Mid & Upper Back

What It Is

The costovertebral joints are where your ribs join the spine in your upper back (the thoracic spine). They are important for normal breathing, because the ribs need to swivel and move up and down a little, rather like a bucket handle (Saker et al., 2016). Just like any other joint, the structures that make up these joints can be injured, for example when the rib cage and trunk are twisted or when an impact occurs (Saker et al., 2016).

Costovertebral Joint Disorder Anatomy

Your ribs come in pairs, one on each side. Most ribs join the spine at two small joints at the back: the head (end) of the rib joins the bodies of the vertebrae (the costovertebral joint), and a small bump on the rib called the tubercle joins the bony side projection of the vertebra, called the transverse process (the costotransverse joint). Ribs 2 to 9 each join two vertebrae – the one with the same number and the one above it. Ribs 1, 10, 11 and 12 join only one vertebra, and ribs 11 and 12 have no costotransverse joint (Saker et al., 2016). These joints give stability to the chest wall and the upper back. Ligaments support the joints, giving strength to the bone junctions and limiting joint movement in the upper part of the back (Saker et al., 2016).

Pain from these rib joints is usually felt over the joint itself, just to the side of the spine in the upper back, and has been described as a deep, dull ache (Young et al., 2008). Most commonly the pain is between the spine and the shoulder blade, but it can occur anywhere along the upper back (just to the side of the spine).

Problems with these rib joints can sometimes cause pain that is felt in the chest, and this can be mistaken for heart or other chest problems (Arroyo et al., 1992). This works both ways, so any chest pain should always be checked by a doctor.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Costovertebral Joint Disorders

Manual therapy, where the muscles and joints of the back are massaged and moved, is one of the treatments the NHS lists for back pain that is not getting better (NHS, 2026). I can help with gentle hands-on work for the muscles and joints around your ribs and upper back, along with exercises and stretches you can do at home. See the My Approach tab for how I work.

There is little research on the best treatment for rib joint pain, and most of what is known comes from a small number of case reports (Arroyo et al., 1992).

Stay Active and Simple Self-Care

Try to stay active and continue with your daily activities, and do not stay in bed for long periods (NHS, 2026). An ice pack (or a bag of frozen peas) wrapped in a tea towel can help reduce pain and swelling, and a heat pack (or hot water bottle) wrapped in a tea towel can help relieve stiffness or muscle spasms (NHS, 2026). Gentle exercises and stretches may help too, but stop if your pain gets worse (NHS, 2026).

Tips

Keep moving: activities like walking, swimming, yoga and pilates may help ease back pain (NHS, 2026).
Avoid long periods of bed rest – this does not help back pain recover (NHS, 2026).
Some therapists talk about "popping a rib" or "subluxing a rib". These are informal phrases rather than medical diagnoses, and they are often used to describe a costovertebral joint sprain or injury.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Chiropractic or osteopathic adjustment: a hands-on technique in which a practitioner moves (manipulates) the spine or rib joints; the evidence for this in rib joint pain is limited to case reports (Arroyo et al., 1992).

How I can help (see the My Approach tab)

Gentle mobilisation of the rib and upper-back joints, never quick thrusts
Hands-on work for the muscles around your ribs, shoulder blades and spine
A home stretch, breathing and strengthening exercises

Treatment

My Approach

Rib joint pain is often very movement-specific: it might catch when you twist one way, take a deep breath or reach overhead, but not when you move the other way. My aim is to find what brings your pain on, ease it with gentle hands-on work, and give you a simple home routine so you stay in control of it.

I start by assessing how your upper back, ribs, neck and shoulders move, and finding the movement or breath that reproduces your pain. I then test a few short treatments against it, rechecking after each, so the plan is built on what actually changes things. Because rib pain can be felt in the chest, any chest pain needs to be checked by a doctor first (see When to Get Help).

Hands-On Treatment

Gentle mobilisation of stiff rib and upper-back joints, in the position that helps most, never quick thrusts or big, fast movements
Massage, myofascial and trigger point work for the muscles along the spine and around the shoulder blades
Contract-relax stretches for larger muscles such as the lats and quadratus lumborum (a deep muscle at the side of the lower back)
Work on the muscles between the ribs and at the front of the chest, only when relevant and with your informed consent and a written consent form
Warm applications in the clinic to help guarding muscles relax

At Home

A slow seated stretch into a bend and twist while pulling on a towel, testing the painful movement before and after
Breathing exercises to get your ribs moving comfortably again
Strengthening for the upper back and shoulder blades, building to gym-based lifting when you're ready
Work on stiff hips, if they're making your upper back twist more than it should

A muscle that feels tight may be guarding rather than causing the problem, so I don't release everything that feels tense. Every technique we try should ease your symptoms, not increase them. Pain with nerve symptoms, or pain that doesn't change with movement, needs your family doctor or nurse practitioner first.

What to Expect

Typical Course

Typical course: Most people come once or twice a week at first, then weekly, then spacing visits out as they manage more on their own, with a reassessment at about 4 to 6 weeks. Expect it to start easing within a few weeks; if it hasn't improved by then, I'll ask you to see your family doctor or nurse practitioner.

What I Focus On

Finding the Painful Movement

Gentle Rib Mobilisation

Back & Shoulder Blade Release

Home Self-Stretch

Breathing & Strength

Please read

When to See a Doctor First

When to Get Help

Call 911 or go to the emergency room at your nearest hospital if you have back pain together with chest pain, or if the pain started after a serious accident, such as a car accident (NHS, 2026).
Ask for an urgent appointment with your family doctor or nurse practitioner if you have back pain and feel hot, cold, shivery or generally unwell, or if the pain is severe and started suddenly or is getting worse quickly (NHS, 2026).
See your family doctor or nurse practitioner if the pain is coming from the top of your back (between your shoulders), does not improve after a few weeks, does not improve with rest or is worse at night, is worse when sneezing, coughing or pooing, or if you have lost weight without trying (NHS, 2026).

Sources

References

Saker, E. et al. (2016) 'Ligaments of the costovertebral joints including biomechanics, innervations, and clinical applications: a comprehensive review with application to approaches to the thoracic spine', Cureus, 8(11), e874. doi: 10.7759/cureus.874
Young, B.A. et al. (2008) 'Thoracic costotransverse joint pain patterns: a study in normal volunteers', BMC Musculoskeletal Disorders, 9, p. 140. doi: 10.1186/1471-2474-9-140
Arroyo, J.F., Jolliet, P. and Junod, A.F. (1992) 'Costovertebral joint dysfunction: another misdiagnosed cause of atypical chest pain', Postgraduate Medical Journal, 68(802), pp. 655–659. doi: 10.1136/pgmj.68.802.655
NHS (2026) Back pain. Available at: https://www.nhs.uk/conditions/back-pain/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooCostovertebral Joint Disorders

What It Is

Costovertebral Joint Disorder Anatomy

Self-Care & Treatment

How to Treat Costovertebral Joint Disorders

Tips

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

Hands-On Treatment

At Home

Typical Course

When to See a Doctor First

When to Get Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooCostovertebral Joint Disorders

What It Is

Costovertebral Joint Disorder Anatomy

Self-Care & Treatment

How to Treat Costovertebral Joint Disorders

Tips

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

Hands-On Treatment

At Home

Typical Course

When to See a Doctor First

When to Get Help

References

Related Conditions

Costovertebral Joint Fixation

Costovertebral Joint Sprain

Cervical Kyphosis

Cervicothoracic Joint (CT) Dysfunction

Book a session