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.
Figure 1 – Relevant Anatomy for a Rib Stress Fracture
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 fracture
A 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 fracture
Patients with this condition typically experience a localized pain in the chest or upper back 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 provoke symptoms. Symptoms typically increase on firmly touching the affected region of the bone and occasionally night ache may also be present.
Diagnosis of a rib stress fracture
A 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 fracture
Treatment for a rib stress fracture
Contributing factors to the development of a rib stress fracture
There 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:
- muscle weakness
- poor flexibility
- joint stiffness (particularly of the upper back, shoulder or neck)
- poor posture
- inadequate diet
- inappropriate or excessive training
- inadequate recovery periods from training or activity
- poor training technique
- menstrual disturbance in females
- a lack of fitness or conditioning
Physiotherapy for a rib stress fracture
Other intervention for a rib stress fracture
Exercises for a rib stress fracture
The 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.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.
Shoulder Blade Squeezes
Begin sitting or standing tall with your back and neck straight (figure 2). Squeeze your shoulder blades together as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Hold for 1-2 seconds and repeat 10 times provided there is no increase in symptoms.
Figure 2 – Shoulder Blade Squeezes
Begin 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 Sitting
Begin sitting tall, with your arms across your chest. Keeping your legs still, gently rotate to one side as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 4). Hold for 1 – 2 seconds and repeat 10 times to each side provided the exercise is pain free.
Figure 4 – Rotation in Sitting (left side)
Rehabilitation Protocol for a rib stress fracture
Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:
- Posture Supports
- Ice Packs or Heat Packs
- Foam Rollers (for upper back flexibility exercises)
- Resistance Band (for scapular stability exercises)
- Swiss Balls (for core stability exercises)
- Sports Tape (for postural taping)
To purchase physiotherapy products for a stress fracture of the rib, click on one of the above links or visit the PhysioAdvisor Shop.
Find a physiotherapist in your local area who can treat this condition.
- Read about Posture.
- Read about Posture Taping.
- View detailed information on when to use Ice or Heat .
- View detailed information on initial injury management and the R.I.C.E. Regime.
- View detailed information on Warming Up and Cooling Down.
- View detailed information on Returning to Sport.
- View detailed information on Returning to Running.
- View our Upper Back & Chest Diagnosis Guide.
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