(Also known as a Bruised Rib, Rib Haematoma)
What is a rib contusion?
A rib contusion (or bruised rib) is a condition that is frequently seen in contact sports and is characterized by soreness in one or more of the ribs, typically following a direct impact (figure 1).
Figure 1 – Relevant Anatomy for a Rib Contusion
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. The intercostal muscles are several groups of muscles that run between the ribs and help form and move the chest wall.
Following a direct blow to the front or side of the chest, or, upper back, stress is placed on the ribs, which may cause injury. This can result in bruising to the ribs and is known as a rib contusion. Sometimes the muscles between the ribs (intercostals) may also be affected. (N.B. If the impact is traumatic and beyond what the rib bone can withstand, a break in one or more of the ribs may occur, when this occurs it is known as a rib fracture).
Occasionally, a rib contusion may occur in association with damage to other organs of the body, such as the lungs, liver, spleen or kidney. This more commonly occurs in severe cases.
Cause of a rib contusion
A rib contusion 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, from a strike to the ribs in martial arts or from an impact from a ball in sports such as hockey or cricket. Rib contusions may also occur during other traumatic events such as a motor vehicle accident or fall from a height.
Signs and symptoms of a rib contusion
Patients with bruised ribs typically experience a sudden onset of chest pain, mid back pain or pain in the side of the ribs at the time of injury that occasionally may radiate into the back, shoulder or neck. Pain may be sharp or dull and can vary in severity.
In minor rib contusions, pain may be minimal allowing continued activity. In more severe cases, patients may experience severe pain, a sensation of feeling ‘winded’ at the time of injury, muscle spasm, weakness and an inability to continue activity. Swelling, tenderness and bruising may also present in the ribs, along with an inability to deep breathe as much as usual.
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, on firmly touching the rib at the site of injury or during deep breathing, coughing, laughing or sneezing. Patients may also experience pain during movements of the upper back such as bending or twisting, or sometimes during certain activities of the upper limb (such as overhead activities, or during heavy pushing, pulling or lifting).
In severe cases of a rib contusion, a visible increase in size of the ribs and intercostals muscles may be detected due to bleeding and swelling. In these cases patients may be unable to sleep due to pain. Occasionally the swelling and bruising may track down to the abdomen or pelvis.
Diagnosis of a rib fracture
A thorough subjective and objective examination from a physiotherapist is important to assist with diagnosis of a rib contusion and to determine the likelihood of associated damage to other organs such as the lungs, liver, spleen or kidneys. Investigations such as an X-ray, MRI or CT scan may be performed to confirm diagnosis and exclude more serious pathology, such as a fracture or damage to internal organs.
Treatment for a rib contusion
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Prognosis of a rib contusion
Patients with a rib contusion usually make a full recovery with appropriate management. Patients can usually return to activity or sport in a number of days or weeks although care must be taken when returning to contact sports as bony bruising is unlikely to fully resolve for a number of weeks (typically 4-6 weeks). In rare cases of severe bony bruising, a full recovery may take a number of months.
Physiotherapy for a rib contusion
Physiotherapy treatment can assist patients with this condition and ensure they have a safe return to activity. Treatment may comprise:
- soft tissue massage
- joint mobilization
- advice on rest from aggravating activities
- dry needling
- protective padding
- exercises to improve posture, flexibility and strength
- activity modification advice
- taping techniques (e.g. postural taping)
- a graduated return to activity plan
Other intervention for a rib contusion
Despite appropriate management, some patients with a bruised rib do not improve adequately and may 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, extended periods of rest, pharmaceutical intervention 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 this condition. 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 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), gently expanding your lower ribs. 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, alternating sides, provided the exercise is pain free.
Figure 4 – Rotation in Sitting (left side)
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Rehabilitation Protocol for a rib contusion
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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
- Resistance Band (for scapular stability exercises)
- Swiss Balls (for core stability exercises)
- Sports Tape (for postural or protective taping)
- Protective Padding
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Find a physiotherapist in your local area who can treat this condition.
- View more Upper Back Stretches.
- View more Upper Back Strengthening Exercises.
- View more Core Exercises.
- View more Scapular Stability Exercises.
- View more Pilates Exercises.
- Read about Posture.
- Read about Postural 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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