Clinical Conversations

Written by: Danya Sadler, SPT

When Rib Pain Isn’t What It Seems

We had a patient this past week with a unique challenge. This patient had been fighting with a serious medical condition for the past couple months and had, a week before seeing us, started experiencing pain on their left lower ribs. This patient had great difficulty sleeping, rolling over, and generally moving around and wanted to see if this new symptom was related to the illness or if it had a mechanical component.

This visit was conducted via telehealth which is a great way for patients to be seen who either are living or travelling far away or people, like our patient in this article, who are homebound due to their illness or injury. This patient was told at the start of the visit that we were going to use this first visit to determine if there was a mechanical component to their rib pain and if there wasn’t, that we were going to help guide them to appropriate medical providers for further evaluation.

Using Movement to Find Answers

During this visit, it was difficult to conclude whether the rib pain was mechanical or visceral. The patient had tenderness around their left lower ribs, but also had right sided tenderness right underneath the ribs dealing more with internal structures. One notable finding was the patient experienced some pain relief when side-gliding to the right and side-bending to the right. Based on this response, we decided to have the patient perform these consistently over the next few days to see if this would relieve symptoms and help us conclude if this rib pain was indeed mechanically based.

An Unexpected Setback—and a Breakthrough

When we followed up with the patient a few days later, they reported an eventful week. Shortly after our initial evaluation, they went to the emergency room with severe rib pain and did not do their PT exercises at all. After testing negative for any illness related cause of her rib pain, she went home and then began performing the assigned movements consistently. They worked! The patient was happy to report that their pain had almost completely gone away! They were very grateful that we were able to provide the tools to reduce their pain and gave them hope even in these really difficult times that they were facing with their illness.

The Power of a Thorough Assessment

This case highlights the value of a thorough physical therapy evaluation, even when symptoms occur alongside a significant medical condition. Rather than making assumptions about the source of the patient’s pain, we used movement testing and symptom response to guide our clinical decision-making and determine the most appropriate next steps. By the patient’s second visit, their rib pain had improved dramatically, allowing them to move, sleep, and function more comfortably. Just as importantly, the patient gained confidence and clarity during a challenging time in their health journey.