Chiropractors frequently treat the painful musculoskeletal issue commonly described as having a “rib out of place.” This condition involves a mechanical problem in the joints connecting the ribs to the spine, leading to significant local discomfort. A professional evaluation confirms whether the symptoms originate from this joint issue, which is highly responsive to manual therapy. This article explores the nature of this rib dysfunction, the process a chiropractor uses to address it, and the necessary safety screening that precedes treatment.
Understanding Rib Subluxation
The sensation of a rib being “out” refers clinically to a Costovertebral or Costotransverse Joint Dysfunction, or a Rib Subluxation. This is not a complete dislocation, but rather a slight positional change or restriction in motion where the rib meets the thoracic spine. This subtle mechanical shift causes irritation to the joint capsule and surrounding ligaments, leading to localized inflammation.
When the rib joint is irritated, nearby muscles, such as the intercostals and paraspinal muscles, tighten up in a protective spasm. This muscle tension further restricts the movement of the rib, often causing a sharp, stabbing pain that worsens with deep breaths, coughing, or twisting. The pain is typically felt near the spine, often described as a tender “knot” or a point of intense soreness beneath the shoulder blade.
This dysfunction can be triggered by minor events due to the delicate balance of the rib cage. Common causes include forceful movements like a sudden sneeze or severe coughing, or repetitive strain from poor posture. Since the ribs must move constantly for respiration, this restricted joint function quickly generates pain that can sometimes wrap around the chest wall.
The Chiropractic Adjustment Process
The objective of chiropractic treatment for rib subluxation is to restore normal movement and alignment to the restricted costovertebral or costotransverse joint. The chiropractor first identifies the exact location and direction of the restriction through palpation and motion testing. Treatment often begins with gentle soft tissue work, such as massage or stretching, to relax the hypertonic muscles surrounding the painful area.
The most common technique used to correct the restriction is a High-Velocity, Low-Amplitude (HVLA) thrust, which is a swift, controlled, and shallow force applied directly to the affected rib joint. A common method is the “hug maneuver,” where the patient wraps their arms around themselves while the chiropractor applies pressure to the back of the rib cage. This specific maneuver uses the patient’s own leverage to facilitate the adjustment. The force is precise and aimed at the specific joint surface to encourage the rib head to move into a more functional position.
During the adjustment, the patient may hear a “pop” or “crack,” known as a cavitation, which is the sound of gas being released from the joint fluid, similar to cracking knuckles. This sound is a byproduct of the movement, and the goal is to restore the joint’s proper range of motion. Many patients report immediate relief of the sharp, stabbing pain following a successful adjustment.
Following the initial adjustment, the treated area can sometimes feel temporarily sore for a day or two. This soreness is typically mild, resulting from the sudden release of tension and the manual manipulation of the surrounding tissues. The chiropractor may also address adjacent spinal segments contributing to the rib dysfunction or use mobilization techniques, which are slower, non-thrust movements, to further improve joint function.
Safety and Medical Screening Prior to Treatment
A thorough safety and medical screening is the first step before a chiropractor treats any patient reporting rib or chest pain. The initial consultation involves a detailed health history, focusing on the nature of the pain, its onset, and any accompanying symptoms. Because rib pain can mimic serious conditions, like cardiac or pulmonary issues, the chiropractor must differentiate the musculoskeletal origin from other potential causes.
A physical examination includes careful palpation of the ribs and thoracic spine to pinpoint tenderness and assess joint mobility. The chiropractor performs specific orthopedic and neurological tests to rule out nerve involvement or other spinal pathology. This examination helps to exclude potential red flags, such as a rib fracture, which requires immediate medical attention.
If a patient reports severe, unrelenting pain, pain that radiates into the arm, or is accompanied by systemic symptoms like fever, dizziness, or shortness of breath, the chiropractor will stop the assessment. The patient will be immediately referred to a medical doctor or emergency care for diagnostic imaging or further testing to rule out non-musculoskeletal pathology. The chiropractor’s role is to ensure the pain is mechanical in origin before proceeding with manual treatment.