Costovertebral Joint Disorder

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Costovertebral joint disorder (also referred to as costovertebral joint sprain) is a condition where the joints in between the ribs and the vertebrae become irritated, compressed, or rotated. The ribs are a set of bones that course from your spinal column, around your body and attach to your sternum or breastbone. These bones serve to protect the contents of your thoracic cavity. They also serve as an attachment point for many muscles and are active during respiration.

Overall, you have a total of 24 ribs, which are 12 on each side of your body. As for vertebrae, it includes a total of 33 individual, interlocking bones that form the spinal column. Each vertebra has three main functional components, which are the vertebral body, vertebral arch, and transverse processes. 

Along with the facet joints, the costovertebral joints are designed to support your body weight and allow movement like bending, twisting, lifting, and arching. Each costovertebral joint (commonly known as the rib joint) is made up of smooth cartilage which lies between the bony surfaces, cushioning the impact of one bone.

Strong connective tissue also wraps around the bony ends, providing support to the joint. When excessive stretching or compressive forces are placed on the costovertebral joints, damage to the cartilage, misalignment of the rib head or tearing of the connective tissue surrounding the joint can occur (thus leading to a costovertebral sprain).

All sprains are usually graded based on the severity of the condition by three degrees:

  • First-degree sprain – This is the mildest form of a sprain, resulting in minimal tissue damage and rapid recovery time.
  • Second-degree sprain – A second-degree sprain occurs when one or more ligaments have been damaged. There is usually more swelling and bruising with a second-degree sprain and it may require additional treatment to heal.
  • Third-degree sprain – This occurs when the ligament has completely torn. It is normally accompanied by a popping sound and can be very painful. There will be swelling, bruising, and an inability to bear weight on the foot.

Causes & Symptoms of Costovertebral Joint Disorder

Causes linked to costovertebral joint disorder commonly occur due to sudden and spontaneous movement of the spine which involves arching or over-extending of the spine, bending, or twisting. Most commonly, these injuries occur because of repetitive movements of the thoracic spine especially bending and twisting activities.

Also, in any activity involving the movement of the spine, both torsional and compression forces act on the joint. When the impact of forces is more than the normal acceptable capacity of the joint that it can sustain, then the joint structure, cartilage, or ligament will be damaged. In some cases, the head of the rib may be dislocated.

Costovertebral joint disorders often cause a wide variety of symptoms that can affect your breathing due to the location of the joint being too close to the chest where the lungs are found. One common symptom linked to this disorder includes a dull ache in the upper back that is worsened by breathing deeply, coughing or rotation movements of the trunk and rib cage. Additionally, costovertebral joint disorder includes other symptoms, such as:


Swelling and inflammation

You may notice swelling and inflammation that can feel painful when you attempt to touch your affected joint.


Prior to the injury, there may be a redness visible on your upper back where your costovertebral joint is located.

Limited range of motion

Experiencing a sprain on your upper back can limit your range of motion. Attempting to rotate your body while feeling pain is a known symptom of a costovertebral joint disorder.


Stiffness is often one of the first symptoms to occur alongside pain. If either sharp or general soreness becomes bad enough, it can contribute to reduced mobility of the upper back’s muscles, ligaments, and/or joints.

Tingling and numbness

Similar to pain, these symptoms can also radiate along a nerve from the thoracic spine and are into the arm, chest, stomach, or lower in the body. Pins-and-needles tingling or numbness radiating from the thoracic spine can feel like the shape of a band running along with one of the ribs.

Additional symptoms that affect the upper back from costovertebral joint disorders could start any number of ways, including:

  • Sudden – Pain could start right after an injury.
  • Delayed – In rare cases, pain from an injury takes a few hours or longer before it appears. This could be due to an inflammatory process or how pain might be felt in another area nearby before it is noticed in the upper back.
  • Gradual – Upper back pain may begin out mild and slowly worsen over time.

Who gets Costovertebral Joint Disorder?

Costovertebral joint disorders are often caused by a number of risk factors that can affect most people, especially if they:


Work in an extreme environment

An extreme environment which requires repetitive bending, twisting, or lifting of heavy objects. Also, lifting a load with poor technique or lifting and twisting at the same time can increase the chances of developing symptoms associated with costovertebral joint disorders.

Experiencing a vehicle accident

Everyone who experiences a car crash may be at risk of fracturing a joint. In cases of costovertebral joint injuries, vehicle accidents are a known risk factor that can lead to the disorder.

Being injured during a sports activity

Certain sports require repetitive bending, jumping, and twisting your body in order to perform a maneuver from a sporting event, such as basketball, soccer, American football, or other activities such as kayaking.

