Rib subluxations are common in hypermobility

Estimated reading time: 9 minutesA rib subluxation happens when a rib partially slips out of its usual position without fully dislocating.

I know it can be a common thing in hypermobility, and it is very painful. In fact, over 60% of people with hEDS report rib subluxation or dislocation as one of their affected joints (1). It can make us anxious about exercising, as we fear a subluxation.

You may have searched for this as a dislocated or popped rib, but a full dislocation is a separate, more serious injury.

I have heard stories from people who have even been told by some medical professionals that a rib subluxation is physically impossible – but I think if you have hypermobility you may disagree with this.

It’s only happened to me once, thankfully, when attempting to demonstrate an advanced exercise in a Pilates mat class many years ago. I hadn’t prepared myself; I was rushing to demo and was generally anxious about doing it.

It was a rollover exercise that required a lot of thoracic mobility. My thoracic spine has always been my stiffest area – I literally felt it pop as I rolled over into the exercise. I had to continue as I had a room full of clients intently watching me.

This got me thinking about the whole topic of rib subluxations and what we can do to prevent them.

What happens anatomically during a rib subluxation?

The ribcage is a flexible structure of 12 paired ribs, each connecting to the thoracic vertebrae at the back of the body and, for most ribs, to the breastbone at the front by cartilage. Rib pain is common in hypermobility: 44% of people with hEDS and 28% of people with HSD report the ribs as a site of chronic pain (1).

The ribs are then classified into three groups based on how they connect to the sternum (breastbone) with cartilage.

The first seven ribs are the true ribs. Ribs 8 through 10 are known as false ribs because the cartilage they connect to doesn’t directly attach to the sternum, but their costal cartilage connects to the seventh costal cartilage. Then there are the floating ribs – ribs 11 and 12 that do not connect to the sternum at all.

There are layers of muscles and fascia around the ribcage because the spine moves in so many directions. Many muscles act on the ribs, including the pectoralis muscles, the obliques, rectus abdominis, serratus anterior, intercostal muscles, the diaphragm, and more.

We can’t treat the rib cage in isolation – everything is connected. Moving my arms will impact the ribs, and moving my legs can impact the ribs.

Bucklin and Francomano state that posterior rib pain, where the rib head connects or articulates with the vertebra, is most likely caused by secondary muscle tension.

Anterior pain in the 8th to 10th ribs may be more associated with slipping rib syndrome instead, which is different than a rib subluxation. They also recommend that anterior rib pain should be checked by medical professionals to rule out other conditions (2).

Is a rib subluxation the same as slipping rib syndrome?

I get asked about this a lot, and it’s worth explaining that they are not the same thing. Rib subluxation and slipping rib syndrome are related but different conditions, affecting different parts of the ribcage in different ways.

A rib subluxation typically involves the joint where the rib meets the spine at the back, often linked to hypermobility and thoracic stiffness I discuss throughout this post.

Slipping rib syndrome is different. It affects the lower false ribs, ribs 8 to 10, where the fibrous tissue connecting them to each other becomes weak and lax, letting the rib tip slip above or below the rib next to it and irritate the intercostal nerve running along its underside.

The result is sharp, radiating pain, often felt at the front of the lower ribcage, upper abdomen, or back, and it’s frequently mistaken for costochondritis, muscle strain, or gallbladder problems before it’s correctly identified (3).

Not every episode of rib pain is a subluxation that needs relocating. Persistent or unclear pain, especially at the front, is always worth getting checked rather than assumed.

Why does thoracic stiffness lead to rib subluxations?

I believe the common thoracic spine stiffness that many people with hypermobility have is partly the cause of rib subluxations.

Here’s why: A stiff, immobile ribcage doesn’t have much flexibility to work with. Add a breathing pattern disorder as well, which I see very commonly in hypermobility; there is even less give.

So when I ask my body to do a sudden or strenuous move (like the rollover I attempted), there is not enough elastic flexibility in the ribs to cope with this.

That sudden move could be anything. Maybe I turn suddenly to look over my shoulder or lift a heavy bag. It’s often made worse by shallow breathing or breath-holding. I could also be bracing or guarding my abdomen, which tends to cause a pressure chamber scenario.

