Rib Pain: Why Do My Ribs Hurt When Breathing, Twisting or Sleeping?

Oct 13

Rib Pain: Causes, Symptoms & Treatment | Osteopath Auckland

Have you ever experienced a sharp pain around your ribs when taking a deep breath, turning over in bed or reaching for something?

Perhaps you've noticed a stabbing sensation along the side of your chest when coughing or sneezing. Maybe your ribs ache after a gym session, or you feel a tight, pulling sensation around your upper back when twisting.

You might even find yourself taking shallower breaths because expanding your chest feels uncomfortable.

Rib pain can be frustrating — and sometimes worrying — because your ribs move every time you breathe.

The reassuring news is that many cases of rib pain are musculoskeletal, meaning they involve the muscles, joints or other tissues around your chest and upper back.

However, not all rib or chest pain comes from these structures, so understanding your symptoms and knowing when to seek medical assessment is important.

Why Do My Ribs Hurt?

Your rib cage is designed to protect important organs while allowing your chest to expand and move as you breathe.

Your ribs connect to your spine at the back, and most connect to your breastbone at the front through cartilage.

Between your ribs are muscles called the intercostal muscles, which help support breathing and movement.

Rib pain can develop when muscles, joints, cartilage or other tissues around your chest become injured or sensitive.

You may notice discomfort following:

A sudden twisting movement
Heavy lifting
Repetitive exercise
A sporting injury
A prolonged coughing illness
A fall or impact to your chest
An unfamiliar movement or activity

Sometimes symptoms develop gradually without one obvious injury.

The location of your pain and the movements that aggravate it can provide useful clues, but they don't always identify the exact cause.

What Does Rib Pain Feel Like?

Rib pain can feel surprisingly different from one person to another.

Some patients describe a constant ache, while others experience a sharp pain only during certain movements.

You might recognise one of these descriptions.

"I get a sharp pain when I take a deep breath."

Perhaps breathing normally feels comfortable, but a deeper breath causes a stabbing or pulling sensation around your ribs.

"It hurts when I twist or reach across my body."

Turning to look behind you, reaching into the back seat of the car or rotating during exercise may aggravate the pain.

"I can't sleep on that side."

Lying on the affected ribs may cause pressure and discomfort, making it difficult to find a comfortable sleeping position.

"I feel pain between my ribs."

You might notice a localised ache or tenderness along the side of your chest.

"The pain is around my shoulder blade or upper back."

Sometimes rib-related musculoskeletal pain is felt towards the back of the rib cage, near the spine or underneath the shoulder blade.

"It hurts when I cough, sneeze or laugh."

These activities involve sudden movement and pressure changes around the rib cage, which can aggravate sensitive tissues.

"It feels like something is catching when I move."

Some people experience a sharp catching sensation with particular movements.

Although these symptoms can occur with musculoskeletal rib pain, pain with breathing isn't always caused by a rib or muscle problem. New, unexplained or significant chest pain should be medically assessed.

Common Musculoskeletal Causes of Rib Pain

Intercostal Muscle Strain

Your intercostal muscles sit between your ribs and help your chest move during breathing.

These muscles can become strained following sudden twisting, lifting, coughing or sporting activities.

You might notice:

Sharp pain between your ribs
Discomfort when taking a deep breath
Pain when twisting your upper body
Tenderness along the side of your chest
Pain when coughing, sneezing or laughing

An intercostal muscle strain can make even simple movements uncomfortable because your rib cage is constantly moving.

Rib Joint Pain

Your ribs form joints with your thoracic spine at the back of your chest.

These joints allow small movements as you breathe, bend and rotate your upper body.

Sometimes the joints and surrounding tissues become sensitive, contributing to discomfort around the upper back or rib cage.

You might experience:

Pain beside your spine
Aching underneath your shoulder blade
Discomfort twisting your upper body
Pain when taking a deeper breath
Tenderness around the back of your ribs

Patients sometimes describe this as feeling like a rib is "out of place".

However, rib pain doesn't usually mean a rib has physically moved out of position. The discomfort may be related to sensitive joints, muscles or other surrounding tissues.

Costochondritis

Costochondritis involves irritation of the cartilage and surrounding tissues where the ribs attach to the breastbone.

It can cause pain towards the front of your chest.

