Mid & Upper Back

What It Is

The costovertebral joint is where a rib joins the spine. It is one of the two places where most ribs attach to the spine at the back. It is important for normal breathing because the rib needs to swivel to some extent, like a bucket handle moving from side to side, and can also rise up and down during breathing (Saker et al., 2016). Just like any other joint, the structures that make up this joint can be injured, for example when the rib cage and trunk are twisted or when an impact occurs (Saker et al., 2016).

Costovertebral Joint Sprain Anatomy

The upper back is known as the thoracic spine, and there are 12 vertebrae making up the thoracic spine, with 12 pairs of ribs joining it (Saker et al., 2016). 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). It is these ligaments that can become sprained, along with the joint capsule (the lining that surrounds the joint).

Pain from these rib joints is usually felt over the joint itself, just to the side of the spine in the upper back (Young et al., 2008).

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

Treatment

Self-Care & Treatment

How to Treat Costovertebral Joint Sprain

Exercises and stretches are recommended for back pain (stop if your pain gets worse), 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 and rib joints, gentle mobility exercises and a strengthening programme to get you back to your normal activities. See the My Approach tab for how I work.

1. Ease Off Activities That Make It Much Worse

If certain activities are causing you a great deal of pain, ease off them for a while. But try to stay active and carry on with your daily activities as much as you can, as this helps back pain recover (NHS, 2026).

2. Relative Rest

Short rests can help the pain settle, but do not stay in bed for long periods of time (NHS, 2026). If the pain does not improve after resting, or is worse at night, see your family doctor or nurse practitioner (NHS, 2026).

3. Anti-Inflammatory Medication and Ice

NHS (2026) advice for back pain includes taking an anti-inflammatory medicine such as ibuprofen, although these may not be suitable for everyone; paracetamol on its own is not recommended for back pain. (This medicine information comes from NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.) An ice pack (or a bag of frozen peas) wrapped in a tea towel can also help reduce pain and swelling (NHS, 2026). I can show you how to use ice safely at home.

Tips

Avoid lifting heavy loads without employing the proper techniques to do so.
Keep moving: activities like walking, swimming, yoga and pilates may help ease back pain (NHS, 2026).
Strengthening exercises for your back and core, which I can guide you through, can help you return to your normal activities.

Treatment

My Approach

A rib joint sprain can make breathing, twisting and even rolling over in bed sore. My aim is to settle the pain, keep your ribs and upper back moving, and rebuild your strength for your normal activities.

Which path we take depends on how bad it is

If it's a mild or moderate sprain (grade 1 or 2), I can treat it directly from your first visit.
If it's a severe sprain (grade 3), it followed a serious accident or fall, or you have numbness, weakness or other nerve signs that are getting worse, see your family doctor or nurse practitioner first. Once they've checked it, I can support your recovery within the limits they set.

I assess how your upper back, ribs and shoulders move, your breathing, posture and strength, and check your nerves if you have tingling or numbness. I find the movement that brings on your pain and recheck it after each technique, so we keep what works.

When It's Sore

Gentle massage for the muscles along the spine, between the shoulder blades and around the ribs
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
Breathing exercises to keep the ribs moving comfortably
Advice on staying active and easing off what flares it

As It Settles

Gentle, low-velocity mobilisation of the stiff rib joints and upper back, never quick thrusts
Contract-relax and stretching for the larger back muscles, and the hips if they're stiff
Side bends and gentle twisting, with a home programme between visits
Strengthening for the upper back, shoulders and core, building to gym-based lifting with good technique

I only work on the chest wall muscles at the front with your informed consent and a written consent form. Exercises should ease your symptoms, not increase them. Back pain with chest pain needs 911 or the emergency room (see When to Get Help).

What to Expect

Typical Course

Typical course: Visits usually start once or twice a week, then weekly, then spread out as you manage more yourself, with a reassessment at about 4 to 6 weeks. A mild sprain usually settles within about 2 to 6 weeks; a severe sprain often takes around 6 to 12 weeks, following your doctor's guidance.

What I Focus On

Assessment

Rib & Upper Back Mobility

Muscle Release

Breathing

Strength & Return to Activity

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

Massage therapy · Kitchener–WaterlooCostovertebral Joint Sprain

What It Is

Costovertebral Joint Sprain Anatomy

Self-Care & Treatment

How to Treat Costovertebral Joint Sprain

1. Ease Off Activities That Make It Much Worse

2. Relative Rest

3. Anti-Inflammatory Medication and Ice

Tips

My Approach

When It's Sore

As It Settles

Typical Course

When to See a Doctor First

When to Get Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooCostovertebral Joint Sprain

What It Is

Costovertebral Joint Sprain Anatomy

Self-Care & Treatment

How to Treat Costovertebral Joint Sprain

1. Ease Off Activities That Make It Much Worse

2. Relative Rest

3. Anti-Inflammatory Medication and Ice

Tips

My Approach

When It's Sore

As It Settles

Typical Course

When to See a Doctor First

When to Get Help

References

Related Conditions

Costovertebral Joint Disorders

Costovertebral Joint Fixation

Intercostal Muscle Strain

Thoracic Intervertebral Joint Sprain

Book a session