What changes occur to the rib cage in pregnancy and how is this associated with rib cage pain?

by Dr. Alison Gault


The rib cage consists of 12 pairs of ribs that start at the spine and travel around to the front of the chest where they attach via cartilage to the sternum or breast bone.  The two lowest pair of ribs are called floating ribs as they are not attached at the front to the sternum. During pregnancy, the growing uterus, placenta and baby push your abdominal organs in all directions to make room. To accommodate this increasing volume, the rib cage, with the help of the hormone relaxin, widens.  You would notice this by often needing to change to a larger clasp on your bra.

In practice, I have noticed that rib cage pain often starts in the first half of the second trimester of pregnancy as the uterus moves out of the pelvic cavity. If there is tightness and dysfunction within the joints or muscles of the rib cage, there will be a resistance to the required widening which results in further problems.  Staying as fit, mobile, malleable and aligned as possible will assist in preventing this pain developing.  This is especially important for those women who have had problems in the thoracic spine or rib cage previously, particularly those with a scoliosis.

Costochondritis in pregnancy

Pain in the upper anterior ribcage is most often caused by a condition called costochondritis.   This is an inflammation of the joint between the rib and the cartilage attaching the rib to the sternum. The pain associated with this condition tends to be nagging, constant, sharp and very tender to touch.  There may also be swelling palpable surrounding the joint.

Pregnancy related diaphragm tightness and cramping

rib cage painPain under the lower aspect of the anterior ribcage may be associated with the diaphragm.  This is the large muscle attached to the lower 6 pairs of ribs that is the main breathing muscle. As the muscle contracts, it drops and creates a vacuum within the lungs which pulls the air in. The rib cage pain associated with this problem is described as more of a cramp or stitch like pain.

Rib cage pain and dysfunction in pregnancy

Pain of a rib dysfunction is most often located in the lateral or posterior aspect of the ribcage.  The rib cage pain is normally experienced in the muscles between the ribs or at the joints where the rib attaches to the spine.  This pain is cased by tightness, fatigue and irritation of the intercostals muscles that lie between the ribs or due to inflammation of the joint along the spine.  This pain can be aching, grabbing, sharp with certain movements and very tender to touch.  Pain may be aggravated with movement and taking deep breaths.

Products for rib cage pain in pregnancy

pregnancy support pillow  supports and lifts the belly when you are lying on your side to reduce the drag and strain on the ribs. This is what I used in my pregnancy after developing discomfort in the muscles in my side and sharper pain in my left lower ribs. It helped me so much that it came everywhere with me!

A pregnancy belly support brace to more evenly distribute the weight of your belly when standing and take strain off your abdominal muscles.  This improves posture which ultimately reduces pressure on your ribs.

The Pelvic Exercises program by Michelle Kenway takes you through pelvic floor and core muscle strengthening exercises. Having a strong core aids in maintaining optimal alignment of the spine and pelvis which can reduce strain on the joints of the ribcage and all the surrounding muscles.

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