Rib pain during running is common. This discomfort can manifest as a dull ache or a sharp, stabbing sensation, occurring on either side of the rib cage. Understanding the potential origins of this pain is important, though it is often temporary and benign.
Musculoskeletal Explanations
The network of muscles, bones, and cartilage around the rib cage can be a primary source of pain during running. Repetitive motions and deep breathing can strain the intercostal muscles, located between the ribs. These muscles assist with breathing and provide structural support; their overuse or sudden movements can lead to micro-tears or spasms, causing localized pain.
Another musculoskeletal cause is costochondritis, an inflammation of the cartilage connecting the ribs to the breastbone (sternum). This condition causes sharp, localized pain that worsens with deep breaths, coughing, or physical activity. Repetitive stress or minor trauma can exacerbate inflammation in the costosternal joints.
Less commonly, persistent rib pain in runners could indicate a rib stress fracture. These tiny cracks develop from repetitive impact and forces on the skeletal system during running, especially with sudden increases in training volume or intensity. Runners with lower bone density or inadequate nutrition may have an elevated risk, with fractures presenting as tenderness to the touch and pain intensifying with movement.
Diaphragmatic Pain and Side Stitches
A common complaint among runners is the “side stitch,” or exercise-related transient abdominal pain (ETAP). This sharp, cramping pain typically occurs just below the ribs, most frequently on the right side, but can manifest on either side. It is temporary and resolves with rest or changes in breathing patterns.
Several theories explain side stitches. One suggests pain arises from spasms in the diaphragm, the large, dome-shaped muscle at the base of the lungs responsible for breathing. Another points to irritation of the peritoneum, the membrane lining the abdominal cavity, which can be stretched or rubbed during the repetitive jarring motion of running.
Stretching of ligaments connecting the diaphragm to internal organs, particularly the liver, is also a factor. As the body moves during running, these ligaments can pull on the diaphragm, causing discomfort. Factors such as consuming food or drink too close to a run, inadequate warm-up, and improper breathing techniques are associated with side stitches.
Other Internal Organ Considerations
Less frequent than musculoskeletal issues or side stitches, pain in the rib area during running can sometimes be referred pain from internal organs. Referred pain occurs when discomfort from an internal organ is felt in a different body part due to shared nerve pathways. These instances are more concerning if the pain is persistent, severe, or accompanied by other systemic symptoms.
For example, pain in the upper left abdomen or lower left rib area could, in rare cases, be associated with spleen issues. While unlikely to cause pain specifically during running, significant trauma to the spleen could result in referred pain. Discomfort in the upper right abdomen or lower right rib area might occasionally relate to the liver or gallbladder.
Conditions affecting the lungs or pleura, the thin membranes surrounding the lungs, can also manifest as sharp pain in the chest or rib area. Pleurisy, an inflammation of the pleura, causes sharp pain that worsens with deep breaths or coughing. While less common causes of pain during a run, their consideration is important if symptoms are severe, persistent, or not directly related to physical exertion.
When to Consult a Doctor
While many instances of rib pain during running are benign and resolve on their own, certain symptoms warrant prompt medical evaluation. Consult a healthcare professional if the pain is severe, persistent, progressively worsens over time, or is unexplained, even when not running.
Immediate medical attention is necessary if rib pain is accompanied by shortness of breath, dizziness, lightheadedness, chest pressure or tightness, or pain radiating to the arm, jaw, or back. These symptoms could indicate a serious underlying condition, including cardiac issues or a pulmonary embolism. Pain occurring at rest, rather than only during physical activity, is also a red flag.
Other concerning signs include rib pain with fever, chills, or unexplained weight loss, as these might point to an infection or systemic illness. If pain developed after a fall or direct impact to the ribs, medical assessment is important to rule out fractures or other injuries.