Ribs dont get the respect they deserve.

They cause chest pain and commonly contribute to upper

back pain. Their normal function is important for clearing upper back pain and preserving
health. They appear to be simple bones but their anatomic relationships are myriad. Most ribs
share joint connections with 2 vertebrae. Ribs continue around to the front of the body where
they change from bone to cartilage. The cartilage connects to the rib and directly or indirectly to
the breastbone creating 2 more joints which can be stuck, sprained or partially dislocated. There
are 3 muscles between the ribs, ribs connect to the low back and sacrum, serve as anchors for the
neck and shoulder girdles, and they connect to the endothoracic fascia (to which the lining of the
chest cavity connects). The mechanical complexity of the ribs becomes self evident.
In front of the ribs, on the inside of the back of the chest, the sympathetic chains that serve to
carry much of the autonomic nervous system input for the body are tethered. When the ribs are
stuck, jammed, twisted or otherwise distorted, mechanical tension is transferred to these chains
which may in turn negatively influence blood flow to the heart lungs and gut, heart rate, stomach
acid production or other gastro intestinal or bronchial symptoms depending upon the level of the
lesion.
Rib problems can affect the muscles that attach to them either causing tension or weakness and
incoordination. This includes neck muscles, muscles that anchor the shoulder girdle e.g.
pectoralis muscles, rhomboid muscles, upper and lower trapezius muscles and others less
commonly spoken of in gym circles. When the balance of these muscles is thrown off, problems
with shoulder blade control arise, which in turn can stress the A-C and ball and socket joints of
the shoulder leading to impingement syndrome or longer term pinching and erosion of the rotator
cuff.
Compliance or flexibility of the chest wall is related to the work of breathing. Those who have
underlying lung disease need a chest wall that will move freely when breathing in and out. Their
lung disease may not be reversible, but they should not be working harder than necessary for
each breath.
Being able to breathe is necessary for normal function in bringing venous blood and lymphatic
fluids back towards the heart. With every inhalation a negative pressure occurs in the chest and a
positive pressure occurs in the abdomen. With exhalation positive pressure in the chest moves
air out of the lungs and the diaphragm relaxes and gives the abdominal organs more room
decreasing the pressure in the belly. When a ribs lack full range, for whatever reason, fluid flow
may be compromised in the whole body, but will be compromised locally. Local fluid flow
restriction can lead to decreased local immune function as well. In the days prior to antibiotics,
osteopaths treated pneumonia by clearing rib and local vertebral problems. During the 1918
influenza pandemic those treated with osteopathy were much more likely to survive. Patients
hospitalized for pneumonia, treated osteopathically were discharged on average over a day
earlier than those receiving usual care. (Noll, DR, Shores, JH, Gamber, RG, et.al. Benefits of
osteopathic manipulative treatment for hospitalized elderly patients with pneumonia. JAOA,
Vol. 100, No. 12, December 2000. pp. 776-782.)
Problems with rib joint mechanics and function lead to issues of pain. Costochondritis, the most
common medical diagnosis of non cardiac chest pain, rarely has inflammation at the tissue level.
The tissues are crying out in duress because the nerve endings are being twisted, sheared or
crushed, not because of inflammation from an auto immune or other disease processes. Chest
wall pain of this nature may come from direct trauma, coughing or sneezing, falling asleep over
the arm of a couch, from a problem with a vertebra or from tension from connective tissue within
such as scarring post pneumonia.
When cardiac chest pain has been ruled out and pain persists, keep in mind the complexity of the
lowly rib and consider looking for an osteopath or other manual practitioner who understands its
importance and knows how to restore its function.