Rib pain from coughing: strains, fractures and what helps

A bad cold, flu or chest infection can leave you with sore ribs long after the cough has started to settle. Repeated forceful coughing is hard on the chest wall, and it can strain muscles, irritate rib joints and occasionally crack a rib.

When is rib or chest pain an emergency?

Call 000 for chest pain or pressure with breathlessness, sweating, nausea, or pain spreading to the arm, neck or jaw; for sudden sharp chest pain with shortness of breath; or for coughing up blood. See a doctor the same day for rib pain with increasing breathlessness, fever, or a cough producing discoloured phlegm, which can indicate pneumonia.

Why do my ribs hurt after coughing?

Each cough is a forceful contraction of the muscles between the ribs, the abdominal muscles and the diaphragm. Hundreds of coughs a day can strain the intercostal muscles, irritate the joints where the ribs meet the breastbone or spine, and, with enough force, fracture a rib.

What does a muscle strain feel like?

A sore, tight or sharp pain between the ribs or along the lower rib margin, worse with coughing, sneezing, deep breaths, twisting and reaching. The area is tender to press. It usually improves over one to three weeks once the coughing eases.

Can you crack a rib from coughing?

Yes. In a series of 54 patients with cough-induced rib fractures, 78% were women, the average age was 55, and 85% had been coughing for three weeks or more. Half had more than one rib broken, most often the middle ribs at the side of the chest. Reduced bone density was a likely risk factor, but fractures also occurred in people with normal bone density (Hanak et al., Mayo Clinic Proceedings, 2005).

How do I know if it's a fracture or a strain?

It can be hard to tell. A fracture is suggested by a sudden sharp pain or crack during a cough, very localised tenderness on the bone, and pain that's sharp with every breath. An X-ray often misses rib fractures; in the series above, a chest X-ray showed the fracture in only 58% of those tested. In practice, uncomplicated rib fractures and strains are managed similarly, so the more important question is whether the lungs are affected.

Could it be costochondritis?

Coughing can irritate the cartilage joints at the front of the chest, causing tenderness beside the breastbone. New chest pain should be assessed by a doctor first.

See our post on costochondritis.

How long does rib pain from coughing take to heal?

Muscle strains usually settle within one to three weeks. Rib fractures typically take around six weeks, sometimes longer. Recovery is slower while the cough continues, so treating the cough matters.

How can I cough with less pain?

Brace the sore area. Hug a pillow or folded towel firmly against your ribs, or press your hand over the spot, as you cough or sneeze. Sitting upright and leaning slightly forward helps. Don't suppress coughs completely during a chest infection, as clearing your lungs is important.

What helps it heal?

Treat the cause of the cough with your GP or pharmacist. Use pain relief as advised so you can breathe deeply and cough effectively. Take several slow deep breaths every hour while awake to keep the lungs expanded. Heat can ease muscle spasm. Rib binders and tight strapping aren't recommended, as they restrict breathing.

How should I sleep?

Many people are more comfortable propped up on pillows or in a recliner for the first few nights. Lying on the sore side sometimes helps by limiting its movement; do whatever is most comfortable.

Can I exercise?

Walking is good. Avoid heavy lifting, hard twisting and intense exercise until deep breathing and coughing are comfortable, then build back gradually.

Should I be checked for osteoporosis?

If you've broken a rib from coughing, particularly if you're a woman over 50 or have other risk factors, it's worth asking your GP about bone density testing.

See our post on osteoporosis and exercise.

Why does my back hurt from coughing too?

The rib joints at the spine and the muscles of the mid and lower back also take load with each cough.

See our post on back pain when coughing or sneezing.

How can an osteopath help?

Once chest and lung causes have been ruled out by a doctor, we can treat the ribs, mid-back and surrounding muscles with gentle techniques, and give you breathing and mobility exercises. We avoid direct pressure over a suspected fracture.

When should I go back to the doctor?

See your GP if a cough lasts more than three weeks, rib pain isn't improving after two to three weeks, breathing becomes more difficult, or you develop a fever.

See our upper back pain guide. Book an assessment at our Berwick clinic. A 60-minute initial consultation is $149, with no referral needed and HICAPS on-site.

Sources

Hanak V, et al. Cough-induced rib fractures. Mayo Clinic Proceedings, 2005.

Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. American Family Physician, 2009.

Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.

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