Rib pain during pregnancy and postpartum

by Bryn Zolty, PT

Rib pain during pregnancy and postpartum can make everything difficult. Taking care of kids, lifting, carrying, rolling over in bed, getting out of a chair, and even breathing can hurt.  

​In many cases, this is due to musculoskeletal changes that occur during pregnancy. Your ribs start changing position even before your uterus is large enough to push pressure up into the diaphragm and rib cage. Therefore, it is thought to be hormonal changes that may play a large role in the alteration of the rib cage. 

Infrasternal Rib Angle
One of the ways we check rib cage changes is the infrasternal rib angle. Place your thumbs in towards the bottom of the sternum to get an estimate of your rib angle. A normal angle is close to 90 degrees. ​

Changes During Pregnancy
This angle can increase by 35 degrees during pregnancy (1). In addition, the ribs flare up and out by 10 to 15 cm and chest circumference increases by 5-7cm (1). This means your rib cage is wider.  ​

Muscle Pain
​These changes to your ribs cause stretching through the muscles that attach into the ribs, including the intercostal muscles and the abdominal muscles. The stretching can be very uncomfortable and can lead to muscle stretch injury or cartilage stretch injury. 

​Joint Pain
When inflammation is present between the ribs and the breastbone at the front chest wall, it is known as costochondritis and is tender to touch. At the back of the ribs, women may complain of stiffness, pain, and pressure where the ribs meet the spine.  ​​

Rare Musculoskeletal Pain Cause
​In rare cases, women will experience transient osteoporosis during their pregnancy. Throughout your pregnancy the amount of calcium transferred from you to the baby increases drastically. It starts at about 2 mg/day and by the 3rd trimester it could be as much as 250mg/day (1)!  As with anyone with osteoporosis or osteopenia, there is an increased risk for fracture in your bones including the ribs. A weakened bone can fracture under normal forces, and if you suspect this you should contact your doctor.  

Muscle dysfunction, painful joints, stiffness, and trouble with normal daily activities can be treated by a physical therapist. If you are pregnant or postpartum and have a pelvic therapist nearby, contact them and make an appointment. They have additional training to help a woman during and after her pregnancy. 

When Rib Pain Is Not Musculoskeletal
There are many causes of chest pain that can occur during pregnancy. These include cardiac causes, clots, pneumonia, heartburn, peptic ulcers, shingles, and more. Your physician will help order any tests needed.

Get Started Before You Make An Appointment
​For some women, the musculoskeletal changes that occur during pregnancy do not go away on their own. Here are some ideas to get started in case you are not ready to start physical therapy.

For getting your abdominal muscles fully back on-line immediately postpartum
How to help your abdominal muscles immediately after delivery (connectpt.org)

Improve Mobility During Normal Tasks
If you feel it is difficult to find time to exercise and stretch, start with incorporating lots of movement into your day. Add trunk rotation and side bending into your normal tasks. This will help mobilize the ribs and the spine. It can also help encourage the obliques to mobilize the ribs as well.  

• when reaching for light objects, reach and twist 
• carry your baby on a different side to vary movement patterns
• if breastfeeding, alternate positions
• monitor for movements that you only do on one side consistently and change it up​

Breathing Moves Your Ribs For You
​​To get your rib cage moving better, you need to use it for breathing!  Pregnant and immediately postpartum, avoid pushing pressure down and out into the lower abdomen and pelvis when practicing this breathing. Instead of pushing your abdomen forward, as you inhale, feel your ribs move 360 degrees out and up, and as you slowly exhale feel them fall in and down.

​See the pictures for hand placement to monitor your breathing.  A hand on your chest and ribs can help you monitor what you do during the breathing exercise. Most of the time, we recommend the 360 movement. With both hands placed on the lateral ribs in the lower picture, your hands will appear to be moving your ribs like an accordion.

If your ribs feel wide and “stuck out’, focus on a long, full exhale.  And absolutely work this breathing pattern into all kinds of stretches and yoga poses. 

If you are pregnant and past your first trimester, it is important to monitor how you feel when laying on your back and limit this position. This breathing exercise can be done in sidelying, sitting, standing, reclined, or any other comfortable position.

​If you feel like getting up and moving, some of these yoga poses may help. Combine them with your 360 breathing. Note she is twisting away from her bent knee in many poses to avoid compression in the groin and maintain open space for your baby.  

Twisted crane pose

Fan pose

Goddess twist

Seated crossed leg twist

Seated straight leg twist

Make an Appointment

Rib flare left untreated can cause altered function of your core muscles.  When you feel ready to attend therapy, your therapist will help customize a stretching, breathing, and strengthening program specific to your body. 

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1 Women's Health in Physical Therapy. Jean and Glenn Irion.Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, ©2010