The Rib Cage and Its Effect on Shoulder Pain

Postural Restoration Institute focuses much of its intellectual prowess on the rib cage and how it influences your whole body.

Why do you care about your rib cage?

Because the causes of shoulder pain don’t always have to be the result of an injury.

They can be due to the position of the shoulder joint itself.

And the position of the shoulder joint relies upon what lies at its foundation: the rib cage.

So shoulder pain relief can often be accomplished without even treating the shoulder. You can focus on the rib cage and its position.

That’s my focus for this post.

The Gleno-Humeral, AKA, “Shoulder Joint”

A brief overview of the shoulder joint (the gleno-humeral joint).

GlenoHumeral Joint– The shoulder joint is a ball and socket joint. The ball is the head of the upper arm (humerus) and the socket is the glenoid fossa, which is part of the scapula (shoulder blade). So what we call the shoulder joint is the intersection of the upper arm bone and the scapula.

– Obviously the arm moves in the socket. But what is less understood, and just as important, is that the socket (again, part of the scapula) can move on the arm. This is normal and desirable. However, if the scapula is positioned improperly (see next point) and thus unstable, the shoulder joint itself will be less stable and may end up causing shoulder pain.

– Normally, the shoulder blade (scapula) rests neatly on top of the rib cage. If the rib cage is positioned incorrectly, this will effect the stability of the shoulder blade, which will no longer lay flat.

scapula on rib cage

Scapulae resting on rib cage.

– So if the foundation (the rib cage) is mispositioned, so too, will be the scapula. A loss of normal movement will occur in the shoulder joint as the arm can no longer move freely in the mispositioned “socket”.

Your arm will lose range of motion in certain positions because it is getting “stuck”, or being “impinged”. This impingement can cause shoulder pain since structures: tendons, muscles, bursae, may be getting pinched. In addition, certain muscles that attach to the scapulae will become long and weakened or short and overactive due to the mispositioned scapulae.

Restoring proper movement at the shoulder joint, by addressing the position of the rib cage that influences it, often causes pain to go away or allows injuries to heal more easily.

My Extended Spine and Elevated Rib Cage

What the video below shows is that my back in a state of extension (excessive curve in the lower back/spine). If you take a moment to arch your lower back, notice what happens to your ribs in front.

They elevate.

This “ribs up” position is how most of us are living every day. This position is natural, but we shouldn’t be living in this extended state continuously. We need to alternate between extension and flexion. However, for brain related issues, we get “stuck”.

I am a special case because although I can get myself out of this “ribs up” or “extension” state, I don’t stay there. It’s due to foot instability and my bite. Don’t try to figure it out. It took me 4 years of obsessive study and many thousands of dollars worth of seminars to understand.

You’re Probably Not Me

Most people aren’t me. They can successfully perform a Postural Restoration program and be good for the rest of their days. I, on the other hand, have a special brain that just loves to throw me into the ribs up extended position. Lucky me.

While it is a major inconvenience and the source of an occasional lower back mini-spasm, I am also a perfect test dummy for PRI methodology. I am the perfect patient.

The Video

I had just returned from work and knew my brain had thrown me into the “ribs up” position (I can feel it happening). So I decided to shoot this video. What you are seeing is my upper body getting out of a state of “ribs up” extension and into what we call “neutral”.

You know I have been successful because of the difference in my right arm’s internal range of motion. In the beginning of the video I’m lacking. At the end of the video I’m not. The change in range of motion indicates my rib cage has repositioned.

Keep you eyes on two things

– My upper chest. Upon my first inhalation, I don’t have very good chest expansion, meaning my chest will not rise towards the ceiling very much. This is because my spine and rib cage are in the state of extension that we are trying to get out of. When you are stuck in this position, your breathing is compromised. (In case you are wondering, it doesn’t matter if I am standing or lying down. I’m in extension no matter what).

As I exhale, you will see my ribs go down. That is me blowing all my air out. Getting the air out, and the ribs coming down, is what then allows me to get better air flow into my chest because my diaphragms are being utilized (if ribs are “up” diaphragms are compromised). You’ll see inhalations 2-5 result in much better chest expansion and thus better breathing.

– My shoulder internal range of motion. The first thing I show is how my right shoulder won’t internally rotate fully. This is because of the impingement that I wrote about earlier. My right arm is stopping because it is hitting part of my scapula. This special breathing exercise repositions my rib cage, which repositions my scapula, which then allows my arm to fully internally rotate. Essentially, I am moving my scapula out of the way so that my arm can rotate. No stretching needed.

