Pelvic Health Blog

Rib pain during pregnancy and postpartum

8/31/2022

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.

What is good posture?

7/11/2022

By Shraddha Wagh, PT

Everyone’s heard the saying “sit up straight” or “stand up with good posture” at some point in his/her lives - but what is good posture, and why is it important?

Which of the following is the perfect posture?

Answer: NONE of them!

There is no such thing as one “perfect posture,” and it is unrealistic to try to maintain one specific posture when performing various activities throughout the day. Each individual has varying body types, muscle flexibility, and muscle tone that can contribute to poor posture. Although there is no ONE perfect posture, good posture is important for multiple reasons.

Prevents injuries during physical activities and exercise
Allows you to center weight over your feet and equally throughout your body
Improves balance and can reduce risk of falls
Improves blood flow and circulation
Increases muscle flexibility and mobility

As more and more jobs are transitioning to remote or involve sitting for extended periods of the day, sitting posture is one of the biggest things to address to prevent future injury and or pain.

Tip when working from home or in the office:

Place a post-it note with “posture” written on it somewhere on your desk around eye level. Every time you see that note, it will remind you to be more mindful of your posture and adjust it if needed- this improved awareness over time will allow you to remain in a better posture for longer periods of time and with less thinking as it will become more subconscious.

Sitting posture

Feet flat on floor
Hips and Knees at 90-degree angle
Elbows and forearms supported
Back support
Shoulders relaxed: no hunching forward or leaning back!
Forehead & eyes level with top of computer screen

Standing posture

Feet flat on floor
Chin tucked, shoulders back and relaxed
Avoid hunching shoulders or rounding upper back!
Balance weight over feet with low back and hips in neutral position. Avoid shifting weight on hips from side to side
Core engaged
Knees straight- no locking out!

See a physical therapist to receive individualized recommendations and exercises for postural corrections and improvements!

Body Talk

4/8/2021

by Karen Bruno, PT

It has been recognized for a long time that there are interactions between the mind and the body. Our thoughts inform our emotions and that triggers a cascade of events in our bodies. (1) Emotions that are expressed freely and without judgement can uplift us, make us feel happier and improve our overall health. Repressing our emotions, especially anxiety and anger, can produce a physical reaction of tension in the body (Tension Myositis Syndrome). Prolonged tension can lead to pain disorders, stiffness and loss of function. (2)

If you are experiencing chronic pain, stiffness or discomfort, what is your body trying to tell you? Here is a short, fun practice to begin dialogue and partnership with your body.

Allow yourself to acknowledge your body’s wisdom.
Acknowledge anything that feels like discomfort or pain is really not discomfort or pain, but rather your body’s desire to call your attention to it and give you information.
Talk to the pain or discomfort. Acknowledge the part of the body from where the pain is coming and speak to it directly.
You may choose to use a mirror and look in the mirror as you speak to that part of your body or you may talk to the body and say, ”Body part, I love you. I am grateful for what you are doing for me. Tell me what you would like me to know”, and then listen.

This may seem awkward or strange at first; it may seem silly or even uncomfortable, but if you do this more and more, you shall receive the answers and your body begins to trust you and you begin to trust your body, thereby creating a partnership for health. Through practicing this over and over you may notice that the pain begins to subside and may eventually be gone.

You may choose to combine this with a very clear intention that it is your intention to 100% enjoy your body fully, and that your body enjoys you inside of it fully and completely. This supports your collaboration with your body for a maximum amount of enjoyment.

Although the pain may not leave immediately, recognize that the physical form takes longer to change, but the change starts once you make a connection and change your thoughts. It is new energy; it is new consciousness; it is new awareness. Your job now is to stay in a mode of receiving and know that you have started the process of feeling better, and while it might not be an overnight healing, it will be steadfast and continuous, and with ease and grace. We want this with ease and grace in the most gentle way for you.

According to Dr. John Sarno, in his book, Healing Back Pain, for a condition like chronic back pain, once you call out the emotion that your body is repressing, there is no longer any need for the pain and the body will no longer need to generate tension. (2)

All of us here at Connect Physical Therapy are here to support you to feel your best.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585554/
Sarno, John (1991), Healing Back Pain, Grand Central Life and Style, New York

Did You Know: Exercise's Lesser Known Impact

10/30/2011

People who exercise greater than 1 hour per week have a lower risk of neck, back, and shoulder pain, as demonstrated by a recent article published in the American Journal of Epidemiology (June ’11).

Exercise, Low Back Pain, Neck and shoulder pain

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Rib pain during pregnancy and postpartum

What is good posture?

Body Talk

Did You Know: Exercise's Lesser Known Impact

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