Rib Pain in Pregnancy

That sharp jab under your ribs while you are sitting on the couch. The dull, gripping ache between your shoulder blades that nothing seems to shift. The feeling that your bra is suddenly too tight, even though nothing about it has changed. Rib pain in pregnancy is one of those symptoms that catches most women off guard. It is also one of the most common reasons pregnant patients ask about treatment in the second half of pregnancy.

The good news is that most pregnancy-related rib pain has a clear mechanical explanation, and the strategies that help are simple. The important thing is to know what you are dealing with, because a small subset of rib pain in pregnancy needs urgent medical attention rather than musculoskeletal care.

What does rib pain in pregnancy feel like?

Rib pain in pregnancy can show up in three main patterns. The first is sharp or burning pain at the front, where the ribs meet the breastbone. The second is a deep, gripping ache at the back, between or just below the shoulder blades. The third is a sore or bruised feeling under the lower ribs, most often on the right side, that flares with deep breaths or with the baby’s kicks. You may have one of these or all three at once. The pain can ease when you change position and worsen the longer you stay still.

When does it usually start?

Most women first notice rib pain in the second trimester, between weeks 20 and 28, as the uterus rises out of the pelvis and starts to take up more space in the abdomen. It tends to peak in the third trimester, when the bump is largest and the baby is most active. Some women are surprised by it earlier, in the first trimester, particularly if they had thoracic stiffness or rib pain before pregnancy.

Why does it happen?

Several mechanical and hormonal changes converge on the ribcage in pregnancy.

The uterus pushes everything up. As your bump grows, the top of the uterus rises into the space normally occupied by your stomach, liver and diaphragm. The diaphragm is pushed up by around 4 centimetres in late pregnancy, and the ribcage flares outward by 5 to 7 centimetres in circumference to accommodate. The lower ribs get the most stretch, and that constant outward pressure on the costal cartilages is one of the main pain drivers.

Hormones soften the cartilage. Relaxin, the same hormone that loosens the pelvic ligaments, also softens the cartilage that connects each rib to the breastbone. The joints become more mobile and more easily inflamed, which is why costochondritis (inflammation of the rib-to-sternum cartilage) is more common in pregnancy.

Posture changes. Breasts grow, the bump pulls the trunk forward, and the shoulders tend to round. The thoracic spine compensates by increasing its forward curve, which loads the joints between each rib and the spine. Studies measuring spinal curves in pregnancy have shown thoracic kyphosis increases by around one degree from the second to the third trimester, with similar increases in the lumbar curve.

The baby’s position. Late in pregnancy, many babies sit head-down with their feet tucked up under one of the mother’s lower ribs, often the right side. Every kick or stretch lands directly on already-irritated ribs.

Bra fit. Breasts can change size by two or three cup sizes during pregnancy. An old underwire or a band that no longer fits sits straight across the most painful part of the lower ribcage and adds pressure exactly where you do not want it. This is the most under-recognised contributor to pregnancy rib pain.

Where does rib pain typically show up?

There are three patterns that account for most cases.

Front of the chest, at the sternum. Sharp, sometimes burning pain right where the upper ribs join the breastbone. This pattern is often a costochondritis-type irritation. It can flare when reaching overhead, taking a deep breath or rolling in bed.

Between or under the shoulder blades. A deep, dull ache in the upper back, sometimes wrapping around the side along the line of a rib. This pattern usually traces back to the rib joints at the back of the spine, particularly around the T6 to T8 levels which take the brunt of the postural changes in pregnancy.

Under the lower ribs. A sore, bruised feeling under the right or left lower ribs, aggravated by sitting upright or by the baby’s movements. This is typically a combination of upward uterine pressure and reduced rib cage mobility. It tends to be worst late in the day, after hours of sitting.

When should I worry?

Most rib pain in pregnancy is musculoskeletal and not dangerous. There are specific patterns that are different, and they need urgent medical assessment rather than chiropractic care. Call your obstetrician, midwife or maternity unit straight away if you experience any of these:

Severe pain in the upper right abdomen, just under the ribs, especially after week 20, particularly if combined with headache, vision changes, swelling in the hands or face, or sudden nausea. This pattern can indicate preeclampsia or HELLP syndrome, where the liver becomes involved.
Rib pain with shortness of breath, palpitations or chest tightness that does not change with position.
Rib pain following a fall, accident or trauma.
Rib pain with fever, chills or a productive cough.

These are not common, but they are important to rule out. Trust your instincts here. If the pain feels different from anything you have experienced before, get it checked.

What the research says

Pregnancy is increasingly recognised as a period where manual therapy can help with musculoskeletal pain, and the thoracic spine and ribcage are part of that picture.

