Rib fractures are acutely painful because you’re reminded of your injury with every breath you take, that’s every 6 seconds. Broken ribs is usually a memorable event and falls under the category of traumatic injuries, like falls or accidents. People older than 65 years are at much higher risk to crack a rib with a small fall. Broken ribs are treated in various ways, so support the fracture site, prevent more dangerous complication and ease the pain. Let’s look the options you have for treatment of your Rib fracture.

Anatomy of your Ribcage

Your thoracic cavity includes the thoracic spine and ribcage as the “hard frame” and serves as the connection of your neck, shoulder girdle and lower back. Even though most modern lifestyles contribute to rigidity and stiffness of the upper back, the thorax has 150 articulations or joints which need to move in harmony. This includes the thoracic facet joints, costotransverse and costovertebral joints. Normal breathing causes these joints to move 3 million times per day. This means that the smallest problem can set off causing havoc in other systems. But each problem has many different team members to borrow movement from before it regresses to a state of pain.

What does my ribs do?


Your ribs help you breathe. The most noticeable movement of the ribcage is during coughing or forced breathing techniques, like the Wim Hof method. But even as you sit and read this article your normal breathing is also moving your ribcage. These gentler movements are controlled by your diaphragm. Forced inhales and exhales are produced by the intercostal muscles. During a cough, sneeze or forced exhale your diaphragm relaxes, while your internal intercostals contract and bring your ribs closer together. The volume of your chest cavity decreases rapidly which in turn increases the pressure and the air is forced out.

Your ribcage protects our vital organs, the heart and lungs, and also the trachea and spinal cord as it descends down to the back. Your lungs are protected within the pleura, like a double bag for extra safety. Between the two bags are pleural fluid and negative pressure, which both prevent your lungs from ever emptying completely. This makes it easier to breathe and fill your lungs.

How did I crack my rib?

When a force is greater than the elastic capacity of the tissue, deformation leads to failure, or in the case of a rib, failure means fracture. It varies from a small hairline crack, to complete separation of bone fragments. This force is sustained in high-energy injuries, like a motor vehicle accident, where fractures to ribs 4 – 10 are most common. Assault fractures any of the ribs subjected to blunt force trauma. Penetrating wounds to the ribcage is a medical emergency because of the risk of pneumothorax. The less obvious, yet dangerous rib fractures are more subtle, but where the loose fragments pierce the plural cavity and leaks air and blood into your lung fields. Small enough that you don’t even notice it’s actually slowly get worse. The slightest rib cage movement causes pain, causing a repetitive stabbing motion with every breath.

Ongoing mechanical stress on your ribs, like persistent coughing in whooping cough, tuberculosis or covid, can cause a rib fracture. These forceful contractions over a long period, cracks the rib’s outer layer of bone.

If the bone integrity is compromised by a disease, like osteoporosis or dysplasia, it can cause multiple rib fractures. Less force is required to break the rib, as the structure of the bone is frail. Elderly are routinely checked after a fall especially then they feel pain while breathing.

Causes of Rib Fracture

  • Direct trauma, like motor vehicle accidents, falls, tackle or assault
  • Severe, chronic coughing
  • Stress fractures with repetitive movements, high-level rowing or throwing athletes
  • CPR
  • Pathological fractures due to osteoporosis or other bone diseases, like osteogenesis imperfecta
  • Fracture due to radiation treatment

Symptoms of Broken Ribs

Tests that you can do to see if you have a cracked rib

  • Sit comfortably on a chair or bed, with your feet supported on the floor, back free to move.
  • Turn your upper body to one side as far as you can go.
  • Take 10 deep breaths.
  • Repeat this movement to the other side.
  • Pain over your ribcage that increases as you inhale may indicate that you have a broken rib.
  • Cough, sneeze or laugh for 10 seconds.
  • If these increase your pain in your injured side you may have a rib fracture.
  • All of these actions increase the pressure in your thoracic cavity and forces movement throughout the ribcage.
  • If lying on your affected side increases your symptoms you may have a cracked rib.
  • Stand comfortably with your feet hip distance apart.
  • Reach overhead with your unaffected arm, as though you are taking something from a high shelf.
  • Repeat on the other side.
  • The familiar pain of your injured rib on movement may indicated that you have a broken rib.

How severe is my cracked rib?

Rib fractures vary in intensity and the time it takes to heal. A single cracked rib from coughing takes less time to heal compared to multiple rib fractures, or even when a lung or spleen is punctured.

Pain from a single rib fracture is felt intermittently on a specific movement, whereas multiple broken ribs’ pain is felt on deep breathing giving you in constant symptoms. However pain is a poor indicator if your rib is broken, a through clinical evaluation can be much more insightful. You’ll notice a sudden sharp pain with big movements or coughs and or just a dull ache throughout the day.