You might notice:

Tenderness near your breastbone
Pain when pressing on the affected area
Discomfort taking a deep breath
Pain during upper-body exercise
Symptoms when coughing or twisting

Costochondritis can sometimes feel similar to other causes of chest pain, so new or unexplained chest discomfort should not automatically be assumed to be musculoskeletal.

Bruised or Fractured Ribs

Rib injuries can occur following a fall, sporting collision or direct impact.

You may notice localised tenderness, bruising or pain when breathing, coughing or moving.

Rib fractures can also occur following severe coughing, particularly in people with reduced bone strength.

If you've experienced significant trauma, severe pain or difficulty breathing, seek prompt medical assessment.

Rib Pain Associated With the Upper Back

Sometimes discomfort around the ribs is associated with the muscles and joints of your thoracic spine.

You might notice aching between your shoulder blades, stiffness after sitting or pain when rotating your upper body.

The rib cage and upper back work together during movement, so symptoms can sometimes involve both areas.

Why Does Rib Pain Hurt During Everyday Activities?

One of the frustrating things about rib pain is that it can affect activities you normally do without thinking.

Rib Pain When Taking a Deep Breath

Your ribs move as your chest expands during breathing.

If the muscles, joints or cartilage around your rib cage are sensitive, a deeper breath may aggravate symptoms.

However, new pain when breathing can also be associated with lung, heart or other medical conditions, so it shouldn't automatically be attributed to a muscle strain.

Rib Pain When Coughing or Sneezing

Coughing and sneezing create sudden forceful movements through your chest and abdominal muscles.

If you've strained an intercostal muscle or injured a rib, these movements may cause sharp pain.

Rib Pain When Turning Over in Bed

Rolling over requires your shoulders, upper back and rib cage to move together.

Perhaps you wake during the night because twisting onto your other side causes a sudden sharp pain.

Rib Pain When Sleeping on Your Side

Lying directly on a painful rib or chest wall area can increase pressure and discomfort.

You may find yourself changing position repeatedly or avoiding your usual sleeping side.

Rib Pain When Twisting

Turning to reach into the back seat of your car, swinging a golf club or twisting while gardening can aggravate sensitive rib joints and muscles.

Rib Pain When Lifting

Lifting groceries, carrying children, moving furniture or weight training places demands on the muscles around your chest, shoulders and upper back.

If these tissues are injured or irritated, lifting may become uncomfortable.

Rib Pain When Sitting at a Desk

Some people notice aching around their upper back and ribs after sitting for long periods.

Staying in one position for an extended time may aggravate sensitive muscles or joints.

There isn't one perfect posture you need to maintain all day. Regular movement and changing positions can often be more helpful than sitting rigidly upright.

Rib Pain During Exercise

Swimming, rowing, golf, tennis, weight training and other sports involve movements through your chest and upper back.

You may notice discomfort during twisting, pushing, pulling or overhead activities.

If rib pain is making everyday movement uncomfortable, an assessment can help determine whether the symptoms are musculoskeletal and what management may be appropriate.

Book a Rib Pain Appointment with Sarah

What Can I Do to Relieve Rib Pain?

The best approach depends on what's causing your symptoms.

If a serious medical cause or significant injury has been excluded, several strategies may help manage musculoskeletal rib pain.

1. Keep Moving Gently

Gentle walking and comfortable movement can help prevent unnecessary stiffness.

Avoid forcing movements that cause sharp or significant pain.

2. Temporarily Modify Painful Activities

If heavy lifting, twisting or certain gym exercises aggravate your symptoms, consider reducing the intensity or changing the activity while the area settles.

You don't necessarily need to stop all movement.

3. Find a Comfortable Sleeping Position

If lying on your painful side is uncomfortable, try sleeping on your opposite side with a pillow supporting your upper arm.

Some people find sleeping slightly more upright helpful for short periods.

4. Try Heat or Cold for Temporary Relief

A warm shower or heat pack may help ease associated muscle discomfort.

If you've recently injured your ribs, a cold pack wrapped in a towel may provide temporary pain relief.

5. Maintain Comfortable Breathing

If you have a confirmed musculoskeletal rib injury, try to continue breathing normally rather than deliberately taking very shallow breaths.

Avoid forcing painful deep breaths.

Following a rib fracture or significant chest injury, appropriate pain relief and breathing advice from a medical professional are important to reduce the risk of complications.

6. Gradually Return to Exercise

Once symptoms begin settling, gradually reintroducing movement and strengthening may help restore confidence and function.

