Rib Fracture

Injuries > Upper Back & Chest > Rib Fracture

(Also known as a Broken Rib, Fractured Rib)

What is a rib fracture?

A rib fracture (or broken rib) is a relatively common condition characterized by a break in one of the rib bones that form the chest and upper back (figure 1).

The chest comprises of 12 rib bones on each side of the body. Each rib attaches to the spine at the back of the body and then travels around to the front of the chest (figure 1). The top 7 ribs attach to the sternum, the 8th to 10 ribs attach to the ribs above via cartilage and the 11th and 12th ribs are known as 'floating' ribs as they are unattached at the front of the chest.

Following a direct blow to the chest, stress is placed on the ribs, which may cause injury. This can result in a bruised rib or if the impact is traumatic and beyond what the bone can withstand a break in the rib may occur. This condition is known as a rib fracture.

Occasionally a rib fracture may result in damage to other organs of the body such as the lungs (e.g. a pneumothorax), liver, spleen or kidney. This more commonly occurs if the fracture is severe and displaced.

Cause of a rib fracture

A rib fracture usually occurs following a traumatic, direct blow to the ribs from an object or person. This most commonly occurs due to a collision with another player during contact sports such as football or rugby, or from an impact from a ball in sports such as hockey or cricket.

Signs and symptoms of a rib fracture

Patients with a broken rib typically experience a sudden onset of chest or mid back pain at the time of injury. Pain is often sharp and intense and may increase during deep breathing, coughing, laughing or sneezing. Patients may also experience an ache in the ribs that is particularly prominent at night or first thing in the morning (particularly the first few days following injury). Pain may increase when lying on the affected side, applying pressure to the rib region or on firmly touching the rib at the site of injury. Patients may also experience pain during movements of the upper back such as twisting, or occasionally, during certain activities of the upper limb (such as overhead activities, or during heavy pushing, pulling or lifting).

Diagnosis of a rib fracture

A thorough subjective and objective examination from a physiotherapist is important to assist with diagnosis of a rib fracture and to determine the likelihood of associated damage to other organs such as the lungs (e.g. a pneumothorax), liver, spleen or kidneys. Investigations such as an X-ray, MRI or CT scan may be performed to confirm diagnosis.

Treatment for a rib fracture

Before commencing treatment, patients with a rib fracture should undergo a thorough medical examination to exclude serious conditions such as a pneumothorax or damage to other vital organs. Once these conditions have been excluded, treatment for a fractured rib typically consists of pain relieving medication and encouragement of deep breathing exercises to prevent localized collapse of the lungs.

It is also important that patients rest sufficiently from any activity that increases their pain. Activities which place large amounts of stress through the ribs should also be avoided, particularly lying on the affected side and direct pressure or impact to the ribs. Rest from aggravating activities allows the healing process to take place in the absence of further 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. This should take place over a period of weeks to months with direction from the treating physiotherapist.

Return to activity or sport is usually appropriate when pain settles and should be guided by the treating physiotherapist. The use of protective padding is important when returning to contact sports following a rib fracture to prevent further injury.

Prognosis of a rib fracture

Patients with a fractured rib usually make a full recovery with appropriate management. Patients can usually return to activity or sport in a number of weeks although care must be taken when returning to contact sports as the rib is unlikely to regain full strength for many months.

Physiotherapy for a rib fracture

Physiotherapy treatment can assist patients with this condition and ensure they have a safe return to activity. Treatment may comprise:

• education
• rest from aggravating activities
• electrotherapy (e.g. ultrasound)
• protective padding
• exercises to improve posture, flexibility and strength, and to prevent localized lung collapse
• activity modification advice
• a graduated return to activity plan
• soft tissue massage
• joint mobilization (usually following completion of fracture healing)

Other intervention for a rib fracture

Despite appropriate management, some patients with a broken rib do not improve and require other intervention to ensure an optimal outcome. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan or MRI or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition.

Exercises for a rib fracture

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

Shoulder Blade Squeezes

Begin sitting or standing tall with your back straight (figure 2). Squeeze your shoulder blades together as far as possible pain-free. Hold for 1-2 seconds and repeat 10 times provided there is no increase in symptoms.

Figure 2 – Shoulder Blade Squeezes

Deep Breathing

Begin sitting or standing tall with your back straight. Breathe in as deeply as possible without increasing symptoms and then relax. Repeat 5 times.

Find a Physio for a rib fracture

Find a physiotherapist in your local area who can treat a fractured rib.

Physiotherapy products for a rib fracture

Occasionally, physiotherapists may recommend products to patients with a broken rib to improve posture and protect the rib from further damage. These products may include:

1. Posture Supports
2. Sports Tape (for postural taping)
3. Protective Padding

To purchase physiotherapy products for a fractured rib click on one of the above links or visit the PhysioAdvisor Shop.

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