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Pain Around Ribs and Back Symptoms

In this article we describe all the possible causes of pain around the ribs and back symptoms and the most effective ways to treat it.

Our body has been designed to perform several important functions. There are vital functions such as protection of the vital organs, repairing and healing the worn-out cells and other body parts, storage of compounds only to be utilized later, and excretion of the toxic and harmful substances so that they do not harm the body. 

At the end of the day, all functions serve to protect our body and keep it in its optimal shape and condition. However, sometimes, due to malfunctions or diseases, the body becomes compromised and is unable to work as effectively as it normally did. 

Body aches and pains are one such unwelcome and uncomfortable condition that can greatly impact the working and functioning of an otherwise healthy and happy human being. 

While body pain may vary from person to person, when we speak generally, backache is undoubtedly one of those body pains that affect almost every other person at least more than once in their lifetime. The most common cause of backache is a poor sitting or sleeping posture. If left untreated, this pain can easily assume a chronic pain condition in your body. [1]

This characteristic pain may affect any part of the back, with the lower back being the most affected region. However, the middle or upper back may be involved just as commonly. In the case of the upper-middle back, the rib cage and chest area also get involved, leading to chest pain later in the course of the pain. 

The Relation Between The Ribs And Upper-Middle Back Region

It is essential to realize the relation between the rib cage and the back muscles if we need to dive deeper into the mechanism of pain occurring between these two regions. 

Contrary to popular belief, both these regions are not just connected by pain but also through muscles. The intercostal muscles, or the ‘intercostals,’ are sets of muscles between two adjacent ribs in the ‘intercostal’ spaces. These muscles work to set up the chest wall and also help connect the ribs. [2]

Therefore, all the pain that occurs in the upper back area or around the rib cage itself is due to problems within the intercostal muscles. 

Common Causes Of Pain Around The Ribs And Back Symptoms

There could be several underlying causes that lead to the development of pain around the ribs and back. It is important to rule out all the possible causes before beginning any treatment because, in some cases, the underlying cause could be a life-threatening one for the affected person, so medical attention could be needed. 

The common causes of back and rib cage pain include: 


Costochondritis, also known as ‘Tietze’s Syndrome,’ is a condition that occurs due to the inflammation of the cartilage that is holding the ribs together. [3]

Since this type of inflammation causes unexpected, sharp pain, the affected people often visit the emergency room (ER) as soon as possible, for they mistake it to be something related to the heart, most commonly a heart attack. 

The pain usually makes the affected person develop difficulty breathing, usually when deep breaths are involved, experiencing the characteristic ‘stabbing’ sensation. [4]

Costochondritis is a common condition that affects people in their middle ages. However, it is still recommended for the people suffering from this disease to get their cardiac workup done, for it is always better to be safe than sorry, especially in patients who already have a history of cardiovascular diseases. 

Warm compresses and over-the-counter pain relief anti-inflammatory medications (Ibuprofen, Naproxen) usually help resolve the pain in no time. [5]


As surprising as it may sound, COVID19 has also been responsible for some rib and back pain cases. However, the pain occurring in and around the breast bone region could have various reasons while remaining in the context of COVID19. 

Some people experience this pain due to the coughing episodes that are a part of the COVID19 symptoms, whereas some develop it as part of the COVID19 infection itself due to the shortness of breath and chest pain that is both, again, considered to be a part of COVID19 symptoms. [6]

Muscle Strain as a cause of pain around the ribs and back symptoms

Just like every other body muscle, the intercostal muscles can get strained too. Now, this condition could occur due to numerous causes. But, usually, it happens when a person suddenly lifts a very heavy weight or performs a strenuous physical activity that they usually do not perform. [7]

It could also occur due to any muscle tears or injury to the intercostals, which have other primary causes leading to the development of pain in this region. 

The pain that occurs due to intercostal muscle strain also has a sharp and severe intensity and sometimes can cause stiffness in the entire back and ribs. 

The treatment of this muscle strain is the same as that for any other musculoskeletal pain. It involves taking the appropriate painkillers. In the majority of the cases, NSAIDs are enough. For people with persistent pain, physical therapy may also be recommended. [8]

Lung Conditions

Apart from the usual muscle and ligament tears and sprains, several other serious conditions and pathologies might also simultaneously contribute to developing back and chest pain. 

Here, it is important to mention that lung-related conditions are one of the prevalent causes of pain in this region. Pathologies such as pulmonary embolism, pleurisy, and lung cancer contribute to the development of rib pain. [9]

For this pain category, it is important to seek medical advice and get the primary condition or the underlying cause treated first. 

Surgery, chemotherapy, or radiotherapy follow the treatment of choice for this back rib pain. 

Visceral (Referred) Pain: 

Sometimes, pain around the shoulder or upper-mid back area can also be present for unexpected reasons. Some of the popular medical conditions that cause this type of pain include cholelithiasis (stones in the gallbladder) or pancreatitis. [10]

In both these conditions, the pain gets referred from the point of origin to the back area, either between the shoulder blades or all the way around the ribs. This pain is also sharp and stabbing in nature, causing difficulty breathing to develop and only gets relieved if the patient makes an effort to bend forward. 