How Does Costovertebral Joint Disorder Affect You? How Serious is it?

Costovertebral joint injuries can involve from mild to severe depending on the impact of their cause. However, injuries in the rib can come with serious or life-threatening complications. Some of these include:


Lung cancer

Lung cancer is the second most common cancer throughout the population. One of the symptoms of lung cancer is rib pain or chest pain that worsens upon breathing deeply, coughing, or laughing. Having severely injured ribs can increase the chance of spreading lung cancer in your ribs.

Collapsed lung

Also known as a pneumothorax, collapsed lung is a rare condition that may cause chest pain and make it hard to breathe.


Pneumonia is a lung infection that can range from mild to severe that you will need to seek immediate medical attention. It occurs when an infection causes the air sacs in your lungs to fill with fluid or pus. Therefore, if you do not breathe deeply enough, mucous and moisture can build up in the lungs and lead to an infection such as pneumonia.

Recommended Treatment & Rehabilitation for Costovertebral Joint Disorder

A diagnosis for a costovertebral joint disorder is similar to how a doctor would diagnose you for regular upper back pain. He or she will perform a thorough physical examination alongside a complete medical history to check for any past injuries that occurred. In addition, your doctor may order imaging tests to be able to get a clearer view of what is causing your pain. These imaging tests include:


Magnetic resonance imaging (MRI)

MRI uses radio waves and a strong magnet to create cross-section images of soft tissues and bones. In particular, an MRI can be good at detecting compression of spinal nerves, infections, tumors, or damage to ligaments, muscles, or other soft tissues.


An X-ray is used to create an image of the bones. This imaging may show fractures, degeneration, and possibly tumors.

Many other imaging tests could be ordered and used, such as electrodiagnostic testing to check nerve and muscle function, computed tomography (CT), or blood tests. After a diagnosis for costovertebral joint disorders has been confirmed, physiotherapy may be advised. Following this type of session, you’ll be given guidance regarding specific treatment plans to aid your recovery. Therefore, a physiotherapist will design a perfect treatment program specific to your condition and goals, including some of the following:


Manual therapy

If you have pain or stiffness which does not completely heal with a range of movement and breathing exercises, your physiotherapist may use hands-on techniques (manual therapy) to help alleviate pain and allow you to further progress with your rehabilitation. There are several manual therapy methods that your therapist may use and teach you. The purpose of hands-on therapy is its neurophysiological effect, which can strongly reduce your pain.

Strengthening exercises

Your physiotherapist may teach you a combination of strengthening exercises to help maintain a strong upper back and allow for more quicker recovery. Strengthening is very important if you’re returning to a sports activity. This will not only help prevent further injury but also maximize your performance and endurance when returning to your activity.

Stabilization exercises

Most people with upper back pain often have a difficult time engaging the correct muscles. The ultimate goal of stabilization exercises is to retrain the deep muscles. Your physiotherapist will teach you how to use the correct muscles before going through a series of motions to stabilize the spine.

Below are a few additional exercises that can help reduce symptoms linked to costovertebral joint disorder:


Shoulder blade squeeze

Begin by sitting or standing while keeping your back in a straight line. Then, squeeze the shoulder blades (both shoulder blades together) as hard as you can. Hold this position for at least five seconds before releasing it. Repeat this method 10 times a day.

Thoracic rotation exercise

Lie down on a flat surface on your back and bend both your knees. Next, lower your knees slowly to one side making sure that the shoulders and feet are in contact with the surface of the floor. Finally, repeat this exercise method 10 times a day.

Chair rotation

Sit sideways in a chair. Your right side should be resting against the back of the chair. Then, keeping your legs stationary, rotate your torso to the right, reaching for the back of the chair with your hands. Hold for 10 seconds, then repeat 3 times on each side a day.

Alternative & Homeopathic Treatment for Costovertebral Joint Disorder

In most cases, mild costovertebral joint pain may take 2-4 weeks to recover. Although, many patients living with costovertebral joint disorders find some pain relief from one or a combination of alternative treatments, such as:

  • Acupuncture – Depending on the specific pain symptoms, an acupuncturist places thin needles in strategic locations of the body to theoretically alter energy flows, ease tension, and reduce pain.
  • RICE method (Rest, Ice, Compression, Elevation) – RICE treatment can be helpful in reducing pain and swelling. 15-20 minutes once every four hours is recommended.
  • Taping – Taping can be used for stability around the costovertebral joint to treat swelling, bruising, and pain as well as for facilitating the body’s natural healing process.
  • Transcutaneous electrical nerve stimulator (TENS) unit – A TENS unit usually uses small adhesive pads to place electrodes at multiple locations on or near the painful region, such as the upper back.

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