Patients frequently present with rib pain, often believing their ribs are "out of place." While true rib dislocations are rare, costovertebral dysfunction is a common musculoskeletal complaint that chiropractors should be well-versed in. This condition can mimic other pathologies, making accurate diagnosis crucial.

1. What is Costovertebral Joint Dysfunction?

Costovertebral joint dysfunction occurs when there is abnormal motion between a rib and its vertebral connections. Though not a dislocation, this dysfunction is a commonly overlooked cause of chest and abdominal pain. Studies indicate that 10-30% of non-cardiac chest pain originates from musculoskeletal issues. (1)

The costovertebral joint, where the rib head meets the thoracic vertebra, is stabilized by ligaments and a thin capsule. These joints are richly innervated by intercostal nerves, which can lead to referred pain along the chest or abdominal wall.

2. How Does Costovertebral Dysfunction Develop?

Patients may develop costovertebral dysfunction due to:

Trauma – Common in athletes involved in wrestling, rugby, football, golf, or swimming.
Repetitive stress – Postural strain, compression, or rotation-based injuries.
Pregnancy – Rib and thoracic pain frequently occur due to postural changes.
Underlying biomechanical issues – Forward head posture, hyperkyphosis, scoliosis, or dysfunctional breathing patterns can predispose patients to rib dysfunction.

3. Recognizing Costovertebral Dysfunction in Patients

Symptoms sometimes begin following sudden, unguarded, or explosive movements, like coughing or sneezing. Patients may report:

Localized pain 3-4 cm lateral to the spine, sometimes radiating along the rib.
Sharp, stabbing, or burning pain, often described as feeling like being “shot by an arrow.”
Increased discomfort with deep breathing, coughing, twisting, or bending.
Worsening symptoms upon lying down (helping differentiate from dorsal scapular neuropathy).

Did you know?

While thoracic spine pain is common, a lesser-known but significant contributor is dorsal scapular neuropathy—a condition that often stems from the neck and radiates symptoms into the mid-thoracic spine and scapular region. Though not frequently diagnosed, studies suggest that dorsal scapular nerve entrapment may account for up to 1.5% to 2% of patients presenting with upper back or scapular pain. (2)

Want to dig deeper? Check out the resources within ChiroUp to learn more about identifying, assessing, and treating dorsal scapular neuropathy.

4. Evaluation & Diagnosis for Costovertebral Dysfunction

A hands-on assessment is essential for costovertebral dysfunction. Chiropractors should:

Palpate for localized costovertebral or costosternal tenderness.
Assess movement patterns – pain with flexion, rotation, or lateral bending supports a musculoskeletal origin.
Perform motion palpation – a prominent rib head with limited joint movement indicates dysfunction.
Use orthopedic tests – rib compression, costovertebral spring testing, and spinal percussion can help differentiate from fractures or visceral pain.

5. Conservative Management for Costovertebral Dysfunction

Chiropractic care provides an effective, evidence-based approach to treating costovertebral dysfunction. Treatment should focus on:

Joint Mobilization & Manipulation – Manual adjustments are the cornerstone of treatment, often providing rapid relief.
Myofascial Release & Stretching – Addressing hypertonic muscles around the thoracic spine and rib cage.
Postural Correction – Patients with forward head posture, hyperkyphosis, or dysfunctional breathing patterns may require rehab exercises.

6. Home Care for Costovertebral Dysfunction

At-home exercises can help alleviate symptoms and improve function and mobility. Costovertebral dysfunction exercises could include:

Want to relay this information to your patients automatically? Here’s a sample lay condition report for costovertebral dysfunction that you can deliver with 4 clicks in ChiroUp.

Conclusion

Simple costovertebral dysfunction typically responds well to chiropractic care. However, lingering pain suggests a need for further evaluation. Chiropractors should remain vigilant in differentiating mechanical pain from potentially serious conditions to ensure optimal patient outcomes. For a comprehensive guide on this condition, explore our full protocol here.

1. National Center for Biotechnology Information (NCBI). Other common causes of chest pain with musculoskeletal origin. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Link
2. Chaves, T. R., Pimenta, P., & Silveira, A. P. (2017). Distal sensory neuropathy and overuse injuries in overhead athletes: A case series. Journal of Athletic Training. 52(8), 756-762. Link

Costovertebral Dysfunction: What Chiropractors Need to Know