Bruising over your ribcage, with sensitive areas on specific points, are not as alarming as rib pain with deep breathing. This is more serious when you’re feeling breathless, only breathing shallowly, or bracing with your breathing to avoid the pain.

With some rib fractures, only after exertion you can bring on the rib pain. This is a good sign, unless accompanied by rapid heart rate spikes and drop in saturation. This cardiovascular adaption happens automatically to provide your body with enough oxygen as the lungs are compromised.

Different broken rib scenarios

A single cracked rib remains quite stable. Like a hoop earring with a single opening. Movement causes pain, but the bones remain aligned because of the integrity of the rest of your chest wall.

A flail chest is when three or more neighbouring ribs are fractured in two or more places, resulting in instability. Essentially there are free-floating segments that are not anchored to the rest of the chest wall. This is more painful than a single cracked rib as every breath causes movement at the site of the rib fracture. Parodixial breathing may indicate a flail chest, where the opposite of what you expect happens during the breathing cycle. On inhalation a flail chest moves in and on exhalation the chest moves out. The impact pierces the lung and compromises oxygen getting in.

A pneumothorax results from the lung tissue being penetrated, blood and air filling up the plural cavity bettn the lung and the inside wall of your chest, limiting the lung to expand. Difficulty breathing, increased heart rate and decreased oxygenation are the symptoms of a lung that cannot fill.

Diagnosis of Rib Fracture

Physiotherapy diagnosis

Our physiotherapists are experts in anatomy, physiology and pathology. We understand the agony you’re going through. Our aim is to created the ideal healing environment for your rib fracture to heal and we have the experience to guide you throughout your treatment. We can accurately diagnose it, send you for x-rays and make sure you recover as fast as possible.


X-rays shows up displaced rib fractures quite easily. However, up to 50% of undisplaced rib fractures may go undetected, even with the correct oblique views. We rely on your history, symptoms and a clinical evaluation to diagnose a broken rib. Your physiotherapist can refer you to get x-rays taken if necessary.

Diagnostic ultrasound

Diagnostic ultrasound is used to identify damage to organs. If you need an ultrasound, your physio will refer you.


A CT scan is more sensitive to diagnosing rib fractures and also enables us to see any associated damage to the organs of the whole thoracic cavity, like the liver, spleen and lungs. If your physiotherapist suspects anything more than broken ribs, you will be referred to the right specialist.

Why is my rib fracture pain not going away?

It is normal to experience pain for up to 8 – 12 weeks while your cracked rib heals. If you feel pain long after this, it is most likely due to compensatory movement patterns you used during your recovery to protect your injured rib. Now when you work or move, this restriction causes other structures, like other costovertebral or costotransverse joints to load unnecessary. This in turn causes inflammation and pain, restricting your movement even more. You become stuck in a cycle of pain, not knowing if it is safe to move or not, because you may think it’s the rib fracture that’s producing the pain. The bone need sufficient time to heal, but then everything should get back normal.

Exercising despite the pain and pure stubbornness to deny there’s a problem months after an accident is our greatest obstacle. When patients fractured a rib and continues as if all is ‘fine’. It slows down the bone reattaching, or even worse, abnormally large callus bone formation due to repetitive re-fracturing of new bone that’s been laid down.

What NOT to do

  • Anti-inflammatory medication are not recommended

  • Manage the pain by only taking pain medication or muscle relaxants

  • Breath shallowly to limit your pain

  • Intense exercise

  • Do not ignore ribcage pain

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us and be safe

What you SHOULD do

  • Rest as needed from lifting, turning and intense activity

  • Avoid activities that flares up your pain, like repetitive twisting and bending

  • Make an appointment to confirm the diagnosis and determine how severe your adaptive behaviour is

  • Spirometer workouts

  • Activities that increase heart rate slightly, like climbing a single flight of stairs

Making it worse

  • Taking only shallow breaths the entire day

  • End range twists and bending

  • Intense exercise, like running, spinning or HIIT workouts

  • Working at your computer without taking movement breaks

Problems we see when patients come to us for rib fracture treatment

The biggest problem we see with cracked rib is that people underestimate the long-term effects it has on their lung function when left untreated. The lungs and ribs work together. Your ribs must move freely and in order for your lungs to expand, fill and supply oxygen for breathing, but more importantly, have the capacity to supply you during more intense exercise.

By guarding the painful side or area you intentionally restrict movement, decreased lung capacity. Long term oxygen deprivation leads to much serious consequences. Once your broken rib has re-attached, the real work starts to ensure that you don’t keep protecting a structure that has already healed. We also ensure the lung can expand and ribcage movement is restored.