The process, which I don’t really explain in the video, is this:

– I inhale in a resting position.

– I slowly exhale while lifting my butt up off the floor slightly by engaging my hamstrings and external obliques.

– At the end of my exhalation, I wait 5 seconds with my butt still in the air, and then I return to my resting position.

– Repeat for 5 breaths.

***note: it’s important not to inhale until you are flat on the ground in the resting position***

Voila! You’ll then see that I have gained full internal range of motion of my right arm. It is free to move and operate as an arm should.

If you are interested in a more detailed explanation of what is going on, check out this post:

Do You Have A Zone of Apposition

 

Comments

  1. Athena says

    Hi, I’ve had chronic rib pain for two years now. It’s affected my shoulder joint and I now have nerve pain that travels across my collar bone area and down my arm. I experience numbness in my fingers, as well as lower shoulder blade area. My shoulder feels like it’s not sitting correctly in the socket. My shoulder blade feels similar(hard to describe). I’m struggling to figure it out. I was diagnosed with Costochondritis. But that’s not accurate. I’ve been trying to find a dr who’ll test for thoracic outlet syndrome. Just found your article and video. My right arm has the same limited motion as yours does in the beginning of the video. I tried the exercise you did and I wasn’t successful in achieving more range.bim going to try daily to see if there’s any change. I’m interested in finding out more from you and if you have any recommendations. I apologize for the long post.

  2. Jason says

    Hi, was wondering if you could point me in the right direction. Have been to multiple chiros, and also through pt. But every time i take a breath, i get the feeling as if something needs to pop or is rubbing on the out side of the outter shoulderblade, just below the arm pit level. It has great restriction on my breathing nad have been dealing with this for 2 years now.

  3. Tabatha says

    Wow!
    I have been suffering from left shoulder pain for over a year, done physical therapy, diagnosed with TOS and never got relief. I literally just came upon your video – tried the exercise and immediately after my arm is sitting back in position, my scapula is lying against my ribcage (no longer winging) and for the first time in over a year it feels right. I never thought about my ribs effecting my shoulder until I seen your post and realized before the pain in my shoulder started I had 3 fractured ribs. I have been in complete misery for many many months I am excited to see how this stays. Over the few minutes writing this post I can already notice a huge difference in my left side chest. Where it almost seemed “deflated” and my left shoulder would not stabilize in a back position where it is now lifted and sitting back just about in line with my ears where before it hung out ahead of my chin. This is absolutely fantastic!!!

    Ps: wish I could have done before and after pictures

  4. Linda says

    I have been in agonizing pain for the last two days and I came across your page. I figured what did I have to lose and I give it a try. I notice that I had the same limited range of motion. I tried the exercise and immediately felt a big decrease the amount of pain and that I was in. I can’t thank you enough. There is still some pain, but I don’t feel like crying anymore.

    • admin says

      Hi Linda. If you did, in fact, feel some relief, it’s likely that a Postural Restoration certified physical therapist would be able to help you, since this is a PRI based exercise. You can go to their website and see if there is a provider in your area.

      Neal

  5. Felicia says

    So very interesting. As you mentioned you are a rare case bcz of your foot and bite. Will you please point me in a direction of what sums up everything . I know it’s all a chain reaction. From my hip or maybe it started in my feet idk now one hip higher one shoulder higher that higher shoulder has had severe pain my arms are rotated forward and facing out so instead of being at me side they are completely outward turned with the insides of arms being seen which it’s been extreme compensation and chain reaction. I had braces my bite completely shifts over. It sounds crazy but now ppl can see it whereas two years ago they couldn’t now its way more obvious in pictures it’s scary I need to find the answer before I am just completely screwed not to mention the amount of pain I’m in ugh. Vertebraes seem to be slipping in and out but my center of gravity is constantly shifting to try to find balance I’ve been researching this since I was 19 I’m now 26 … chiropractic took x rays he diagnosed with double s curve and head forward posture.. then I went to spine specialist he treated me like crap acting like I made these documents and stuff it was insane literally so I haven’t continued to try to see specialist bcz of how bad the rejection and embarrassment was from that spine specialist. Ya know. Recently I brought up to my family doctor (new doctor) the shoulder thing and rib and facial asymmetry along with bite shifting to one side of face he’s like yup. I can it. He can see it all. Ugh but now what direction it’s like half the articles I read they won’t do anything bcz in America they don’t think compensation contributes to that much it’s insanity ughh please any direction or advice helps thank you . P.s was a gymnast was in three bad accidents. A few other incidents too. Never had an MRI thsts my goal