7. Seek Assessment if Your Symptoms Persist

If rib pain continues, keeps returning or is affecting your sleep and everyday activities, an assessment may help identify the cause and guide treatment.

Persistent pain shouldn't simply be ignored, particularly when it involves your chest or breathing.

Book an Osteopathy Appointment with Sarah

When Is Rib Pain Something More Serious?

Although many cases of rib pain are musculoskeletal, chest and rib pain can sometimes be associated with heart, lung, abdominal or other medical conditions.

Call 111 in New Zealand for severe or concerning chest pain, particularly if it is accompanied by:

Shortness of breath or difficulty breathing
Chest pressure, tightness or heaviness
Pain spreading into your arm, jaw, neck or back
Sweating, nausea, dizziness or fainting
Sudden sharp chest pain with significant breathlessness

Seek urgent medical assessment for pain when breathing accompanied by coughing up blood, fever, new breathlessness or unexplained symptoms.

Following an injury, severe rib pain, significant trauma or increasing difficulty breathing also requires prompt assessment.

Children with unexplained chest pain, breathing difficulties or significant pain following an injury should be medically assessed.

If you're unsure whether your rib pain is musculoskeletal, it's important to have serious causes excluded before seeking hands-on treatment.

How Can Osteopathic Treatment Help Rib Pain?

If your rib pain has been assessed as musculoskeletal, osteopathic treatment may help manage associated discomfort and improve movement.

I'm Sarah Boughtwood, a structural osteopath based in Milford on Auckland's North Shore, with over 10 years of clinical experience.

I treat adults and children aged five years and older, helping patients manage musculoskeletal aches, pains and injuries.

My approach is to understand not just where your ribs hurt, but how that pain is affecting your everyday life.

Perhaps you're struggling to turn over in bed, take a comfortable deep breath, twist your upper body, exercise or lift your children.

During your appointment, I'll take the time to understand how your symptoms developed, what movements aggravate them and whether further medical assessment is needed.

If osteopathic care is appropriate, I'll assess your rib cage, upper back and surrounding muscles and joints.

Depending on your symptoms and diagnosis, treatment may include:

Gentle soft tissue techniques to help manage muscle discomfort
Appropriate joint mobilisation where suitable
Advice on comfortable movement and activity modification
Individualised mobility and strengthening exercises
Practical strategies for sleeping, lifting and returning to exercise
Referral for imaging or further medical assessment when indicated

Treatment is adapted to your symptoms, comfort levels and medical history.

Hands-on treatment may provide short-term relief for some people with musculoskeletal chest wall or thoracic pain, but it isn't appropriate for every cause of rib pain.

My aim is to help you understand your symptoms, move more comfortably and return to everyday activities with confidence.

Book a Rib Pain Assessment with Sarah

How Long Does Rib Pain Take to Settle?

Recovery depends on the cause of your symptoms.

A mild muscle strain may improve over days to a few weeks.

More significant muscle injuries, persistent chest wall irritation or rib fractures may take several weeks or longer.

Rib fractures often take around six weeks or more to heal, depending on the injury and individual circumstances.

If your pain isn't improving as expected, is worsening or new symptoms develop, further medical assessment may be needed.

Can I See an Osteopath for Rib Pain Under ACC?

Yes. If your rib pain is related to an injury that qualifies for ACC cover, you may be eligible for subsidised osteopathic treatment.

For example, rib or chest wall injuries following a fall, sporting accident or sudden muscle strain may qualify.

Not all rib pain is covered by ACC, particularly when symptoms develop gradually without a qualifying injury.

I'm an ACC-registered osteopath, and you don't need a GP referral to book an appointment.

Don't Let Musculoskeletal Rib Pain Keep You Uncomfortable

Rib pain can be surprisingly disruptive.

Perhaps you're struggling to turn over in bed, twist your upper body, exercise or find a comfortable sleeping position.

And when pain occurs around your chest, it's understandable to feel concerned about what might be causing it.

The important first step is making sure your symptoms have been appropriately assessed.

When rib pain is musculoskeletal, there are often ways to help manage discomfort and support recovery.

If you're experiencing persistent rib, upper back or chest wall discomfort that has been assessed as musculoskeletal, I'd love to help you explore your treatment options.

I'm Sarah, a structural osteopath based in Milford, Auckland, providing individualised care for adults and children aged five years and older.

Let's work towards helping you move more comfortably and get back to the activities you enjoy.