Understanding Slipping Rib Syndrome: A Comprehensive Guide

Slipping rib syndrome, also known as rib tip syndrome or clicking rib syndrome, may not be well-known but can cause significant discomfort and confusion for those affected. This condition involves the lower ribs—usually the 8th, 9th, and 10th, known as false ribs—slipping and moving in a way that can cause pain and other symptoms. This blog post explores what slipping rib syndrome is, its symptoms, causes, diagnosis, and treatment options.

Slipping Rib Syndrome and back pain

What is Slipping Rib Syndrome?

Slipping rib syndrome occurs when the cartilage on the lower ribs slips and moves, leading to irritation of the intercostal nerve, abdominal muscles, and other surrounding structures. The affected rib slips under the superior adjacent rib, causing severe, intermittent pain in the lower chest or upper abdominal area.

Understanding the Relevant Anatomy of Slipping Rib Syndrome

Close up of the spine and rib attachment

To fully grasp why slipping rib syndrome occurs and how it affects the body, it’s helpful to have a basic understanding of the relevant anatomy. Here’s a simple breakdown that explains the structure and function of the ribs and surrounding tissues:

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The Rib Cage

  • Structure: Your rib cage comprises 12 pairs of ribs that form a protective cage around the vital organs in your chest, including the heart and lungs.
  • Function: The primary role of the rib cage is to protect these organs, but it also plays a crucial role in breathing as it expands and contracts with each breath.

Types of Ribs

  • True Ribs: The first seven pairs of ribs are known as “true ribs.” They connect directly to the sternum (breastbone) in the front of the body through their own set of cartilage.
  • False Ribs: The 8th, 9th, and 10th ribs do not directly connect to the sternum. Instead, they are connected to the cartilage of the rib above them. These are the ribs typically involved in slipping rib syndrome.
  • Floating Ribs: The last two sets of ribs, the 11th and 12th, are called “floating ribs” because they are not attached to the sternum or the ribs above them. They are only connected to the spine at the back.


  • Role: Cartilage is a firm yet flexible connective tissue that joins the ribs to the sternum and spine, allowing the rib cage to expand during breathing.
  • Vulnerability in Slipping Rib Syndrome: In cases of slipping rib syndrome, it’s usually the cartilage of the false ribs that becomes weakened or overly flexible, leading to the ribs “slipping” under stress or movement.

Intercostal Muscles and Nerves

  • Muscles: Intercostal muscles are located between each rib and assist with breathing by lifting and lowering the rib cage.
  • Nerves: Intercostal nerves run along the bottom of each rib, providing sensation to the chest and abdomen. If a rib slips, these nerves can become irritated, leading to pain.

Why It Matters

Understanding this anatomy helps to explain why slipping rib syndrome can cause symptoms like pain and clicking sensations and why movements such as deep breathing or bending can exacerbate the discomfort. It also highlights the importance of the rib cage’s flexibility and stability, balancing protection with movement—a balance that is disrupted in slipping rib syndrome.

Symptoms of Slipping Rib Syndrome and Chest Pain

The symptoms of slipping rib syndrome can vary but typically include:

  • Sharp, Intermittent Pains: These are often felt in the upper abdomen or lower chest and can be described as abdominal pain.
  • “Clicking” Sensation: Some patients report feeling a popping or clicking sensation in their ribs.
  • Breathing Issues: Pain may worsen with deep breaths, coughs, or during certain movements, leading to difficulty breathing.
  • Chest Pain: This can be severe and may require immediate medical attention.
  • Tenderness: The area around the affected ribs may be particularly tender to the touch.

Causes and Risk Factors

Understanding the causes and risk factors of slipping rib syndrome can help in managing and preventing this condition:

  • Hypermobile Ribs: Excessive flexibility in the chest wall can lead to rib slippage.
  • Trauma: An injury to the rib cage, such as from contact sports or an accident, can cause the ribs to become displaced, leading to slipping rib syndrome.
  • Repetitive Movements: Activities that involve repetitive upper body movements like rowing or swimming may increase the risk.
  • Poor Posture: Chronic poor posture can contribute to undue stress on the rib cage.