The treatment plan for either of these conditions is the same as that involving lung conditions – the underlying cause needs to be treated first. 

How Is Pain Around The Ribs And Back and Back Symptoms Diagnosed? 

Diagnosis of pain conditions involving the ribs and back area could be quite tricky. The reason for this uncertainty is the proximity of the heart to this region. With any painful situation that arises over here, a heart attack or other angina-related pain is usually the first suspicion for anyone. 

Visiting a doctor should be your first resort. A doctor will take a detailed history and perform a proper physical examination to help rule out any visible or possible causes of rib and back pain. 

Along with that, in all such cases, it is best to get an X-ray done. It will help visualize all the inner details from a broken bone to any muscle-related problem (by showing that every other structure is intact) that will ultimately lead to a doctor leading their list of exclusions in the case. [11]

Conditions such as a broken rib, a blood clot due to pulmonary embolism, COVID19, and bruised ribs might all become life-threatening in the long run. They might also start compromising the health and vitality of the other structures around them, which might turn into a complicated series of events out of nowhere. 

The treatment for all back and rib pain cases can be effectively treated with over-the-counter painkillers, analgesic or anti-inflammatory balms, or physiotherapy for chronic pain. The earlier the condition gets diagnosed, the better it is for it to get evaluated and treated. 

A scan of a persons ribs

Other treatment options


Many of the structures have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that help to heal these structures.

Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is required to heal and repair.

As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.

Summary of pain around ribs and back symptoms

A common scenario is a condition that causes pain to develop around the rib cage or back area. Even though it might be nothing serious to worry about, it is best if people get it evaluated as soon as it starts, for in some cases, it might also turn out to be an alarm for a possible medical emergency – a heart attack might just be around the corner, and you will have no idea! 

The diagnosis and treatment of rib and back pain are simple and easy to follow. Therefore, many people experience the resolution of their symptoms in no time when they opt for rapid treatment.


Frequently Asked Questions 

  1. Does COVID19 Cause Your Ribs To Hurt?

The COVID19 infection can indeed cause the ribs to hurt. Sometimes, it is due to the cough that accompanies the infection; sometimes, it is due to the chest pain that leads you to develop shortness of breath during the infection – so yes, it is completely normal to experience rib pain during COVID19. 

  1. When Should I Be Concerned About Rib Pain?

Rib pain is usually serious when it does not resolve after taking a strong painkiller. Apart from this, if you develop difficulty breathing while moving in a particular direction or while sneezing or taking deep breaths, you need to visit a doctor right away as it might be something serious that is causing these muscle strains.  

  1. Does Pancreatitis Cause Rib Pain?

Yes, pancreatitis can lead some patients to develop visceral or ‘referred’ pain between their shoulder blades and around the rib cage. This referred pain usually occurs in cases of chronic pancreatitis because the patients find their relief in bending forward and so do not consult their doctor for definitive treatment. 

  1. Is Costochondritis A Symptom Of COVID19?

Costochondritis was found to occur in patients who were severely attacked with COVID19 infection. In other mild to moderate cases, costochondritis usually does not take place. 

  1. What Causes Rib Pain Without Injury?

Several medical conditions can cause rib pain without any significant injury. Pulmonary embolism, pleurisy, lung cancer, pancreatitis, and gallstones are some possible causes of the rib pain. 


  1. Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/
  2. Tang A, Bordoni B. Anatomy, Thorax, Muscles. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538321/
  3. Schumann JA, Sood T, Parente JJ. Costochondritis. [Updated 2021 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532931/
  4. Proulx, A. M., & Zryd, T. W. (2009). Costochondritis: diagnosis and treatment. American family physician, 80(6), 617-620.
  5. Mott, T., Jones, G., & Roman, K. (2021). Costochondritis: Rapid Evidence Review. American Family Physician, 104(1), 73-78.
  6. Kucuk, A., Cumhur Cure, M., & Cure, E. (2020). Can COVID-19 cause myalgia with a completely different mechanism? A hypothesis. Clinical rheumatology, 39(7), 2103-2104.
  7. Ayloo, A., Cvengros, T., & Marella, S. (2013). Evaluation and treatment of musculoskeletal chest pain. Primary Care: Clinics in Office Practice, 40(4), 863-887.
  8. Fabricant, L., Ham, B., Mullins, R., & Mayberry, J. (2013). Prolonged pain and disability are common after rib fractures. The American Journal of Surgery, 205(5), 511-516.
  9. Jany, B. (2017). Pulmonary causes of chest pain. Der Internist, 58(1), 22-28.
  10. Vera-Portocarrero, L., & Westlund, K. N. (2005). Role of neurogenic inflammation in pancreatitis and pancreatic pain. Neurosignals, 14(4), 158-165.
  11. Heiderscheit, B., & Boissonnault, W. (2008). Reliability of joint mobility and pain assessment of the thoracic spine and rib cage in asymptomatic individuals. Journal of Manual & Manipulative Therapy, 16(4), 210-216.

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