Sharp Rib Pain When I Breathe: What Is Causing It?

A sharp pain in the ribs that bites every time you breathe in is one of the few complaints where the first job is not finding the cause. It is clearing the causes that need a hospital. Most of it turns out to be the chest wall, and that treats well. But several causes of painful breathing are dangerous, some of them within hours, so this page starts there.

Call 911 now if any of this is happening

• Sudden sharp chest or side pain that is worse when you breathe in, with breathlessness, a fast heartbeat, or coughing up blood. That can be a blood clot in the lung. Risk rises after a long flight, surgery, a stretch off your feet, or a clot in a leg. Flights in and out of St. Thomas are long ones.
• Chest pressure, or pain spreading to the jaw, neck, back or arm, with sweating, nausea or breathlessness. That is cardiac. In women it more often shows up as back pain, nausea and breathlessness than as crushing chest pain, so it may not feel the way you expect.
• Sudden sharp one-sided pain with breathlessness, particularly in a tall, thin, younger person or after a blow to the chest. A lung can collapse with no warning.

Do not talk yourself out of any of those, and do not wait to see whether the breathlessness settles. Call 911 or go to the nearest emergency room.

See a physician the same day for these

• Pain on breathing with fever, chills, a cough, or feeling unwell. Pneumonia and pleurisy both do this and need medical assessment, not manual therapy.
• Rib pain after a fall or an impact, especially with breathlessness or in an older adult. A fracture has to be excluded before anyone puts hands on the ribs.
• Burning, band-like pain wrapping one side with no injury behind it. Shingles does that, often days before the rash appears. Antivirals work best started early, so it is time-sensitive.

None of that is chiropractic. We do not treat lungs, hearts or infections.

What the mechanical kind feels like

• A sharp, small catch to one side of the spine or under a shoulder blade, biting on a deep breath, a cough, a sneeze, or rolling over in bed. You can find it with one fingertip, in the same spot day after day.
• You feel well otherwise. No fever, no breathlessness, no cough.

Where chest wall pain comes from

Every rib joins the spine in two places, at the vertebral body and at the bony wing that juts out to the side, and breathing asks both to swing a little all day. When one stops moving properly, the breath keeps catching on it at the top. Often nothing happened. You woke up with it.

The muscles between the ribs strain like any others: a week of coughing, an unusual lift, a twist while reaching behind you. Strained muscle covers a wider area than a locked joint and hurts most as the chest expands. At the front, where ribs meet the breastbone through cartilage, that junction can become inflamed and tender to press. Costochondritis is sore on a deep breath and alarming because it sits over the heart, and that is not a call to make on your own.

The sign that helps, and what it does not prove

Mechanical rib pain is usually reproducible. Press the exact spot and it hurts, move a certain way and it appears on demand, and it stays put instead of spreading. That is a supportive sign and not proof. A sore chest wall can sit on top of something else, and a person with a clot in a lung can have a strained muscle too. It rules nothing out, which is why the questions come before the hands.

How we treat it at Tradewinds

At Tradewinds Chiropractic & Wellness in Charlotte Amalie, St. Thomas, the first visit opens with that history: what brought it on, whether you have flown or been laid up, whether there has been fever or a cough. If any of it belongs with a physician or an emergency room, you get told plainly and sent there. If it points at the chest wall, the exam moves to the rib joints and the segments they attach to. Dr. Keys is the Chair of the Virgin Islands Board of Chiropractic Examiners, a member of the Virgin Islands Chiropractic Society, and the International Chiropractors Association representative for the U.S. Virgin Islands.

Care is usually specific adjustment of the rib and the segment it sits on, soft tissue work on the muscles guarding it, and breathing and mobility work to hold the gain. Our services page lists the methods. A broader ache across the mid back rather than one sharp rib is upper back pain. Pain that settles between the shoulder blades is pain between the shoulder blades.

Visitors, crew and cruise passengers

Long-haul arrivals, divers hauling tanks and crew in narrow berths all land in this spot. A long flight stiffens rib joints, and it is also the classic setup for a clot in the lung, so pain that started after flying with any shortness of breath is a 911 call.

Getting seen

Call (340) 690-4994 to book an exam. We take walk-ins and same-day appointments. We are in the VI Medical Foundation Building, Suite 202, 9150 Estate Thomas, St. Thomas, USVI 00802. Hours are Mon, Wed, Thu: 10:00 am to 1:00 pm and 3:00 pm to 7:00 pm. Tue, Fri: 7:00 am to 2:00 pm. Closed Sat and Sun. New patient forms are at forms. Tradewinds has more than 180 five-star Google reviews. If what you have matches the emergency list above, do not call us first. Call 911.

Questions patients ask

Why do I get a sharp pain in my ribs when I breathe?

Most often a rib joint where it meets the spine has stopped moving properly, so the breath keeps catching on it. Strained muscle between the ribs and inflamed cartilage at the front of the chest do the same thing. Before any of that is assumed, painful breathing has to be cleared of a clot in the lung, a cardiac cause, a collapsed lung, infection, a fracture and shingles, which is where a first visit starts.

Can rib pain when I take a deep breath be serious?

Yes. Call 911 for sudden sharp pain on breathing that comes with breathlessness, a racing heartbeat or coughing blood, for chest pressure or pain spreading to the jaw, neck, back or arm with sweating or nausea, and for sudden one-sided pain with breathlessness. See a physician the same day for pain on breathing with fever or a cough, for rib pain after a fall, and for burning band-like pain on one side that could be shingles.

What causes pain in the side of my ribs when breathing?

On the side, the usual mechanical causes are a rib joint restriction referring around the chest wall and a strain of the muscles between the ribs, often after coughing or an awkward twist. Both are sore to press and both get worse as the chest expands. Side pain that came on suddenly with shortness of breath is a different situation and needs 911.

How do I know if my rib pain is muscular or something worse?

Mechanical rib pain is usually reproducible: pressing the exact spot or moving a certain way brings it back, it stays in one place, and you feel well otherwise. That is a supportive sign, not proof, because a sore chest wall can sit on top of another problem. Breathlessness, fever, a fast heartbeat, coughing blood or feeling unwell overrides it and needs medical care first.

Can a chiropractor help rib pain that hurts to breathe?

When the source is a rib joint, a chest wall muscle or the cartilage at the front, yes, and it is often one of the more satisfying things to treat. Chiropractic does not treat lung, heart or infective causes of painful breathing, and the job of the first visit is to sort which one you have before anything is adjusted.