All these factors add up to a ribcage that acts like a ‘cage’. It is fixed, tense, and generally tight. It’s not responsive to extra stresses. Under the extra stress and strain, the ribs have little choice but to pop.

What contributes to thoracic stiffness?

Thoracic stiffness rarely comes from one thing; it is often a mix of several overlapping features. The good news is we can address many of these things to reduce stiffness and get the ribcage moving effectively.

• Pain and fear of pain: Whether we are already in pain or anticipating it, the instinct is to lock down and prevent movement to protect itself. Over time, that guarding can become a source of stiffness.
• Altered breathing patterns: Living with a chronic illness can be stressful; we often develop a subconscious pattern of protection. When this pattern becomes chronic, it can definitely lead to tightening of the connective tissue.
• Lack of movement & deconditioning: Moving less, often out of caution or fear of triggering pain, is understandable. But over time, that lack of movement leads to deconditioning: the muscles and tissues around the ribcage lose capacity and tolerance for load, which in turn makes them stiffer and less able to cope with sudden or strenuous moves. This can absolutely be addressed – there is always somewhere to start wherever you are!
• Bracing to find stability: Many of us do this without realizing it. Researchers describe it well: “Hypermobiles frequently use a ‘bracing’ pattern with breath holding in an attempt to improve stability and produce more force . . . The ribs can become fixed and efficient respiration is affected (4).”
• Posture and muscle compensations could be impacting the thorax, leading to muscular imbalances and tension.

Photo from Relaxing Breathing Patterns class in The Zebra Club.

How does breathing help prevent rib subluxations?

Relaxed and well-expanded breathing helps prevent rib subluxations by releasing bracing and muscular tension that leave the ribcage stiff and unable to absorb sudden movement.

I used to focus purely on diaphragmatic breathing here, but I’ve since moved toward whole-body breath instead, feeling the whole torso expand on the inhale and soften on the exhale.

This matters especially with rib instability: forcing an inhale or exhale can actually increase pain when the ribcage joints aren’t fully stable, so the aim is always gentle expansion, never force. If your thorax isn’t used to expanding, this can feel challenging at first, and that’s expected.

I’ve found it is best to start any breathing techniques in a supine position. This way, the posterior muscles can relax, and the body has a different relationship to gravity.

Then progress to a seated position – with a back support to enable relaxed posterior muscles. Finally, move to a standing practice position. But this may take time, and that’s OK.

I always start with my 1,2,3 breathing. Breath is the first principle of the Integral Movement Method, and I dedicate a full chapter to it in my book Integral Movement Method for Hypermobility Management. I also have a few videos using this technique, as well as an audio meditation in The Zebra Club.

A recent small study revealed measurable differences in proprioception of breath or the perception of lung volume (at moderate volumes) in people with hEDS compared to controls (sex-, age-, and weight-matched). They also found that the hEDS group had erratic breathing patterns when focusing on a cognitive task (5). The good news is we can improve our breathing!

Becoming aware of breath is the first step to noticing your patterns. Do you hold your breath? Do you breathe shallowly? Integrating breath into our movement practice will translate to making everyday life easier.

With some simple breathing practices that focus on gentle expansion of the ribs and thorax, you can achieve a lot. Not only do you start to get natural movement in the thorax, but you also start to relax those overworking muscles around the ribcage.

How do you manage a rib subluxation in the acute phase?

Managing a rib subluxation in its acute phase means combining rest, gentle pain relief, and calm breathing, not pushing through or forcing movement. Here are some ideas. Importantly, try to relax above all else. If we are anxious, the tissues will tense more.

• Initial Rest and Immobilization: Rest may help you avoid further strain on the affected area. You may find using a supportive brace or wrap to provide support and reduce movement can be helpful.
• Pain Management: Apply ice packs to the affected area for 20-minute intervals several times a day during the first 48 hours to reduce inflammation and pain. Check with your physician about safe pain relief options for you, which may include over-the-counter medication.
• Breathing Exercises to relax the area: Gentle breathing exercises can help maintain rib mobility and relax. Try this video or any of the breathing classes and meditations in The Zebra Club platform.