A 2016 systematic review with meta-analysis by Hall and colleagues, published in Medicine (Baltimore), examined 11 studies of complementary manual therapies (chiropractic, osteopathy and massage) for pregnancy-related back and pelvic pain. The review found a moderate effect on pain intensity and disability compared with usual care, with no major adverse events reported across the included studies.

A 2021 review by Conner and colleagues in Clinical Obstetrics & Gynecology concluded that chiropractic care is a reasonable, evidence-based first-line option for musculoskeletal pain in pregnancy, including thoracic spine and rib-related complaints. The authors highlighted that conservative care is particularly valuable in pregnancy given the limits on medication options.

The European Guidelines for Pelvic Girdle Pain (Vleeming et al., 2008) treat the pelvis and the thoracic spine as a connected system, noting that thoracic stiffness frequently develops as a compensation for changes lower down and should be assessed and treated alongside the pelvis.

Costochondritis itself, while not pregnancy-specific, is well-described in the StatPearls clinical reference (updated 2024) as a self-limiting inflammatory condition that responds to activity modification, gentle mobilisation and time.

How chiropractic care can help

The aim of treatment for rib pain in pregnancy is to restore movement at stiff segments, calm irritated joints and give the ribcage room to move with each breath again. Most of the work is gentle and side-lying.

Thoracic spine mobilisation. Soft, low-force techniques applied to the joints between each rib and the spine. The adjustments are done with the patient on her side or supported with pregnancy pillows so there is no pressure on the bump.

Rib mobilisation. When a single rib has become locked or moves out of step with its neighbours, targeted mobilisation can settle the pain quickly. The change is often immediate.

Soft tissue work. Release work on the intercostal muscles, the diaphragm attachments along the lower ribs, and the muscles that wrap from the shoulder blade onto the ribcage. These muscles tighten down protectively around irritated ribs, and releasing them is often the most relieving part of treatment.

Breathing mechanics. Many women shift to shallow, upper-chest breathing as the bump grows. This locks the ribcage even further. A few minutes of guided diaphragmatic breathing, retrained during a session, can reset how the ribs move on every breath.

Posture and ergonomic guidance. Small adjustments to how you sit, stand and sleep tend to make the biggest day-to-day difference.

What you can do at home

These are the strategies that consistently help.

Get refitted for a bra. This is the single most overlooked fix for pregnancy rib pain. Bra size can change by two or three cup sizes through pregnancy. An old band that sits straight across the painful rib is making the problem worse. A soft, flexible, well-fitted maternity or sports bra often gives noticeable relief within a day.
Sit tall, not slouched. A small lumbar roll behind your lower back encourages your ribs to lift off your bump rather than collapse onto it.
Sleep on your side with pillows supporting your upper back. A pillow tucked behind you stops you rolling fully back during the night and takes the load off the rib joints. See the pregnancy sleep positions article for more on this.
Try cat-cow and gentle thoracic rotations. A few minutes of slow, supported spinal mobility work in the morning loosens the ribcage before the day’s postural load builds up.
Diaphragmatic breathing. Two or three rounds of slow, low-belly breathing, several times through the day, expands the lower ribs and resets shallow breathing patterns.
Use heat on tight upper back muscles. A warm compress on the upper back or between the shoulder blades can ease muscular tension. Avoid heat over the abdomen.
Use ice on sharp front-of-chest pain. A cold pack on a costochondritis-pattern flare for 10 to 15 minutes can settle the inflammation.
Stand up and move every 30 to 40 minutes if you sit at a desk. Sitting locks the ribcage. Brief, frequent movement keeps the joints from stiffening.

When to get help

If your rib pain is making it hard to sleep, work or take a deep breath comfortably, do not wait it out. Ribcage stiffness builds compensatory patterns through the upper back, neck and shoulders, and those can stick around postpartum if they go untreated. If you are already managing pregnancy back pain or pelvic girdle pain, rib pain often responds to the same kind of gentle, targeted care.

Get assessed sooner rather than later if:

The pain has not improved in a week despite home strategies and a properly fitted bra
The pain is severe enough to wake you at night
You are losing range of movement through your upper back or shoulders
You feel breath-restricted or have to consciously work to breathe deeply

You do not have to push through

Pregnancy rib pain is treatable. The combination of a few simple home adjustments and gentle, hands-on care is usually enough to bring the pain down quickly and keep it down through the rest of pregnancy. And the postural patterns that drive rib pain do not have to follow you into the postpartum period.

If you are dealing with rib or upper back pain in pregnancy, get in touch or book an appointment.

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