The back of your ribcage is a complex area composed of the thoracic spine, twelve pairs of ribs, and a dense network of muscles, ligaments, and nerves. Pain here is a common complaint that can feel sharp, dull, or burning, stemming from sources that are either superficial or deep within the body. While most cases relate to a simple muscle strain, this pain can occasionally signal a more significant underlying issue involving the spine, nerves, or internal organs. Understanding the origin of the discomfort is the first step toward effective relief.
Structural and Musculoskeletal Causes
Intercostal muscle strains, which affect the small muscles running between the ribs, often result from sudden, forceful movements like coughing, sneezing, or improper lifting. This injury typically causes a sharp, intense pain localized to a single spot, significantly exacerbated by deep breaths or twisting motions of the torso.
Poor posture and repetitive stress can lead to chronic muscle tension and spasm in the large muscles of the upper back. Dysfunction in the joints where the ribs connect to the spine, often caused by trauma or chronic slouching, can cause a dull ache or a sharp, stabbing sensation near the spine that may radiate along the rib.
Costochondritis is an inflammation of the cartilage that connects the ribs to the breastbone. Although the pain is usually felt in the front of the chest, it can sometimes be referred to the back where the ribs meet the vertebrae. This inflammatory pain is sharp, often worsens with movement or deep inhalation, and is generally self-limiting. Rib fractures, including stress fractures, also cause severe, localized pain that intensifies dramatically with pressure, movement, or breathing.
Pain Originating from the Spine and Nerves
Pain that feels electrical, burning, or radiates in a distinct band often suggests a problem directly involving the thoracic spine or the nerves that exit it. A herniated or bulging disc in this region can press against a spinal nerve root, causing pain that follows the nerve’s path around the ribcage toward the front of the body.
Intercostal neuralgia is neuropathic pain along the intercostal nerves, which run directly beneath each rib. This pain can feel like a sharp, stabbing, or burning sensation that wraps around the chest or abdomen from the back. Common causes include trauma to the chest, surgical procedures, or viral infections like shingles, which can inflame the spinal nerve roots.
Degenerative changes, such as thoracic spinal stenosis or osteoarthritis of the facet joints, can also cause persistent back-of-ribcage pain. Spinal stenosis involves the narrowing of the spinal canal, which can compress the spinal cord or nerve roots. In these spinal conditions, the pain may be worse at night, with certain movements, or after prolonged periods of sitting or standing.
Referred Pain from Internal Organs
Pain felt at the back of the ribcage can be referred pain, where an internal organ issue is perceived on the body’s surface. The kidneys are located high in the back, and issues like kidney stones or pyelonephritis (kidney infection) frequently cause pain in the flank area. This pain is typically constant, severe, and often described as a sharp ache that does not improve with changes in position, unlike musculoskeletal pain.
Other abdominal organs can also refer pain to the back. Pancreatitis, which is inflammation of the pancreas, often results in a deep, persistent pain in the mid-back, frequently accompanied by nausea or vomiting. Severe ulceration of the stomach or duodenum can also radiate pain through to the back.
Lung and pleural issues are another source of referred pain. Conditions like pneumonia or pleurisy—inflammation of the pleural lining—can cause a sharp pain in the chest or back that is distinctly worse when taking a deep breath, coughing, or sneezing. This pain is often accompanied by other symptoms like a persistent cough or fever.
Knowing When to Seek Medical Attention
While many causes of back-of-ribcage pain resolve with self-care, certain symptoms warrant a prompt medical evaluation to rule out serious conditions. You should seek immediate professional attention if the pain is sudden, severe, or crushing, especially if accompanied by shortness of breath, chest tightness, or pain radiating into the arm or jaw. These are signs that could indicate a cardiac or pulmonary emergency.
Red Flags Requiring Urgent Care
Other symptoms that require an urgent visit to a healthcare provider include:
- Pain that is constant, unrelenting, and not relieved by rest or positional changes, particularly if it wakes you up at night.
- Constitutional symptoms such as a high fever, chills, or unexplained weight loss.
- Changes in bowel or bladder function.
- Any pain that follows a major traumatic injury, such as a car accident or a fall from a height, requires a thorough assessment.