rib pain

Rib Pain Or Heart Attack

Last Updated on January 26, 2022 by Dr Timothy Lim

Rib Pain or other ribs issues occurs somewhere in the chest but how do you know it’s not a heart attack? As a patient, you want to know your rib pain or chest pain is life-threatening or something we can fix. The reason rib pain causes can be so confusing is that there are at least six other conditions with symptoms in the rib or chest area just like it! So I’m going to briefly describe the most common rib pain conditions, but when in doubt get your medical doctor to rule out the more serious infection or heart-related rib pain

Table of Contents

Common Symptoms for Rib Pain Intercostal neuritis

Rib pain may have very similar types of pain regardless of the cause. You may experience one or more of the following symptoms:

  • Sharp or dull ache
  • Pain when coughing or sneezing
  • Pain can be intermittent or on/off
  • Pain is worse when breathing in and sometimes exhaling
  • Pain moving or only in a certain position such as lying on your side during sleep
  • Feels like a bruise
  • The area is tender to touch

Rib Pain Causes that Need Medical Attention First

Rib Fracture

A rib fracture is a trauma caused by pain in the chest from a direct hit to the rib or falling onto a hard object. For someone like the elderly with osteoporosis, they may get a “cracked” rib, less than a fracture or broken rib, simply from strong pressure. An x-ray should be ordered to confirm this suspicion.


Pleurisy or pleuritis can lead to sharp chest pain commonly caused by viral or bacterial infection of the membranes that envelope the lungs. Patients with pleurisy often have symptoms of coughing or sneezing.


Three common heart-related chest pain that requires medical attention or the Emergency Room (ER). The first is called angina where you may experience squeezing or pressure pain (sometimes to the arm or jaw) in the middle of the chest. It is caused by reduced blood flow and usually worsens with strenuous activity or exercise. However, the pain goes away once you rest from the activity. Some angina attacks may cause one to pass out before they get a chance to complain about chest pain. When an angina attack occurs without strenuous activity, then the heart condition may be more serious indicating more severe artery blockage. 

Heart Attack

While angina chest pain is usually resolved with nitroglycerin under the tongue, a more serious condition is called a heart attack or Myocardial Infarction (MI). The chest pain in the middle can last for more than 30 min without any relief. It’s more serious because blockage results in heart muscle damage.


The third type of heart-related rib pain is called pericarditis. The cause is not blockage of the arteries but from inflammation of the “heart sac” that surrounds the heart. It may be associated with a viral or bacterial infection. The rib or chest pain is also in the middle and the individual will find it harder to breathe when lying down. However, breathing is easier when seated upright. 

Types of Rib Pain that We Can Treat

Many ribs issues such as a rib out of place or popped rib or feeling that the rib is out of alignment can cause the following issue. Heavy pressure or an inexperienced chiropractor can also unintentionally cause rib pain after an adjustment. Diagnosis given may sound similar because they are as the terms are used to describe the location and age group they commonly affect.

Diaphragm Strain

A diaphragm strain can cause pain under the rib cage on the left but can also occur on the right side. You may have experienced a stitch on the side of the lower ribs especially common if you run after not doing so for a while. Most of the diaphragm muscle issues we see in the clinic are usually asymptomatic. In other words, you don’t even know it’s there until I look for it. Diaphragm muscle can contribute to lower back pain and shoulder pain.

Tietze’s syndrome

Tietze’s syndrome is most common in middle age women experiencing moderate to severe rib pain for no particular reason that occurs on one side or sometimes both sides costochondral joints. The costochondral joints are located in the front ribs where the cartilage of the ribs joint the body anterior portion of the ribs. When is very severe, a pain injection by a medical doctor is one option to consider.


Costochondritis is most common in younger people. It is different from Tietze’s syndrome in that rib pain occurs on both sides at the middle of ribs near the sternum.

Costotransverse sprain

A costotransverse sprain is a rib pain of ligaments between the rib and the thoracic spine. The costotransverse joint is at the back of the chest near the spine, while the costochondral joints are in the front of the chest.

Rib Muscle Strain

Rib Muscle Strain occurs when one experience rib or chest pain due to overuse or moving heavy objects when the muscles are not conditioned for the activity. 


Fibromyalgia is a pain in many places and it’s most common in women. The pain is not just in the chest area but also in other joints of the neck, shoulder, elbow or knees.

Slipped rib

Slipped rib occurs in the lower ribs (8th to 12th) and ribs feel out of alignment or run off-track due to prolonged coughing or carrying heavy objects using the wrong technique. Also called slipping rib syndrome because these ligaments are injured and cannot hold the ribs in place.

Intercostal Neuritis

Intercostal Neuritis rib pain feels like a “band” around the chest. Intercostal neuritis is a nerve inflammation between the ribs and can be as common as a rib misalignment. It can also be due to shingles, triggered by stress from a past chickenpox infection. Rib pain is usually on one side and is usually accompanied by rash or blisters along the rib. Sometimes the rib pain can occur even after the blisters are gone. We recommend the use of FSM or Frequency Specific Microcurrent Therapy,


At our clinic, we help your figure out what rib pain issues you may have. Fortunately, rib pain from misalignments responds quickly to chiropractic treatments. 

It’s important to know that rib pain causes it not always from the rib bones, but rib pain can come from deep inside the chest such as the heart, lungs, stomach and even food pipe (esophagus or gullet) gastric reflux. We call this referred pain or pain that spreads from the source.

Unfortunately for some people who are only treated with pain killers or pain patches, their rib pain may not be resolved completely. Rib pain could then recur, and for these people, the problem can be a source of great frustration.

The chiropractic examination is first aimed at ruling out serious medical problems. It is then followed by a detailed examination of the joints and muscles.

The aim of the treatment is to restore the movement, reduce pain and reduce the muscle spasm. This is done using a variety of different ‘hands on’ techniques and exercises. Chiropractic is such a versatile treatment that doesn’t matter how old you are, or whether you are affected by osteoporosis or other medical problems.

There is always a suitable treatment method the chiropractor can use that is safe and effective for you.