How to Diagnose Slipping Rib Syndrome

Diagnosing slipping rib syndrome often involves several steps to diagnose slipping rib syndrome:

  • Medical History: A detailed discussion of symptoms and any relevant activities.
  • Physical Examination: The “hooking maneuver” is a common technique used in diagnosis, where the doctor hooks their fingers under the rib margin and pulls upward to reproduce symptoms.
  • Imaging Tests: While not always necessary, ultrasound or MRI can help rule out other conditions.

Slipping Rib Syndrome Treatment Options

Treatment for slipping rib syndrome focuses on relieving pain and stabilizing the ribs:

  • Rest and Activity Modification: Limiting activities that exacerbate the pain is crucial.
  • Pain Relief Medications: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage symptoms.
  • Physical Therapy: Exercises to strengthen the muscles around the ribs can help stabilize the rib cage and prevent further slippage.
  • Intercostal Nerve Block: In severe cases, a nerve block can be used to manage pain by targeting the intercostal nerves.
  • Surgical Options: If conservative treatments fail to alleviate severe pain, surgical intervention might be considered to remove the mobile segment of the rib.
  • Painful Rib Syndrome: Also known as slipping rib syndrome, this condition involves excessive movement of the lower rib tips, causing pain in the lower chest or upper abdomen. The pain is often associated with specific movements or activities, such as twisting, bending, deep breathing, sneezing, or coughing. Treatment options include rest, avoiding certain activities, or stretching out the rib cage.

Can Manual Therapy Assist with Slipping Rib Syndrome?

You can treat rib issues with manual therapy

Manual therapy is a form of physical treatment primarily used by physical therapists, chiropractors, and other trained health professionals to treat musculoskeletal pain and disability; it most commonly includes kneading and manipulation of muscles, joint mobilization, and joint manipulation. Here’s how manual therapy can be beneficial for patients suffering from slipping rib syndrome:

Understanding Manual Therapy

Manual therapy techniques involve hands-on methods aimed at reducing pain, increasing range of motion, and improving function in affected areas. For slipping rib syndrome, specific techniques may include:

  • Soft Tissue Mobilization: To relax and stretch the muscles around the ribs, potentially easing the tension and pain.
  • Joint Mobilization: Gently moving the joints in ways patients cannot move them themselves can help reduce the discomfort associated with slipping ribs.

Benefits of Manual Therapy for Slipping Rib Syndrome

Manual therapy can offer several benefits for those dealing with slipping rib syndrome:

  • Pain Reduction: Manual therapy can help reduce inflammation and alleviate pain by targeting the soft tissues and joints around the ribs.
  • Increased Mobility: Manual therapy can help improve the range of motion in the rib cage, which might be limited due to pain or stiffness.
  • Alignment and Stability Improvement: Techniques used in manual therapy can improve the alignment and stability of the ribs, potentially preventing further slippage.
  • Enhanced Breathing: Since slipping rib syndrome can affect breathing, improving the movement and stability of the rib cage can help make breathing more accessible and less painful.

How Manual Therapy is Applied

A trained therapist will typically perform a thorough assessment to determine the best approach. For slipping rib syndrome, the treatment may involve:

  • Identifying the Affected Ribs: The therapist will first locate which ribs are causing discomfort.
  • Tailored Techniques: Depending on the severity and specific symptoms, the therapist might use various hands-on techniques to manipulate and mobilize the ribs and surrounding muscles.
  • Education and Advice: Part of manual therapy also involves educating patients on exercises and postures to maintain their condition at home.

Considerations and Cautions

While manual therapy can be highly beneficial, it’s important to approach it with caution:

  • Professional Guidance: Always seek treatment from a certified professional experienced in treating rib-related issues.
  • Gradual Progression: The therapies should be applied gently, especially at first, as aggressive manipulation might worsen the symptoms.
  • Monitor Symptoms: Keep track of how your body responds to treatment. Any increase in pain or new symptoms should be reported to your therapist.

Manual therapy can be a valuable part of the treatment plan for slipping rib syndrome, offering pain relief, improved mobility, and better quality of life.

