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Rib cage anatomy and its implications in back pain

'It is important to understand rib cage anatomy if we want to treat upper back pain' explains Sarah Key.   

The thoracic spine supports twelve pairs of ribs that slope gently down from the back as they pass around to encase the thorax. The first rib is right up in the angle of the neck and shoulder. Troubles with the first rib can cause pain in the neck while breathing, especially if the person is a mouth-breather (see later). The eighth rib is approximately at bra level and the twelfth rib dips to high waist level.


Each rib is very intricately invested into the sides of the spine, including to the sides of each disc


The rib-to-spine junctions are very complicated. Each head of rib attaches to the sides of each intervertebral disc, as well as notching into its neighbouring vertebrae above and below. These are called the the costo-vertebral joints. The rib attaches again to the side of the lower vertebra on its way around to the front of the chest. This is called the costo-transverse joint. Several tiny, but very strong ligaments hold the rib tethered firmly in place to all these different moving parts of the spine.



It is significant that the rib attaches directly to the discs. It means that each rib must accommodate to the stretching-and-compressing activity of these dynamic, water-filled pillows as they move and cushion each vertebra. As you will see later, there may be adverse consequences if a rib-to-spine junction gets sprained and the rib stops moving, because this will make the disc stop moving too.

rib cage anatomy and breathing

RibCage from BigStock

The ribcage is made to be flexible and springy so the lungs can fill and deflate easily


The ribcage is like a large-scale collapsible chicken carcass. It's designed to move with respiration, the ribs rising and lowering with each breath, thus increasing the capacity of the chest cavity while reducing its pressure. Each rib moves like a bucket handle; lifting up off the rim as we inhale and settling down again on the rim as we breathe out. All the ribs do this in unison as the lungs inside inflate with air and empty again.

Each rib must be fully mobile and springy so that the lung tissue under doesn't fail to fill ~ or worse, start to collapse. Optimal breathing means optimal gaseous exchange. This in turn means optimal cerebral function, optimal health and fitness, and optimal wellbeing.


Lungs from BigStock Photos

Oxygen pulled into the lungs by the diaphragm enters the blood stream through the mini raspberry-like alveolar sacs. Carbon dioxide is unloaded here too 


The magic thing here is that the ribs continue their physical waxing and waning rhythm whatever else our body is doing. You could be turning over in bed, coughing, or simply glancing over your shoulder. The rib excursions have to keep going, whatever else is happening and come what may. As you might imagine, it is a feat of supreme coordination to keep things running smoothly at all the various nook-and cranny joints, all the time.


the way we breathe normally . . .

image of diaphragm BigStock

The diaphragm is like an elasticated umbrella that flattens out as it contracts & descends, reducing the intra-thoracic pressure and thus drawing air into the lungs


The diaphragm is a dome-shaped muscle under the ribs that separates the thoracic from the abdominal cavity. The diaphragm is the main breathing muscle. As it contracts it lowers, like drawing down the flange of a syringe and this sucks air in passively through the nose, filling right down to the bases of the lungs. An out-breath is brought about by the passive elastic recoil of the diaphragm muscle. As it lets go, it moves up into the thoracic cavity, pushing stale air out through the nose or mouth.

The intercostals are the fine muscles between the ribs. They are more involved in forced expiration and coughing to forcibly shrink the chest and push air out in a gust through the nose and mouth.


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