RIB & THORACIC JOINT IRRITATION 

A sharp catch when you breathe in. A deep ache between the shoulder blades. Pain that wraps around the rib cage to the front of the chest. These are some of the most common, and most alarming, complaints we see at our Sandton practice. Many patients come to us after an ER visit that ruled out a heart problem, relieved but still in pain.

The mid-back has 12 vertebrae, each connected to a pair of ribs through small joints that move subtly with every breath. When one or more of these joints becomes stiff or inflamed, it produces localised pain, referred pain around the chest wall, or that sharp catching sensation. Research estimates that 15 to 45% of non-cardiac chest pain is musculoskeletal in origin. Once serious causes are ruled out, this is exactly what we treat.

Costochondritis (inflammation where the ribs attach to the breastbone) is another common source of chest wall pain. It typically resolves with conservative care, and a case series found that manual therapy directed at the rib cage and thoracic spine produced an average pain reduction of 5 points out of 10.

A randomised controlled trial of 115 patients with acute musculoskeletal chest pain found that chiropractic treatment, including thoracic and rib manipulation, produced significantly better outcomes at 4 and 12 weeks compared to self-management alone. Thoracic manipulation also benefits conditions beyond the mid-back itself, including neck pain, headaches and shoulder problems.

Assessment includes a thorough history, orthopaedic testing, palpation of the thoracic and rib joints, and screening to rule out non-musculoskeletal causes. Treatment typically involves gentle manipulation of the restricted joints, soft tissue work, postural advice and exercises to prevent recurrence. Most patients notice a clear improvement within the first few visits.