Costovertebral Dysfunction is when one or more ribs become restricted or slightly misaligned from their attachment to the spine. Patients frequently present with rib pain, often believing their ribs are "out of place." Though not a dislocation, this dysfunction is a commonly overlooked cause of chest and abdominal pain. Studies indicate that 10-30% of non-cardiac chest pain originates from musculoskeletal issues. (1)
This condition can mimic other pathologies, making accurate diagnosis crucial. Be sure to tell your provider if your symptoms include any unusual cough, indigestion, nausea, vomiting, fever, flu-like complaints, or if you notice a rash developing along the border of your rib. Seek immediate medical attention if you notice chest pressure, discomfort radiating into your arm and jaw, or shortness of breath. These are possible symptoms of heart problems and must be addressed immediately.
Patients may develop costovertebral dysfunction due to:
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Trauma – Common in athletes involved in wrestling, rugby, football, golf, or swimming.
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Repetitive stress – Postural strain, compression, or rotation-based injuries.
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Pregnancy – Rib and thoracic pain frequently occur due to postural changes.
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Underlying biomechanical issues – Forward head posture, hyperkyphosis, scoliosis, or dysfunctional breathing patterns can predispose patients to rib dysfunction.
Symptoms sometimes begin following sudden, unguarded, or explosive movements, like coughing or sneezing. Patients may report:
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Localized pain 3-4 cm lateral to the spine, sometimes radiating along the rib.
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Sharp, stabbing, or burning pain, often described as feeling like being “shot by an arrow.”
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Increased discomfort with deep breathing, coughing, twisting, or bending.
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Worsening symptoms upon lying down.
What are some in-office treatments for Costovertebral Dysfunction?
Chiropractic care provides an effective, evidence-based approach to treating costovertebral dysfunction. Treatment should focus on:
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Joint Mobilization & Manipulation – Manual adjustments are the cornerstone of treatment, often providing rapid relief.
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Myofascial Release & Stretching – Addressing hypertonic muscles around the thoracic spine and rib cage.
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Postural Correction – Patients with forward head posture, hyperkyphosis, or dysfunctional breathing patterns may require rehab exercises.
What are some at-home treatments for Costovertebral Dysfunction?
At-home exercises can help alleviate symptoms and improve function and mobility. Costovertebral dysfunction exercises could include the Cat/Cow, Foam Roller Thoracic Extensions, and YTWL Scapular Depression.
Conclusion
Chiropractic care is often effective in relieving the symptoms of costovertebral dysfunction. To speed recovery, it is important to avoid activities that increase pain and to initially limit reaching, pushing, and pulling. Women may find rellef by switching to a sports bra to help diffuse pressure on the aching ribs. Sports creams and applying ice for 15-20 minutes directly over the painful area may also provide relief.
References
- National Center for Biotechnology Information (NCBI). Other common causes of chest pain with musculoskeletal origin. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
- Chaves, T. R., Pimenta, P., & Silveira, A. P. (2017). Distal sensory neuropathy and overuse injuries in overhead athletes: A case series. Journal of Athletic Training. 52(8), 756-762.
- ChiroUp Team. Costovertebral Dysfunction: What Chiropractors Need to Know. ChiroUp website and blog. April 03, 2025
