The legendary comedian Rodney Dangerfield coined the phrase “can’t get no respect‘ and after careful consideration, I believe he was referring to rib pain. Well, probably not, but it is amazing how little attention/ appreciation rib pain receives in the massage therapy community. Clients typically blame ‘between-the-blade‘ pain on tight muscles, and session after session the therapist beats on the rhomboids and lower traps only to amplify the problem. In many cases, a simple functional evaluation leads to the true culprit….fixated ribs and intervertebral joints. Not to say muscles don’t play an important role in creating/perpetuating rib misalignment, but the muscle itself is usually not the primary pain generator. Highly innervated joint capsules, spinal ligaments and nerve dura often prove to be the main events (key lesions) responsible for long-term pain and disability.
Hypertonic knots palpated in the lamina groove indicate joint dysfunction and an exquisitely tender iliocostalis muscle at the lateral rib angle tells us the rib is fixated in either internal or external rotation (Fig. 1). I’ve found external rib torsions to be more common and symptomatic.
Below is an example of a sequence of events leading to development of this condition.