Massage therapy · Kitchener–WaterlooCostovertebral Joint Fixation

Costovertebral joints are the joints connecting the heads (ends) of the ribs to the bodies of the thoracic vertebrae (the bones of the upper back). The ribs join the spine at two different places: the head of the rib and a small bump on the rib called the tubercle. For ribs 2 to 9, the head of the rib has two small joint surfaces (facets) that connect to two neighbouring vertebrae, forming a gliding joint. The joint is strengthened by the radiate ligament and the intra-articular ligament (Saker et al., 2016).

Costovertebral Joint Fixation Anatomy

How to Treat Costovertebral Joint Fixation

Exercises and stretches are part of the NHS self-care advice for back pain, and manual therapy, where a trained therapist massages and moves the muscles and joints of the back, is one of the treatments the NHS lists for back pain that is not getting better (NHS, 2026). I can help with hands-on work for the muscles around the ribs, chest, neck, shoulders and spine, gentle mobilisation of the stiff joints, and exercises to strengthen and loosen your upper back. How many sessions you need, and how long recovery takes, will vary with the severity of the problem. See the My Approach tab for how I work.

Tips

• Physical therapy is used to ease pain and improve mobility in the upper back and ribs.
• An ice pack (or a bag of frozen peas) wrapped in a tea towel can help reduce pain and swelling, and a heat pack wrapped in a tea towel can help relieve stiffness or muscle spasms (NHS, 2026). I can advise you on which to use.
• Depending on the severity of the problem, you might need to work on your strength, endurance, flexibility, balance and coordination.
• Try to stay active and continue with your daily activities, and avoid long periods of bed rest (NHS, 2026).

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

Pain from the rib joints beside the spine is often very movement-specific: it hurts turning or bending one way but not the other, or with a deep breath. My aim is to find what eases it, get the stiff rib and spine joints moving again, and give you a simple routine that keeps them moving.

I start by assessing how your upper back, ribs, neck and shoulders move, your breathing and posture, and which movements bring on your pain. Because rib joint pain can feel like chest pain, I'll also ask about other symptoms. I then try a few short trial treatments, rechecking your painful movement after each, and whatever changes it most becomes the plan.

Hands-On Treatment

• Warmth first, then massage, myofascial and trigger point work through the upper back, neck and shoulders
• Gentle, low-velocity mobilisation of the stiff rib and spine joints, never quick thrusts
• Pin-and-stretch and contract-relax for the larger back muscles, such as the lats and quadratus lumborum
• Chest wall work only when it's clinically relevant, with your informed consent and a written consent form; work near the armpit with your informed consent
• Work on stiff hips if they're making your mid-back twist more than it should

Exercise and Self-Care

1. 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
2. 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
3. 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
4. NHS (2026) Back pain. Available at: https://www.nhs.uk/conditions/back-pain/ (Accessed: 7 October 2026).