However, it should be approached as part of a comprehensive treatment plan, ideally coordinated by a healthcare professional familiar with this condition.

If you suspect you have slipping rib syndrome, or if you’re looking for non-surgical ways to manage your symptoms, consider consulting a specialist who can determine whether manual therapy is appropriate for you.

Preventive Measures for Slipping Rib Syndrome

Influencing the core through the plank position. Extended arms reaching into the floor.

Preventing slipping rib syndrome requires a proactive approach to addressing and mitigating underlying risk factors. Effective prevention can help minimize the occurrence or recurrence of symptoms. Here are expanded details on the preventive measures:

Strengthening Exercises

Regular exercises that target the core and upper body muscles play a crucial role in supporting the rib cage and preventing the slippage of ribs. Here are some specific exercises and benefits:

  • Core Strengthening: Exercises like planks, abdominal crunches, and leg raises help strengthen the muscles around the abdomen and lower back, providing better stability for the rib cage.
  • Upper Body Workouts: Incorporating exercises such as push-ups, pull-ups, and dumbbell rows can enhance the strength of the upper back and chest muscles, which are integral to rib cage support.
  • Flexibility and Mobility Workouts: Activities like yoga and stretching improve flexibility and mobility, which can prevent the muscles and joints around the ribs from becoming stiff or tight, reducing the risk of slippage.

Improving Posture

Good posture is essential for reducing stress on the ribs and preventing conditions like slipping rib syndrome. Here are practical tips for maintaining proper posture:

  • Awareness and Correction: Regularly check and correct your posture throughout the day, especially if you spend long hours sitting or standing. Ensure your back is aligned, your shoulders are back, and your chest is open.
  • Ergonomic Workstations: Set up your working environment to support good posture. Ensure that your chair and desk height allows your feet to rest flat on the ground and that your computer screen is at eye level.
  • Posture-Supportive Tools: Consider using ergonomic chairs, standing desks, and posture correctors, reminding you to maintain proper alignment.

Avoid Repetitive Stress

Repetitive movements, especially those involving the upper body, can stress the ribs and surrounding muscles, increasing the risk of slipping rib syndrome. Here are strategies to modify activities to prevent undue stress:

  • Activity Variation: Rotate your activities to avoid overuse of the same muscles and joints. If your sport or job involves repetitive motion, find ways to change your movements or take frequent breaks.
  • Technique Adjustment: Ensure that your techniques in sports or physical activities are correct. Improper techniques can put unnecessary stress on the rib cage. Consider working with a coach or therapist to adjust your movements.
  • Use of Supportive Gear: For sports or activities that strain the rib area, use supportive gear such as rib protectors or compression garments to help distribute forces more evenly across the body.

By incorporating these preventive measures, individuals can significantly reduce the risk of developing slipping rib syndrome and maintain better overall rib and torso health. Regular consultation with healthcare professionals, such as physical therapists or trainers, can also provide personalized advice and adjustments to your preventive regimen based on your specific health needs and lifestyle.

In closing

Slipping rib syndrome is a lesser-known condition that can cause significant pain and discomfort.

Understanding the symptoms and getting an accurate diagnosis is key to effectively managing and treating this condition.

If you suspect you have slipping rib syndrome, consult a healthcare provider who can offer a comprehensive evaluation and appropriate treatment plan tailored to your needs.


PostureGeek.com does not provide medical advice. This information is for educational purposes only and is not intended to be a substitute for professional medical attention. The information provided should not replace the advice and expertise of an accredited health care provider. Any inquiry into your care and any potential impact on your health and wellbeing should be directed to your health care provider. All information is for educational purposes only and is not intended to be a substitute for professional medical care or treatment.

About the author

Nicholas Barbousas is the founder of PostureGeek.com and an experienced therapist with extensive expertise in human movement and physical conditioning. With over 30 years in the profession, he specializes in Rolfing Structural Integration, utilizing proven methods to enhance body alignment and functional health. As an educator and author, Nick has developed comprehensive programs in manual therapy, myofascial release, and fitness training, advancing the practice of manual and movement therapies through his contributions to PostureGeek.com.

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