  6. says

    Fascinating article . I have suffered for around 20 years with bite and foot injuries. Like you have spent many thousands $$$ trying to find a lasting solution and like you have found some exercises and keys to help correct the root problem. My problem is on the left side, foot rotation and Hip rotation cause lower back pain which alternates with neck Rib & Shoulder /arm pain. When I get up in the morning I have to loosen my ankle joints and then I can get a lower body crack when rotating to the painful side. As you rightly say, the Ribs become elevated meaning the diaphragm just cannot function correctly, most people will have some anxiety along with their pain when these symptoms come up as the nervous system and Vagus nerve gets stressed. All in all a pretty negative downward spiral. I suggest each sufferer keep a diary of the following to correct their issue. 1) Take Postural pics from Front side & Back of full body. 2) Exercises/activities that aggravate 2) Exercises that give relief thx for posting would be good to swap notes:)

    • admin says

      Well said, Mark.
      If you haven’t seem this post: The ribcage, pelvis, and diaphragm work together to create what is called the Zone of Apposition.
      http://novusfitnesstraining.com/zone-of-apposition/

      And yes, anxiety, fear, and pain go hand-in-hand to create a negative downward spiral.

      If you live in an area that has a Postural Restoration certified physical therapist, they are trained to deal with everything I write about on this site.

  7. Seán says

    Woah. I have spondolysthesis at L5 and incredible shoulder pain – just did this exercise a few times and my shoulder has opened up. I guess this shoulder pain is due to ribcage imbalance. This has been bugging me for about 10 years, so a million thanks to you.

    • admin says

      Good to hear that you felt a difference. I’d advise you to find a PRI provider. They would be able to help further.

      Neal

  8. Daniel Melendez says

    Ive been dealing with this rib pain for over a year…I just did this exercise and shoulder and rib pain are gone…lets see how often I have to do it but holy cow this is amazing…THANK YOU!!!

    Do you have any suggestions for outer hip pain…I had orthoscopic surgery for impingement in my right hip in January…strength is there but upper outer butt and hip are still sore 24/7…

  9. Merve says

    Hi Neal,
    I have terrible shoulder pain and I have the same thing with my rib cage as you show in the video AND I also have underbite and your sentence on your bite made me think – does the bite also cause ribcage/shoulder blade position problems? I’d love to learn more.

    • admin says

      Hi Merve,
      Any type of malocclusion, underbite, overbite, openbite, crossbite, can have a huge impact on the function of the rest of the body. Some dentists are aware of this, some PTs are aware of this. Postural Restoration demonstrates this relationship during their neck seminar. People always state “that it’s all connected” meaning the human body, but it is not really understood how closely it is all connected. I would never have changed my upper body tests until I got out of my crossbite. If you are in the US, I’d highly encourage you to seek out a PRI trained professional.
      Neal

  10. Ali says

    Hello,

    I have been having pain, discomfort and movement within my breast bones/ rib cage and shoulders for about a year. I have gone to physio, chiro, massage therapy and no one seems to be able to diagnose what is wrong. My doctor keeps telling me it’s a tight muscle. I know what right musckes feel like and this feels like my chest is collapsing. I get a burning sensation in the center of my chest as if someone is standing on it with their foot. It also feels also it my bones are slipping out of place.

    Can help me diagnosis this or have any idea of what this could be?!

  11. AT says

    Hi I have always had some misalignment so that one side of my from rib cage is visibly out then the other one never had any back or shoulder pains. However when I began a heavy regiment of lifts and fitness excersisies everything was fine until I hurt my shoulder with the press. I went to a massage therapist and he tried to fix it with lots of pressure howeve it just got worse. It’s been more then a year now that I can excersise and the pain starts from the back of shoulder blades and my rib cage, and now I have very soar lower back and both my legs are in painful spasms between my legs. Nothing has helped so far, from Chyropractor to physio, I had MRI and X-rays done doctors tell me everything is fine. Tried yoga, Pilates, all forms of stretches and nothing has changed. I tried to slowly do some weights and one side of chest is now higher and larger then the other side.
    So please somebody help

    • admin says

      Hi Gwyn. My legs are up on a couch. Just make sure the surface is not too soft. It has to be a bit firm. A low chair would probably be a better option.

