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Aug 27, 2023

Rib pain without an Injury? Osteopathic Manipulation May Help


During normal inhalation and exhalation, the ribs move up and down to expand the thoracic cavity, and allow air to flow into the lungs. Rib dysfunctions occur when one or more ribs do not follow their unique pattern of movement during the inhalation or exhalation phase (Koch et al, 2020). A disruption in this natural movement pattern present as chest pain, thoracic back pain, or difficulty taking deep breaths.

An inhaled rib dysfunction is present when ribs are elevated on inhalation, but do not move freely on exhalation. Alternatively, exhaled rib dysfunction occurs when there is poor upward movement of the ribs on inhalation (Jawed & Bordoni, 2022).

Common causes of rib dysfunctions include poor posture and mechanics, excessive coughing, trauma, tight musculature, repetitive motion as seen with certain sports, and improper lifting techniques. These factors can cause the ribs to feel stuck or out of place, and lead to pain and discomfort.


Osteopathic Manipulative Medicine, or OMT, aims to relieve pain and discomfort in the musculoskeletal system by improving the biomechanics utilizing a variety of hands-on techniques. OMT techniques address different aspects of the musculoskeletal system, including the fascia, muscles, ligaments, tendons, and alignment of bones.


OMT offers a holistic approach by addressing the entire musculoskeletal system. There are several techniques that can be used to manipulate ribs back into place in order to restore normal function. Symptom relief may be felt in as little as one session of OMT, or may require more than one treatment.

In addition to decreasing pain and restriction, OMT can prevent other complications from occurring. Left untreated, rib dysfunctions can progress causing chest wall pain, musculoskeletal pain, thoracic outlet syndrome, intercostal neuralgia (nerve pain) and respiratory issues (Flodine & Thomas, 2022).

Research shows applying OMT for rib dysfunctions may also benefit chronic respiratory conditions including asthma, chronic obstructive pulmonary disease (COPD) and pneumonia by restoring normal movement of the diaphragm, allowing improved respiration (Jawed & Bordoni, 2022).

In cases of infection, rib fracture, hematoma (bruisng), osteoporosis or metastatic disease, then OMT treatment would not be appropriate for rib pain (Koch et al, 2020).


Flodine TE, Thomas M. Osteopathic Manipulative Treatment: Inhaled Rib Dysfunction. 2022 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.

Jawed M, Bordoni B. Osteopathic Manipulative Treatment: Muscle Energy Procedure - Exhaled Ribs. 2022 Feb 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.

Koch J, Tsui C, Talsma J, Pierce-Talsma S. Osteopathic Manipulative Treatment for Inhaled Rib Somatic Dysfunction. J Am Osteopath Assoc. 2020 Jul 28. doi: 10.7556/jaoa.2020.109. Epub ahead of print.

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