Costovertebral Joint Dysfunction: Cause of Rib, Chest and Upper Back Pain

When upper back pain strikes, it is often the result of poor posture and improper body mechanics. Usually, the pain is muscular in origin; it may involve the trapezius muscle, the rhomboids and/or the erector spinae muscles in the upper back. Spinal disc and facet joint pain are not common in the upper back, since the thoracic spinal section is less mobile and load-bearing than the sections in the neck and lower back. When upper back pain is not caused by muscular dysfunction, it may be caused by costovertebral joint dysfunction.

Costovertebral Joints

Nine of your thoracic vertebrae (T2-T10) attach to ribs via the costovertebral joints. These joints consist of smooth cartilage that cushions the slight movements of the bones.

Costovertebral joints are supported by ligaments. A traumatic injury, such as a violent twisting motion, can cause sprain to the ligaments supporting a costovertebral joint or may damage the cartilage within it. Injury can also be cumulative; years of poor posture and improper body mechanics or years of repetitive lifting, bending and twisting can damage the joint and its ligaments. Damage to the joint and ligaments may be secondary to a more systemic problem, such as weak core musculature that fails to support proper posture and spinal stability.


Localized pain, usually on one side of the spine


Nearby muscle spasms

Pain that radiates along the rib to the side and the chest

Worsened pain on coughing, sneezing, twisting, bending and lifting


The first step toward healing a costovertebral joint is to cease activities that overtax it; this will give cartilage and ligaments time to heal. You will likely be instructed to limit or eliminate bending, twisting and heavy lifting for a few weeks.

Another crucial component of treatment is posture correction. Slouching strains the joint and its ligaments; maintaining upright posture reduces stress on them.

Exercise therapy to strengthen supporting muscles in the back is also important. Exercises like the shoulder blade squeeze will likely be prescribed.

Since poor posture and improper body mechanics can often be traced back to a weak core, overall core strengthening will likely factor into your treatment.

To help manage pain, anti-inflammatory medications or injections may be prescribed. It is important to consider these forms of pain management temporary solutions as opposed to cures for joint dysfunction.

If you have upper back and rib pain, costovertebral joint dysfunction may be the cause. If you have radiating pain that originates in the upper back, make a doctor’s appointment and request diagnostic tests to confirm or rule out joint injury in the thoracic spine.