  12. Morgann says

    Hi .
    I have been having pains on my left shoulder for 2 years now
    I go to an osteopath who says it’s my rib causing the problem
    Every time he puts it back in place but many months later it comes back
    I don’t know what to do the pain increases and I can feel now a pain also but left side on the front by my rib cage ?
    Do you know what it could be ?
    I want to get better so knowing what to do would be good
    Thanks

    • admin says

      Hi Morgan, if you are in the US, I’d recommend checking the PRI website for a PRI provider in your area. Ribs should rotate with inhalation and exhalation, but they can sometimes get stuck when we have developed compensatory breathing patterns. That could be what is occurring.

      Neal

  13. Kevin Bogle says

    Hi Neal, This past Saturday I had trauma to my right shoulder and broke 4 ribs. I went to the ER and had an xray, they said no shoulder fracture just ribs. Having done the same type of trauma in June to the left side the clavicle doesnt feel broken but I have acute pain in my right shoulder blade(scalpula) that seems to have gotten worse since my incident. The scalpula pain seems to have gotten worse. Is this normal, will the excercise you exhibit help, or am I just suffering normal pain associated with the rib fractures? My shoulder joint is severely sprained according to the ER doctor. In my incident I fell directly on the point of my shoulder driving my bent arm in to my upper side, therefore the rib fracture. Thanks for any advice.

    • admin says

      Hi Kevin,
      Honestly, I have no way of knowing. But rib fractures are painful and since the shoulder blade sits on the ribs, I’m sure it could be related. What I wrote about is not really for acute injuries. It’s more for pain that seems to not have any physical origins.

      Neal

  14. VENUGOPAL says

    Sir,

    I am Venugopal from India.
    I have been experiencing pain in the left rib cage spreading from breastbone to back side of ribs cage, left elbow and palm including middle and ring fingers. Sometimes, the pain is experienced
    starting from uppish part of left chest… to be precise-it starts from below the collar bone via area below the axilla and the L5 & L6 ribcage. And also, sometimes, the pain is felt in the centre of the chest bony area. Occasionally, I observe pain at the centre of the spine and downwards. What it could be? Could you please guide me as to how I should approach the treatment options?

  15. Ste says

    I have been using pri therapy for the last 4 or 5 years now so we have finally got my pelvis neutral but my ribs still are stuck in extension. They have got me doing vision work and also think my bite is driving something. Like you I always seem to return to this position so I was just wondering have you found a way to make yours stick in a good position? Are you having to constantly do it to put them back. Also did you undergo the dental work as I know you mentioned Your bite was affecting it too. I am currently waiting for my dentist to refer me for a lateral ceph X-ray as that is what my physio wanted to see. Thanks in advance

    • admin says

      Ste, vision and occlusion can be huge contributors in all this. While I no longer have a crossbite (my jaw used to deviate right, not it is straight) it left me with canines on the top and bottom that are angled out to the side a bit. Due to this issue, I don’t stay completely neutral in my upper body and neck. My pelvis stays pretty good. I have to keep a certain amount of PRI exercises in my life, which is no big deal. I just treat it as part of what makes me feel good. I did not undergo any dental work, but I did get a flat plane splint in order to stabilize my OA joint. That did seem to work since my lower back micro-spasms (they always occurred just above my left SI joint and were uncomfortable but easily removed with PRI exercises) have stopped. Physically, I’m pretty good. But, no, I don’t stay completely neutral. Vision and dental complicate things greatly unfortunately.
      Neal

  16. HUMONGOUS TWO says

    Neal you are a pussy – all the correct names for the joints, etc. And then they do little to help. If you are biologically male, try pinching your nipple on the side affected, then raise/extended your arm upward same side. Did you really do this? Ass wipe. Okay try this> stick a clean pencil up your ass. Now pull it out and wipe it off with a piece of tissue. How much shit is on the tissue? Can you weigh it? Result? Goodbye Neal and have a terrific night or day or whatever. HUMONGOUS/

  17. Karissa says

    I have had terrible shoulder blade pain for going on 3 years. It’s in my left side between my shoulder blade and spine. It’s a pinching feeling sometimes the pain travels to my chest but recently it’s been uNader my armpit/breast area. It’s very frustrating. I also have GERD. Any help?

    • admin says

      Karissa, quite often there can be something called “scapular instability” (that’s what PRI calls it, at least). It means the shoulder blades aren’t sitting on the ribcage properly. PRI exercises are designed to restore the proper positional relationship between the two, but it’s a complicated process. I’d check the PRI website for a provider in your area.
      Neal

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