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.

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.

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.

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.

• 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

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.

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 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.

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.

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.

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.

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.

• 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.

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.

• 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.

• Thoracic disc herniation

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

• Rib fracture
• Cracked rib
• Broken rib