spine and rib cage and muscle spasm may be experienced around the affected joint. Occasionally pain may be referred along the rib, into the chest, into the shoulder blade or sometimes the upper limb. Symptoms may be exacerbated during coughing, sneezing or deep breathing or with activities that involve twisting, lifting, arching backwards, bending forwards or bending sideways.

Diagnosis of a costovertebral joint sprain

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a costovertebral joint sprain. Investigations such as an MRI or CT scan may be required to confirm diagnosis.

Treatment for a costovertebral joint sprain

Most patients with a costovertebral joint sprain heal quickly and have a full recovery with appropriate physiotherapy. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. Maintaining optimal posture in daily activity is also essential to minimize stress on the costovertebral joint (a postural brace may be required).

Regular icing and anti-inflammatory medication may be beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). This can significantly hasten the healing process by reducing the pain and swelling associated with inflammation.

It is important to perform early movement and strength exercises to prevent stiffness and weakness from developing and to ensure the back is functioning correctly. The treating physiotherapist can advise which exercises are most appropriate and when they should be commenced.

Prognosis of a costovertebral joint sprain

The recovery time for a costovertebral joint sprain may vary from patient to patient depending on compliance with physiotherapy. With ideal treatment, patients may be pain free in as little as several days, although typically this may take 2 – 3 weeks. It is important to note, however, that injured tissue takes approximately six weeks to restore the majority of its strength in ideal healing conditions. Care must therefore be taken when returning to activity during this period.

Physiotherapy for a costovertebral joint sprain

Physiotherapy for patients with this condition is essential to hasten the healing process, ensure an optimal outcome, and reduce the likelihood of future recurrence. Treatment may comprise:

• soft tissue massage
• mobilization
• electrotherapy (e.g. ultrasound)
• postural taping or bracing
• dry needling
• education
• activity modification advice
• ergonomic advice
• Clinical Pilates
• hydrotherapy
• exercises to improve flexibility, strength, posture and core stability

Contributing factors to the development of a costovertebral joint sprain

There are several factors that may contribute to the development of a costovertebral joint sprain. These factors need to be assessed and corrected with direction from a physiotherapist and may include:

• poor posture
• thoracic spine stiffness
• a sedentary lifestyle
• poor core stability
• muscle weakness or tightness
• inappropriate lifting technique
• a lifestyle involving large amounts of sitting, bending or lifting

Other intervention for a costovertebral joint sprain

Despite appropriate physiotherapy management, a small percentage of patients with this condition fail to improve and may require other intervention. This may include pharmaceutical intervention, corticosteroid injection, investigations such as an X-ray, CT scan or MRI, or assessment from a specialist. The treating physiotherapist can advise on appropriate management and can refer to the appropriate medical authority if it is warranted clinically.

Exercises for a costovertebral joint sprain

The following exercises are commonly prescribed to patients with a costovertebral joint sprain. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 - 5 times daily and only provided they do not cause or increase symptoms.

Shoulder Blade Squeezes

Begin sitting or standing tall with your back straight. Squeeze your shoulder blades together as hard and as far as possible pain-free (figure 2). Hold for 5 seconds and repeat 10 times.

Figure 2 – Shoulder Blade Squeezes

Thoracic Rotation in Lying

Begin this exercise lying on your back with your knees bent as demonstrated (figure 3). Slowly lower your knees to one side while keeping your feet and shoulders in contact with the floor. Repeat to the other side. Perform 10 repetitions, going as far as possible without increasing your pain.

Figure 3 – Thoracic Rotation in Lying

Physiotherapy Products for a costovertebral joint sprain

Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:

1. Postural Braces
2. Lumbar Rolls for sitting
3. Ice Packs & Heat Packs
4. Protective Tape (for postural taping)
5. Foam Rollers
6. Spikey Massage Balls

To purchase physiotherapy products for a costovertebral joint sprain click on one of the above links or visit the PhysioAdvisor Shop.

More Exercises

• View more Upper Back Flexibility Exercises
• View more Upper Back Strengthening Exercises
• View Beginner Pilates Exercises (to improve posture)

Find a Physio for a costovertebral joint sprain

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