How stiff ribs can lead to back pain, hernias and hunching…
In a previous post, Every Breath You Take, I talked about the risks of ‘chest breathing’. This is the habit of primarily using your ribs and chest muscles to breathe in and out rather than your abdomen, and this can lead to brain fog, dry skin, poor sleep, as well as muscle fatigue and aches in your upper body. If you find yourself stressed or tired without reason, then you may benefit from the yogi’s knowledge of abdominal breath to re-set your breathing patterns.
I Take it Back…
However, as my knowledge grows and more patients come to my door, I am starting to appreciate far more the role of our ribs! Strangely and wonderfully, I’ve come to this via the alternative route of ‘bottom up’, through my learning about pelvic floor function and how the diaphragm and the pelvic floor need to work in harmony. As the diaphragm contracts and moves downwards to suck air into the lungs, the pelvic floor relaxes to allow our abdominal contents to move downwards too, allowing the lungs their space. If we can abdominally breathe, pushing our tummies out on the inhale, while stabilising our spine with our healthily functioning lower back muscles, then all will be right with the world. Right?
The Ribs’ Role
But that’s not quite true. The diaphragm doesn’t do all the work, and thoracic (rib-cage) lateral expansion is also an important part of getting enough air into the lungs for optimum function and gas exchange. I have seen a few patients now who do abdominally breathe. And they use their shoulders to help the chest lift upwards on forced inhalation (think blowing out birthday candles). But the ribs are barely doing a darned thing. And crikey, do they have back pain…!
See in the picture on the left just how far the diaphragm moves – it’s quite a lot! It’s easy to understand that the sheer volume of the lungs will need space wherever possible to fill fully. If the ribs are not able to fully expand and contract when required then we are still messing up our abdominal pressures, as the diaphragm has to move further downwards to get in enough air, our upper chest muscles are still having to over work, and all that pressure has to go somewhere.
What’s the Problem?
This can be why men so often get hernias, and why mums don’t fully get their tummy muscles back to their original alignment (a very common condition called Diastasis Recti).
It’s usually weak muscles that are to ‘blame’ for these conditions and lots of effort goes into securing everything fast again, but if the abdominal pressure is still out of whack then we are only treating the symptom.
This can also be why back pain can hang around so long – because the back and the tummy aren’t the problem. If the diaphragm, the abdominals and the pelvic floor are trying to ‘give’ as much space as possible to the breath, then something has to hold on like mad to stabilise it all – cue our hard-working back muscles.
Once again, our lifestyle can be a wolf in sheep’s clothing. Sitting for long periods, shallow breathing, our life less than a foot away in a glowing screen… leads to a stiff (and painful) thoracic spine, and stiff ribs. Upper back tension, neck crunching, the list goes on!
The actual problem is that the body is so amazing at compensating. So problems go undetected for months and years, and are therefore harder (but not impossible!) to resolve.
Firstly, know that this is a brillant thing to tackle for long term health – both in terms of your range of movement as well as your internal supply of oxygen and potentially avoiding respiratory diseases and disorders in the future. I’ve posted this picture before but it really does illustrate the point so well – as our upper spine starts to creep forward into a bend, our rib movement is restricted further and once this starts to happen it’s much harder to pull things back to a better posture. Having said that, ribs are often restricted even when people have mostly good posture – that’s your back and chest muscles working overtime to give that military posture, which, sadly, is mostly for show.
Responsive Ribs? Find out for Yourself
For this easy experiment, you’ll need a room that isn’t overlooked, and a large mirror that enables you to see your whole upper body. That’s it. For the more technical version, you would need a tape measure and a kind friend who you are ok to take your top off with.
- Sit or stand in an upright position. Place your hands around the sides of your rib cage, fingers towards each other in the centre front.
- Staying upright, try not to bend forward as you breathe all the way out. Watch your hands as the thumbs move towards each other, and feel your ribs move inwards and downwards.
- Take a big breath in through your nose and think about breathing into your ribs. Watch and feel your ribs move – and ask yourself the following questions:
- Do they go forwards and outwards? Or just one direction?
- Do you feel your chest move, but your lower ribs are mostly static?
- Do you see your shoulders lifting (they should be staying still throughout, or at the most only raise a bit at the very end of the in-breath)?
- Does one side move more than the other?
- Repeat steps 1-3 with your hands in different places, e.g. further round to the sides or back of your rib cage, or on your upper chest. Is there much movement anywhere? Is the movement all at the front? (this is ok at your upper chest but not for your lower ribs, which should have a lot of lateral movement too).
If you like specifics, this is a good video to try with a friend and get some accurate measurements of your chest expansion. Ankylosing Spondylitis is a condition that results in restricted chest expansion (amongst other things) but having restricted ribs doens’t mean that you have that condition so please don’t worry!
What is ‘Normal’ Range?
The range of ‘normal’ depends a bit on your age and gender, but on average somewhere between 5cm and 7cm is a healthy expansion. Remember you may have no obvious ill-effects from restricted chest expansion, but it may be a contributing factor in lots of other physical issues, so it’s worth having a look at.
You may be surprised to know that you can often adjust imbalances in your rib movements by focusing your attention on it. If your left side feels more flattened, or is moving less, then on the next breath, think about breathing into that area. You may well feel that it responds and starts to expand more evenly after a few goes.
However, many people have restrictions that are not as easy to tease out of their current physical capacity. Long term rib or thoracic stiffness can create really quite firm resistance which you are best to get mobilised by a professional. Getting a friend to ‘crack’ your back in the office may feel good, but the evidence shows this ‘cavitation’ effect only lasts around 20 minutes, so will have no chance of re-setting long-held breathing patterns or postures.