The rib cage is one part of our skeleton that just about everyone knows. We know where it is. We know what it looks like. We can palpate it on ourselves. But there is always more to learn. Let’s take a look at the bone structure, what it does for our bodies, and explore one injury that can happen – rib subluxation (a rib that has moved out of place).
This post is very personal to me because I recently had a rib subluxation for a week and a half. I thought I fully understood the rib cage before, but once I had something wrong with mine, I realized how vital it truly is. To be fair, most of our body parts and organs are vital. But as you will see, the rib cage is part of our trunk and is near some extremely important organs. I wanted to share my experience because it was something I knew nothing about. I spent days googling my symptoms looking for answers. The pain was intense and I was at my wit’s end. Now that I’m on the mend and explain to people what happened, I also get a lot of questions. So let’s clear those up too.
But first, the bones and structure.
The rib cage consists of 12 rib bones on each side, 24 in total, 12 thoracic vertebrae, and the sternum. The curved rib bones attach to the vertebrae on the back and the sternum on the front. The dark grey areas in the image above represent the cartilage that attaches the bones to the manubrium and body of the sternum. There are joints on the back where the ribs articulate with the vertebrae, but they are much smaller than what we see on the front.
While we have 12 ribs, they are are not all the same. We have 7 true ribs, 3 false ribs, and 2 floating ribs. 1-7 are true ribs, which attach directly to the sternum. 8-10 are false ribs, which attach indirectly to the sternum via the cartilage, aka costal cartilage, of the ribs above them. The lowest ribs, 11 and 12, are floating ribs. As you can see in the drawing, they don’t attach to the sternum at all.
The ribs help protect the heart, lungs, and abdominal organs. However, because the lungs expand and contract when we breath, the rib cage also needs to be able to shift and change. With help from the diaphragm and the intercostal muscles, the rib cage lifts up and out, creating more space between the vertebrae and the sternum as we inhale. That space allows the lungs to take in more air without being restricted. Our false and floating ribs help create that freedom for our respiration.
If you want to feel the expansion of your ribs for yourself, sit comfortably and tall. Wrap your hands around your rib cage with the heel of your palm around the back, palms on the sides, and your fingers on the front of your rib cage. Breath in deeply and you can feel your ribs start to move out in all directions. As you exhale, notice your ribs pull back together.
There are various injuries that can occur with the rib cage, but a rib subluxation was something I hadn’t even heard of before I experienced it. On Google you might also see it as a slipped rib, slipping rib syndrome, or rib separation. There is a lot of controversy in the literature of how to exactly describe a rib subluxation. My doctor told me many people say it as a “rib popped out of place.” More accurately, it’s that a rib has moved out of its normal position.
Ribs can shift forward or back. When that happens, you can feel an indent on one side and the rib sticking out more than usual on the other side. For example, my rib had shifted back. On my front side, my doctor could feel the indentation next to my cartilage, which was very inflamed (more on that in a moment). She then felt on the backside for the corresponding rib, comparing it to my other ribs. It was more prominent.
Rib subluxations can happen because of coughing, sneezing, trauma, or injury. I have also read that hypermobility of the cartilage or ligaments can also cause or make you more susceptible. This doesn’t mean every time you get a cold this could happen, but if you do and start experiencing a pinpointed pain in your chest, seek help.* My doctor told me that after it’s happened once, it is possible and even likely that it can happen again. Take it easy, rest, and be mindful of your movements.
To give a brief backstory, I had been sick for a week, followed by another week of pretty intense coughing. The intercostal muscles, muscles between the ribs, can begin to tighten. I noticed some soreness on the left side of my ribs when I was teaching my classes Friday morning. It wasn’t bad, mostly just noticeable when I opened up my shoulders. However, Saturday night things turned worse. I had my arms outstretched, probably a slight twist of my spine as well, and picked up a glass of water and all of a sudden the soreness turned into pain. I tried toughing it out but ended up searching for the heating pad and stayed in bed the rest of the night.
The next morning, Sunday, the pain was still there and it hurt even more if I breathed too deeply. I went to a clinic, pinpointed where the pain was, and ended up being misdiagnosed with pneumonia. I had no idea what was wrong so I took the antibiotics but the chest pain stayed the same, sometimes growing even worse. It took time to get comfortable sitting. I had to roll to one side and hold my ribs to stand up, trying not to wince. Anytime I used my left arm, from opening the fridge door to turning the steering wheel, to even putting on and taking off clothes, the pain would intensify.
By Thursday I couldn’t take it anymore. I couldn’t focus on anything because I was constantly uncomfortable. Before and after teaching, I would stay in bed wrapped in the heating pad for some temporary relief. I scheduled a doctors appointment but couldn’t get in until the following week so I went to see my chiropractor. He was very gentle and when I pinpointed where it hurt, he told me that was where the cartilage met the bone. We could feel that it was inflamed. I didn’t know it at the time, but it seemed very swollen because of the indentation next to it where my rib normally resided. Cool.
Long story short, that visit helped a lot and started getting the rib back in place, but it wasn’t until the doctor’s appointment that I was told what it exactly it was and have the rib fully glided back into place. I was immediately able to notice a difference with breathing. I felt a light stabbing when breathing deeply before, but after I could breath deeper and while there was still a little discomfort, it was more like a soreness feeling. However, my rib had been out of place for a while so my cartilage was quite inflamed, also known as costochondritis. I was prescribed an anti-inflammatory to take for a week.
As of this post, it has been 2 weeks since that diagnosis. I still have soreness. I’m still battling some inflammation. And sadly, I’m still not practicing much yoga. I have to take it easy and continue to let my body heal. However, things are improving. Driving is still not perfect, but significantly easier. I can breath fully. I can open the refrigerator. I can wear a bra for few hours, but because of the inflammation I’m still opting for long line bras and bralettes.
This experience was really hard, physically and mentally. The journey continues but I appreciate how important the rib cage is for our respiration but also as a piece of our foundation. I say it every time I talk about anatomy, but our body is so connected. The parts of our structure support each other and when one piece is off, it can throw off so much. Don’t take your body for granted and always give it the love and respect it deserves.
*I am not a doctor. I am not a physical therapist. If you are feeling anything like what I’ve described, or something just doesn’t feel right, please seek a medical professional.