Over the years when I worked in hospitals, I occasionally saw patients who were admitted with chest pain. A heart attack wasn’t the culprit (but of course had to be ruled out), but after many tests and doctor examinations, it was determined that the source of pain was due to inflammation at the joint where the ribs meet the sternum, or breastbone. This condition is known as costochondritis.

The joints where the ribs attach to the sternum do not allow a great amount of motion, but they do glide and can become inflamed or irritated. In many cases, the problem stems from poor posture. When the shoulders and upper back round forward, the chest caves in and the joints at the breastbone get compressed. The pain associated with this often increases with coughing, sneezing, sudden movements, slouching, or stretching the chest.

If you experience any chest pain, it’s essential to seek care from a physician immediately in case it is of cardiac origin (early access to care is the best indicator for positive outcome with coronary events). If they determine that you have costochondritis, you may be prescribed anti-inflammatories and rest or referred to an orthopedist, physical therapist, or chiropractor.

I recommend being very aware and careful with your posture and avoid slouching at all. Use a lumbar support cushion to help maintain upright sitting posture with ease. Deep breathing, gentle chest stretching (as long as it doesn’t increase your pain) and icing the area are also helpful to facilitate healing.

Rib fractures or rib pain due to other sources of trauma to the thorax can be a source of significant pain…why, even breathing can be excruciating. From a medical management perspective, the only real option is prescription medication to reduce pain and allow the individual to function to their highest capacity. As a physical therapist over the past 10 years, I’ve only had a couple of people referred to therapy due to rib fractures. These are techniques I taught them:

1. Deep breathing: With a rib fracture, the action of breathing is painful because when you inhale, the ribcage expands. As a result, people tend to breath in a shallow manner, which can result in respiratory infections. Slow, deep belly breathing will help promote a relaxation response to help decrease pain. In addition, it will keep your lungs healthy as you heal.
2. Splinting: Use a folded blanket or small pillow to hold over the painful area when you cough or sneeze. This provides gentle support to the area to reduce the impact from these forceful actions. You can also splint the area as you transition in and out of bed, again to provide comfort and support.
3. Shoulder roll exercises: In order to protect the body from pain, people with rib fractures (and most other injuries, for that matter) tend to hold themselves in a rigid way, and a lot of tension can build in the neck, shoulders, and upper back. This tension can cause muscle spasm, which causes more pain. Taking the shoulders and gently rolling them up, down, and back will help relax the surrounding muscles and reduce overall pain levels.
4. Sit upright: When sitting in a car, at your desk, or on your couch, sit in a well-supported, upright fashion. Use a pillow or lumbar support pillow to keep your spine aligned. This will reduce the amount of muscle effort needed to sit up, and better posture will reduce the intensity of pain in the ribs that could worsen with slumping or slouching.

It takes approximately 6-8 weeks for a rib fracture to heal in otherwise healthy people. In the interim, hopefully some of these tips will help you to function as comfortably as possible.