Ribs: A Pain in your Neck! Part 2

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I have been so busy these last 2 weeks. I am excited to be doing a webinar to over 600 practitioners this upcoming weekend through an international platform! I will be analyzing a complex case study for a female who suffered groin pain and how influences from the spine can be the culprit. I promise to get a post out soon addressing this very topic in the near future to all of you!

If anyone is interested in attending, please feel free because it is free! You do not have to be a clinician.

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This is Part 2 of a post I did years ago, but I really needed to get a video out displaying the exercises because so many people have reacted to it.

I am excited to share my new video explaining how to self-correct the upper back/upper shoulder blade/upper rib pain region that is a hot spot for pain.

I use so many names for this region because it is where the shoulder meets the base of the neck but is really located in the upper rib/thoracic region. People call it many different names, so it can make it confusing.

Please go back to Part 1 to read about the anatomy and factors that predispose you to this type of pain to get a further understanding.

Let’s get started!

Feel the knot between your shoulder blade and spine. The painful side should feel like it is sticking out into your fingers. That is why you always want to massage right there. And you may get a massage and it still doesn’t go away. That is because there is bone right underneath the muscle that is minimally protruding out. Don’t worry, it is not dislocated it is just tweaked enough to be a very painful nuisance.

Here is the Video for 4 SIMPLE tips to relieve a “Crick” in your Upper Back/Rib Region and more detailed descriptions below!

Hold/Contract Rib Exercise

This exercise should be done in front of a wall or doorway (not like in the picture, the red arrow is representing the wall)

You will lift the arm on the painful side, so that your elbow is the same level as where your pain is located on your backside. So, if your pain is more towards the base of your neck/back (upper back), then your shoulder/arm will be flexed in front of your body AT LEAST 90 degrees, if not a bit higher. Keep your elbow straight, if possible.

If your pain in your middle back is lower then it could be even with your nipple, then your shoulder/arm will be flexed forward about 70 degrees. I only say nipple because my friend called me today complaining about his rib pain after falling off his bike and he used the anatomical term, nipple, to tell me where his pain was located equally on the backside. Thanks, David!

Step #1: While keeping your elbow straight and palm open, you are going to press

your palm/wrist into the wall. This will be a 50% maximum contraction.

Step #2: You can self palpate with your other hand the space between the shoulder blade and spine where it is painful and you might be able to feel the knot pull away from your fingers while doing Step #1.

Make sure you are starting in the correct posture and not hunched forward.

This exercise should REDUCE the pain in the region. It should not INCREASE it.

If you get no relief, no worries, switch the wall position so you are pressing the back of your palm into the wall and pushing your arm in an outward position.

Press into the wall/doorway for 5 seconds. Repeat 5-10 times.

You can do this exercise every waking hour that day if improvement in mobility and pain levels improve.

One-Sided Shoulder Shrug/Squeeze Hold

Sit with correct posture (shoulder blades not slouching) and try squeezing both your shoulder blades together. If you are a woman or not a woman…imagine you are a woman wearing a bra and try pulling your shoulder blades down towards the center of your back towards your bra strap.

Now that you got the hang of it.

Begin with shrugging your painful shoulder up towards your ear but only about 50% of the available range (essentially a mini shoulder shrug).

Then squeeze the painful shoulder blade down (shoulder retraction) and back towards your spine.

So, Step #1- Shoulder shrug of painful side. Keep your hand in your lap the whole time.

Step #2- While maintaining the shoulder shrug, slightly pull your shoulder blade back and down towards your bra strap.

Step #3- Take your non-painful hand and place your over your painful shoulder, like

your palm is cupping the top of your shoulder and your fingertips are on your shoulder blade. Provide a counterforce with your hand and pull your shoulder forward. Your shoulder blade is going to provide a counterforce into your hand.

This is a hold contraction. No movement should be occurring. Your hand and shoulder are equally holding their ground.

Again, make sure you are starting in the correct posture. This will not work if your shoulder is slouched forward excessively. You may need to provide a little shrug to your painful shoulder prior to the hold contraction to place it in a more optimal placement.

Hold the contraction for 5 seconds. Repeat 10 times.

If you felt no relief in your painful region, then switch your non-painful hand placement to the front side of your body along your collarbone, as shown in the video.