If symptoms persist or worsen, always seek medical advice.

Jason Parry, a hypermobility physio, states, “What if it doesn’t go back? Don’t expect the joint to go straight back in. It is often not unusual for joints to remain out of place for hours or even days. But once it’s out, it’s out. It’s not going out even more, so try not to panic(6).” I think this is a good reminder to keep in mind.

How can you prevent rib subluxations long term?

Preventing rib subluxations long term comes down to how you move, not just managing symptoms in the moment. It means retraining the body’s habitual tension patterns before building strength or stability.

• Starting low and slow: We can’t start with strength work – we need to find safety and connection. It is a common mistake to start hypermobile patients on stability and strength work, but this can cause more pain and even subluxations. The tensional habits must be addressed first before introducing stronger work.
• Focus on integrated movement patterns:
  • Whole body integration takes the load off of any one particular area.
  • Fascial friendly work is particularly helpful as it helps distribute forces throughout the whole system.
  • With the Integral Movement Method (IMM), we teach the body to move in an integrated way, with even force distribution as opposed to taking the path of least resistance (something the brain will often try to do).
• Focus on the breath: As covered above, gentle whole-body breathing, never forced, helps release the bracing that leaves the ribcage vulnerable. This video has a great introduction to focusing on the breath to address rib subluxations
• Release tension: It is super key to release that habitual tension that acts as muscular armour for many people. Starting with gentle movement and meditation is a good way in.
• Ease into stability work once tension has settled: Stability work is essential, but there is no rush. It becomes far easier once the body has been allowed to settle without tension. Otherwise, you’re just putting more tension on top of tension.
• Postural alignment and environment: Postural alignment and overall postural tone can help too. Think about your environment as well: is there a particular way you sit at your desk that might be compressing the ribcage? How you use your arms matters too. Check out this video on correct arm movement.
• External Support: Some people do find wearing supportive braces can help them feel safer during activities that strain the rib cage. This can be helpful if you are just starting out on your movement journey and rehabbing the thorax.

Here is my live class where I talk a bit about my approach to rib subluxations and walk you through a movement practice. If you are looking to go deeper The Zebra Club is here for you!

FAQ

What does rib subluxation feel like?

A rib subluxation may feel like a muscle spasm in the back near the spine where the rib articulates with the spine. It may feel sharp and may hurt with deep breaths or arm movements. If the pain is in the front of the body, it should be assessed by a medical provider to rule out other conditions.

What is the difference between a rib subluxation and a dislocation?

A subluxation is a partial shift where the rib does not fully separate from its joint. People often say “dislocated rib” in everyday language, but a true full dislocation is rarer and needs urgent medical care.

How long does a rib subluxation take to heal?

Healing time varies. Some people feel better within hours, while others take days or weeks for the ache to fully settle. Subluxations that keep recurring in the same spot may take longer to calm down.

How do you fix a rib that feels subluxed?

The safest first step is relaxed, gentle breathing in a supported position, never forcing the inhale or exhale, and not attempting to force the rib back manually. If pain persists, a physiotherapist, osteopath, or clinician experienced in hypermobility can help you safely.

Can rib subluxation be a symptom of EDS or hypermobility?

Yes. Rib subluxation is one of the joint issues reported by the majority of people with hEDS, and by a substantial share of people with HSD, most likely linked to the general joint laxity that comes with connective tissue differences in these conditions.

What is the difference between rib subluxation and slipping rib syndrome?

Slipping rib syndrome specifically affects the lower false ribs, where cartilage tips override each other. A rib subluxation more often involves the joint where the rib meets the spine. Both are more common with hypermobility, and slipping rib syndrome is diagnosed in about 11% of people with hEDS.

Will a rib subluxation heal on its own?

Jeannie Di Bon

Jeannie Di Bon is a movement therapist, educator and author specializing in hypermobility, Ehlers-Danlos Syndrome and chronic pain. She is the founder of The Zebra Club app and the creator of the Integral Movement Method.