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Rib Stress FractureInjuries > Upper Back & Chest > Rib Stress Fracture(Also known as Stress Fracture of the Rib)What is a rib stress fracture?A rib stress fracture is a condition characterized by an incomplete crack in one of the rib bones. 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. Numerous muscles of the abdomen, shoulder girdle and back attach to one or more ribs. When these muscles contract or are placed on stretch, a pulling force is exerted on one or more rib bones. When these forces are excessive or too repetitive, and beyond what the bone can withstand, bony damage can gradually occur. This initially results in a bony stress reaction, however, with continued damage may progress to a rib stress fracture. Stress fractures of the first rib are occasionally seen in baseball pitchers or tennis players, whilst stress fractures of the fourth and fifth ribs are often seen in rowers. Cause of a rib stress fractureA stress fracture of the rib typically occurs over time with excessive muscle traction on the ribs. Although uncommon, this may be seen in throwing sports (such as baseball pitchers), overhead sports (such as tennis players) or in paddling sports (such as rowers or kayakers). A rib stress fracture often occurs following a recent increase in activity or change in training conditions or technique. A rib stress fracture may sometimes occur traumatically in contact sports from a collision or fall to the ground. Signs and symptoms of a rib stress fracturePatients with this condition typically experience a localized pain in the chest, upper back, shoulder or lower neck that increases with exercise and activities which place strain on the ribs (e.g. rowing, throwing or bumping the ribs). Often the patient may have to stop activity due to the pain. Pain usually decreases with rest. Occasionally, pain may radiate into the back, side of the ribs, shoulder or neck. In severe cases, deep breathing, laughing, coughing or sneezing may also be provoke symptoms. Other symptoms may include night ache or pain on firmly touching the affected region of the bone. Diagnosis of a rib stress fractureA thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose a rib stress fracture. Further investigations such as an X-ray, MRI, CT scan or bone scan are usually required to confirm diagnosis and determine the severity of injury. Prognosis of a rib stress fractureWith appropriate physiotherapy management, most patients with a rib stress fracture can make a full recovery (i.e. return to sport or normal activities) in a period of 6 - 24 weeks. In more severe cases, recovery may take longer. In rare cases, some patients may experience ongoing symptoms or complications which may require further management. Treatment for a rib stress fractureTreatment for a stress fracture of the rib typically involves an initial period of rest from aggravating activity such as non participation in training or sport for a number of weeks. Following this, a gradual increase in activity and exercise can usually occur as tolerated, provided symptoms do not increase. This should take place over a period of weeks to months with direction from the treating physiotherapist and will vary depending on the severity of the injury and how well the contributing factors have been addressed. Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the rib stress fracture altogether. Immediate, appropriate treatment is essential to ensure a speedy recovery. Manual "hands-on" therapy from the physiotherapist such as massage, trigger point release techniques, dry needling, joint mobilisation, stretches, and electrotherapy can assist with hastening healing, improving range of movement, pain and function and correcting factors that have contributed to the development of the rib stress fracture. This can generally commence once the physiotherapist has indicated it is safe to do so. Patients should also perform specific pain free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. In addition, alternative activities which place minimal force through the affected bone should be performed to maintain fitness, such as cycling, walking or possibly running. The treating physiotherapist can advise which exercises and activities are most appropriate for the patient and when they should be commenced. In the final stages of rehabilitation for a rib stress fracture, a gradual return to activity or sport can occur as guided by the treating physiotherapist provided symptoms do not increase. Training technique or training methods may also need addressing to decrease the likelihood of injury recurrence. Contributing factors to the development of a rib stress fractureThere are several factors which may contribute to the development of a rib stress fracture. These need to be assessed and, where possible, corrected with direction from the treating physiotherapist. Some of these factors include:
Physiotherapy for a rib stress fracturePhysiotherapy treatment for patients with a rib stress fracture is vital to hasten healing, prevent injury recurrence and ensure an optimal outcome. Treatment may comprise:
Other intervention for a rib stress fractureDespite appropriate physiotherapy management, some patients with this condition 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, MRI or bone scan, extended periods of rest, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the rib stress fracture. Exercises for a rib stress fractureThe following exercises are commonly prescribed to patients with a stress fracture of the rib. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily once the physiotherapist has indicated it is safe to do so and only provided they do not cause or increase symptoms. Shoulder Blade SqueezesBegin 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 BreathingBegin sitting or standing tall with your back straight (figure 3). Breathe in as deeply as possible without increasing symptoms and then relax. Focus on breathing with your lower lungs (instead of elevating your shoulders) and allow your stomach to gently expand. Repeat 5 times.
Figure 3 – Deep Breathing (in standing) Rotation in SittingBegin sitting tall, with your arms across your chest. Keeping your legs still, gently rotate to one side until you feel a mild to moderate stretch pain free (figure 4). Hold for 1 - 2 seconds and repeat 10 times to each side.
Figure 4 – Rotation in Sitting (left side) Find a PhysioFind a physiotherapist in your local area who can treat a rib stress fracture. Physiotherapy products for a rib stress fracture
To purchase physiotherapy products for a rib stress fracture click on one of the above links or visit the PhysioAdvisor Shop. Other Exercises
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Figure 1 – Relevant Anatomy for a Rib Stress Fracture
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