The 12 ribs on each side of the chest are an important part of the chest wall that protect underlying internal organs.
Rib fractures commonly occur in the middle ribs. Fracture of the first two ribs is rare as they are somewhat protected by the clavicle (collarbone), whilst the lowest two ribs are also rarely fractured because they do not insert into the sternum (breastbone) so they are able to move more freely.
Fractures usually occur from direct blows or from indirect crushing injuries. Rib fractures can be painful and may lead to severe injury inside the abdomen and chest.With any rib trauma, x-ray is suggested to rule out a fracture. Also a chest examination is recommended to be certain that there is no injury to the lungs as a result of the fracture.
Rib fractures may be sustained during sports or recreational activities or they may be the result of a motor vehicle accident or from a fall. However, ribs can be fractured by means other than direct trauma. Prolonged coughing, cancer, osteoporosis or weakened bones from bone infections can all lead to fractured ribs.
Stress fractures of the ribs may occur with overuse, usually related to repetitive movements in sports such as rowing or baseball pitching in which the muscles that insert into the ribs work excessively hard leading to the stress fracture.
The most common indicator of a fractured rib is sharp localised pain during breathing, especially with inspiration (breathing in). There may be a grating sound with breathing or movement of the fractured rib that causes the chest wall to flail. A flail chest is a potentially fatal condition in which a portion of the chest wall moves separately from the rest of the chest. The flail segment moves in while the rest of the chest moves out. If this occurs, immediate medical attention is necessary as it may lead to a pneumothorax (a punctured lung).
Pain from rib fractures can make any movement, especially changes in position such as getting out of bed, very difficult due to pain.Also, because breathing is painful, the person may try to suppress deep breathing or coughing, which can lead to a chest infection. Early mobilisation after a rib fracture is important to prevent infection, pneumonia, constipation and deep vein thrombosis (DVT).
Physiotherapy can help patients with fractured ribs in a number of ways:
- Assist you to walk and show you the best ways to change positions, while heeding necessary precautions
- Apply padding or strapping to stabilise and support the fracture site and ease pain
- Provide pain relief in the form of ice, heat and ultrasound
- Strengthening and/or flexibility exercises to help return to sport
If you have sustained a trauma to the ribs, come and see how we can help you.
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