Rib Pain Postpartum: How pregnancy changes your rib cage

Your body goes through so many changes during pregnancy! It is truly miraculous how our bodies transform. Whether this is your first pregnancy or your fifth, new sensations can arise after birth that might surprise you like rib pain postpartum. This might feel like a muscle pull, pain in your lower ribs, chest pain or upper back pain. Accompanying issues like your bra fitting tighter, diastasis recti or pelvic floor dysfunction can also be present. The good news is that it often resolves on its own or after focusing on rib cage positioning and exercises to provide relief.

Many things can bring about this pain. This includes the positioning of your ribcage, the movement of your internal organs, stretching of your abdominal muscles or even from your baby kicking your ribcage during pregnancy.

Hormonal changes can also play a role. They affect the laxity of your ligaments which makes it easier for you to pull a muscle or more difficult for you to take a deep breath. Events like vomiting, childbirth and carrying a newborn for hours on end can also strain the ribcage.

The anatomy of your ribcage

Your ribcage is made up of a set of 12 paired bones wrapping around your body in a dome shaped structure. In the back, they attach via joints to your thoracic spine. In the front, the attachments vary. Ribs 1-7 attach via movable cartilage directly to the sternum. Ribs 8-10 attach to the cartilage above them. Ribs 11 and 12 are considered “floating ribs” because they don’t attach to your sternum but instead connect with your abdominal muscles.

In between your ribs are muscles known as the external and internal intercostal muscles. Your external intercostals expand your ribcage during inhalation and your internal intercostals pull your ribcage back down during exhalation.

Inside of your ribcage, your heart and lungs are protected by this basket like structure. Rather than being rigid and immovable, your rib cage can change shape. Rib cage mobility is important during respiration and for accommodating the movement of your organs during pregnancy.

How pregnancy changes your ribs

During pregnancy, your ribcage changes shape to accommodate your growing baby. This includes changes to your infrasternal angle and rib cage flare. Especially during your third trimester, your growing uterus presses your internal organs including your stomach and liver up into your ribcage. This is also why heartburn is more common during pregnancy.

Infrasternal Angle

Your infrasternal angle refers to the angle along the bottom portion of your ribs. When your abdominal muscles stretch out, your ribs also widen. Ideally, when you are not pregnant, this angle is around 90 degrees. However, this angle is usually wider than 90 degrees during pregnancy and can remain wide postpartum.

Rib Flare

Rib Flare on the other hand happens when your whole ribcage is tilted up towards the ceiling. When you are pregnant, there is a tendency for your pelvis to be in an anterior pelvic tilt. Picture the classic pregnant mamas stance: an arched back in order to balance out her belly in the front. This posture tends to continue postpartum because now you are constantly carrying around a newborn.

It is also possible to have a one-sided rib flare. Left rib flare is more common since the diaphragm attaches lower on the right side which helps to pull that side down. However, factors like how you stand and if you always carry your baby on the same hip can contribute to this imbalance.

Diastasis Recti and Pelvic Floor Issues

Diastasis Recti, the separation and thinning of the tissue between our abdominal wall, can be present with a wider infrasternal angle or rib flare. While diastasis recti is a normal adaption to pregnancy, there are ways to minimize its severity with our how we breathe, manage pressure in our core and how we move. By addressing your abdominal muscles, you can move your ribcage into better alignment over your pelvis.

Pelvic Floor Dysfunction including leaking, pain with sex, difficulty peeing or being able to fully contract your pelvic floor can also occur as a result of how you position your ribcage and activate your abdominals.

To understand this think of your core muscles as a balloon. This includes your abdominals, pelvic floor muscles, Psoas muscles, Multifidus, erector spinae and diaphragm.

If you compress one section of an inflated balloon, the pressure in that balloon will push out on the opposing side. If, for example, you have pelvic floor tightness than that will push more air out of your belly. That can exacerbate a diastasis or lead to low back pain and pelvic floor tension. With front rib flare, that could mean your upper back is tighter.

How to address diastasis recti and pelvic floor issues

The best way to heal is through properly building core strength changing your posture habits and through diaphragmatic breathing. I also recommend seeing a pelvic floor physical therapist. They who can evaluate how your pelvic floor and core are activating together. My guide to your pelvic floor is a great place to understand how this all works together.

Learning to take deep diaphragmatic breaths

When you take a deep breath, expand 360 degrees around your torso. Start with a good inhale expanding your ribcage and moving the breath down to your pelvic floor. Follow that with a great exhale actively bringing your bottom ribs together.

If your infrasternal angle is too wide or your ribs flare out, deep breaths will be challenging. You can think of a wide infrasternal angle as being stuck in a state of inhalation. Since it’s already expanded, its harder to get more expansion on your inhale. That makes it harder to move the ribs back together on your exhale. Manual Therapy and self-myofascial release can help you to take deeper breaths.

Organ Movement during Pregnancy

By the third trimester, your uterus extends up into your ribcage. As it grows, it presses your abdominal organs including your liver and stomach up to make room for your baby. Due to the location of your the pancreas, right kidney, gallbladder, liver, and intestines, rib pain is more common on the right side of your ribs.

It then takes time postpartum for your organs to descent back downwards. You stomach’s high position coupled with hormonal changes can cause heartburn. You also could have pain from the movement of the organs themselves.

Hormonal changes affecting rib pain

During pregnancy, your body produces a hormone called relaxin. This hormone helps to loosen the joints and ligament for child birth. It can stay in your body 6-12 months postpartum. Relaxin can also cause pain in your ribs because it can cause heartburn by relaxing the esophagus.

 Human chorionic gonadotropin (HCG) is another hormone that is present during pregnancy and often responsible for nausea and vomiting. If you are vomiting repetitively, you may be putting a lot of strain on your intercostal muscles between your ribs. You may even strain or pull one of these muscles during from that forceful expulsion.

How to Alleviate Rib Pain Postpartum

If your rib pain is from a strained or pulled muscle, rest and ice may be your best course of action. If it lingers, then your first step would be to learn how to breathe deeply, address your posture and properly activate your core. It is a good idea to see a physical therapist or a postpartum exercise specialist (like me!) who can guide you through exercises and help you focus on good posture and proper form.

Gentle thoracic mobility exercises like thread the needle, open book and cat/cow can all be helpful for better posture and ribcage mobility. When you get your upper back and shoulder blades moving, you will create a chain effect helping your posture, core and pelvic floor all of which can decrease rib pain postpartum.  

When should you see a doctor?

New moms can be at risk for life-threatening complications like postpartum hemorrhage, hellp syndrome, blood clots, high blood pressure, heart disease, heart attack or pulmonary embolism. Therefore it is crucial that you voice any concerns right away before they become life threatening health problems.

Postpartum Care should be more than going to your 6-week checkup and getting the green light to have sex again. It should be a time to take the time to talk with your Obstetrician or Midwife about how you are feeling and any issues your are having like rib pain postpartum.

It can be easy to forget about yourself while you are busy caring for a newborn but remember to metaphorically speaking “put yon your own oxygen mask first”! The best way to care for your baby is to take care of yourself so that you can be there for them.

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