Postpartum rib flare

by Bryn Zolty, PT

Rib Flare
Rib flare refers to an altered ribcage position. This means the rib cage is tipped up/forward, flattened and wide, or both. Rib flare has many potential causes.  For this article, we will focus on the postpartum individuals.

Ribs Tipped Up Flare
First, let's look at the rib cage position from the side to identify the ribs tipped up flare. Ideally, the rib cage would line up over the pelvis and the curve in your lower back is greatest in your lower back. You can feel the top of your hips and walk your hands around to your back, this is where your lower back curve should be located. See the arrow from her hips to her lower back.

The first picture (left) demonstrates fairly neutral (good) posture. Notice the horizontal arrow from the top of the hip bone to the low back showing the curve. Also, note the vertical line running through the middle of the shoulder, trunk, and hip. The line is fairly centered in these locations. The ribs below her bra line are tucked in the abdomen.
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The second picture demonstrates the tipped up rib flare.  Notice the curve in the spine compared to the first. The curve in the back is higher. It continues throughout the middle back and her shoulder blades sit further back. The ribs are tipped upwards and stick out further than her abdomen. Also, note the vertical line running through the shoulders, trunk, and hip. The trunk is more forward and not centered as in the first picture.

This rib tipped up position, the second picture, in a postpartum population is common. Later in pregnancy as the baby grows, the ribs tip up to make room.  Women may lean back to maintain balance as their weight has increased forward.  Next, women carry around a growing baby and continue to lean back.   After standing in this position for months, your body begins to recognize this posture as straight. 
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Postpartum, the front abdominal muscles are stretched and weakened. The muscles in the lower back have been in a shortened position and can become painful and overworked as their counter parts in the front need time to regain strength.  However, to do that, we need to restore posture. It is difficult to strengthen abs that are lengthened if the ribs stay tipped up! When this position is maintained for a long period of time, the back muscles can become tight and even maintain the tipped ribs when laying down. 

Note in the picture the space between the floor and the back. The left rib cage here is sticking up. This individual will require some release work and stretching in addition to posture modifications. 

Infrasternal Rib Flare
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Another type of rib flare is seen in a front view. This is the infrasternal angle, the angle formed by the ribs coming together under the breastbone. A normal angle is 90 degrees. Place your thumbs together in this space and see if they form a 90 degree angle. When this angle is greater than 90 degrees, there is a rib flare. 

Commonly with a rib flare, the internal oblique muscles tend to be dominant, creating muscle imbalance. The internal oblique muscles flare the ribs wide. 

Here is the same individual lying flat looking at the front view to check for infrasternal rib flare.  Now you can see the left rib is more pronounced and wider than the right. This angle is greater than 90, and is asymmetrical.
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In the picture below, she was asked to start to curl up her shoulders off the ground. Note the ribs pulling wide and as her internal oblique muscles contract strongly demonstrating her muscle imbalance.

Rib flare does not get better on its own and needs individualized care to improve posture and muscle recruitment. So many functions in the body rely on the diaphragm and rib position.   Dysfunction can alter digestion, create back pain, increase your sympathetic nervous system, and decrease pelvic floor muscle flexibility. Muscle imbalance can create compensatory patterns and resulting pain and/or weakness. Many women tell us they want their core back and their stomach to look pre-baby. Rib flare can prevent abdominal muscles from contracting well and even push(pooch) out the lower abdomen if muscle imbalances exist. 

The key to treating rib flare is improving alignment and muscle balance. And not just muscle imbalance in your back and abdomen, but also shoulders, legs, feet, and pelvis. How you stand, sit, carry your kids, and exercise at the gym can all be part of improving rib flare.

At Connect PT we are happy to help evaluate and treat your posture, muscle coordination, and improve your strength!