Physiotherapy treatment for rib fracture

Our physiotherapists have years of experience in diagnosing all types of injuries. Our physios can diagnose a rib fracture, after we’ve done a clinical assessment. We’ll guide you through your recovery by implementing the correct broken rib treatment techniques, giving you a lot of advice to ease the pain and a home program to make your recovery as comfortable as possible.

Physiotherapists are uniquely qualified to identify and treat broken rib fractures because of our background in pulmonary (A subspecialization). We auscultate your lungs to determine if you have adequate air entry throughout both lungs and all lobes to prevent complications like atelectasis. Your lung function is assessed and treated by incorporating breathing and chest expansion exercises into your recovery program from the start. We test rib and thoracic mobility, muscle strength and endurance of your intercoastal muscles.

Phases of rehabilitation for broken rib treatment

1st Phase for broken rib treatment: Symptom relief (weeks 0 – 2)

During the first two weeks of your rib fracture treatment, we will give you all the information you need to make informed decisions. You can expect to get a little anatomy lesson so that you understand why you are experiencing certain symptoms, but also why it is important to endure some pain while maintaining your lung expansion. Your treatment will be focussed on pain relief with electrotherapy techniques, like LASER and ultrasound, gentle range of motion exercises and joint mobilisations and breathing exercises. We will also teach you how to brace when you need to cough, sneeze or laugh. To progress to the next phase of your rib fracture treatment you need to be able to breathe approximately 50% of your lung volume without pain and do thoracic movements, like side bending and twisting with little discomfort.

2nd Phase for broken rib treatment: Regain mobility (weeks 3 – 5)

During this next phase of your broken rib treatment, we aim to restore your shoulder, upper and lower back mobility. Treatment techniques, like massage, neural mobilisations and visceral manipulation is used while your home exercise program will include goals like reaching overhead, planks and cobra positions. To progress to the next phase of your treatment you need to be able to do an overhead press and reach while you side bend away and maintain a deep and regular breathing pattern.

3rd Phase for broken rib treatment: Increase lung capacity (weeks 6 – 8)

Now that you can move freely we must incorporate lung endurance training to your rib fracture treatment. This means upping the intensity of your cardiovascular activities to include climbing stairs, a brisk walk or even a jog. Shoulder strength and core activation should be possible while maintaining a regular breathing pattern. We will include a spirometer, blowing bubbles or balloons to work your lungs too. To progress to the next phase you should feel comfortable to go back to training.

4th Phase for broken rib treatment: Paced return to training (weeks 8 – 12)

Once you start to gradually return to your sport of choice, be it weight training or pilates, you should be comfortable maintaining a steady breathing rate with no pain and meet the fitness goals to keep up with the cardiovascular demand of the sessions. Physiotherapy treatment is only necessary during this phase if you have over exerted yourself. You should have no symptoms and feel confident that your broken rib is healed and start to test your breathing under strain.

Healing time for a rib fracture

Rib fractures generally take 3 – 6 weeks to heal. Your physiotherapy protocol will run from your first consultation to your discharge when you can return to your chosen sport and training regime pain free. You will need physiotherapy treatment twice a week for the first two weeks for pain relief. After this, your treatment sessions are spaced out to once weekly when you have the responsibility to do your breathing and mobility exercises at home. How fast you recover will greatly be up to you. Once you have your mobility back we gradually get you back in the gym, pacing your sessions to allow progress without causing your pain to flare up. A full recovery takes 8 – 12 weeks and it’s safe to strain the ribs again.

Other forms of treatment for broken ribs

  • Your doctor (GP) prescribe analgesic medication for pain relief.
  • Braces to support your ribcage is helpfull, but make sure you’re off it by week 8.

Is surgery an option for rib fracture treatment?

Most rib fractures heal without surgery. Surgery may be needed in cases where the internal organs were damaged with high-velocity traumatic injuries. After surgery physiotherapy is crucial to ensure normal rib movement, chest expansion for regaining lung capacity, thoracic mobility and strength and endurance training.

What else could it be?

  • Compression fracture of the thoracic vertebral body

Moderate to severe upper back pain that is worse with movement. This is the result of osteoporotic changes to the vertebral body or from direct trauma.

  • Shingles

This is a viral infection that is mostly limited to a single side of the chest wall with an accompanying blister-like rash.

  • Costochondritis

This inflammatory condition of the cartilage of the rib and sternum joints is felt more on the breast bone, also with deep breaths, coughing or sneezing.

  • Lung infection

Pain is felt especially on breathing out and will be accompanied by fever, general malaise, and increased heart rate.

Pain felt along the dermatome distribution of the nerve root that is compromised due to the disc bulge.

Also known as

  • Rib fracture
  • Cracked rib
  • Broken rib