Attempt this 10 times for 5 seconds. You can repeat this exercise every waking hour the first day if there is relief being made.

Lower Rib Twist

This exercise is located along the middle and lower rib region. But why this self-treatment is so effective to the upper rib area? It helps unwind the rib cage and offload the fascial components connecting the upper and lower ribs, places the diaphragm and abdominal muscles in a more optimal position to ultimately allow the upper rib to take on appropriate forces in the correct way.

I think of our body as a huge mobile, like what floats above a baby crib, everything is interconnected and interdependent of each other. One strong pull one way causes changes on the other end. Between dominant and non-dominant sides asymmetry is going to occur in the body, that is a given. But balancing those asymmetries is the goal for us!

You can do this exercise in standing or sitting, although I prefer standing.

It is best to watch the video for this one. You again will be doing this technique on your painful side.

Step #1: Spread your painful side’s thumb and index finger apart as wide as you can go. If you do not have the flexibility for this, you can also just keep your thumb close to your palm. Reach for your painful side’s middle ribs right below where the bottom of your bra would be located. Try not to be too low.

Between your ribs are intercostal muscles, cup the space between your thumb and index finger and hook “up and in” to this “meaty” inter rib space.

Step #2: While taking a deep breath in through your nose, apply an upward pressure with your hand raising your ribs in the motion they are going anyways since you are inhaling. You are just helping to guide them a little bit more.

Step #3: While exhaling through your mouth, apply a counterclockwise force with your hand (a clockwise force with your right hand, if you are correcting the right side). You will feel like you are twisting your ribs back. The front of your ribcage is “opening up.”

Step #4: Maintain the force of your hand on your ribcage and repeat steps #1 and #2. Your elbow will be slowly moving more back behind your body with each breath. Your shoulder blade will be retracting more and more towards your spine.

Modified Option: If you do not have the shoulder flexibility to do this on yourself. If you have a partner to help you, the partner can stand directly behind you and do this technique from behind. Their left hand would be on your left side if that is the side you are correcting. Sometimes a partner can apply more pressure, if you are too weak. The hand pressure should be firm and feel like it is in contact with the bone/muscle, not just soft tissue/fat.

Repeat this exercise 2 times with 2 breathes at each repetition.

Self-Mobilization to Upper Rib Region

You will need a pillowcase or handtowel to complete this exercise and a weight up to 5 pounds. No dumbbell? Use a large jar of marinara! Something in your pantry.

Go grab them now!

You will be lying on your back. It is better to be on the floor rather than a soft bed. But if you cannot get on the floor, then lay a yoga mat or 2 towels on your bed to harden it a little more on top.

Step #1: Roll the pillowcase up in a roll after folding it into a 1/4 (Fold in half 2 times). Place the roll between your shoulder blade and your spine, right where your pain is located! Lie on your back with your knees bent/feet flat on the ground.

Step #2: Take your weight and hold with both your hands over your head with your elbows straight (but slightly relaxed, not stiff as a board).

Step #3: Move both your arms up and over your head so you are flexing your arms. Move your arms back and forth. You should feel some pressure where the pillowcase is on your upper rib region.

Repeat 15 times slowly.

You can modify by rolling a highlighter into the towel to increase the pressure or a small bar of soap (<2” wide) or a tennis ball to be point specific.

Other option: Lower your arms by your side and lift your butt into a bridge motion. Try to keep your shoulder blade and chest relaxed.

Repeat 15-20 times.

A great follow up movement exercise to do is my “10 Simple Bed Exercise” Video but only the exercises that pertain to the upper/mid back region. Although all the exercises are great and simple!

Here is the link.

One product I recommend is the Theracane. You can use this to apply direct pressure to the rib dysfunction and also apply muscle releases to the surrounding region. Plus, it makes a great Christmas gift! Wrap it up like a candy cane!

Usually, the rib that is “stuck back”…is usually the side you sleep on. Make sure to side sleep on the other side for a while! And switch the way you lie on the couch to watch TV!

Lastly, but most importantly, please consult with your local physical therapist! They can be wonderful with providing manual treatment to get an acute rib dysfunction back on track. Even a chiropractor is great, too! Just make sure both clinicians provide manipulations to the rib region. Sometimes, all you need is one manipulation to get you feeling like gold.

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