Rib Flare

Rib flare is a common symptom that occurs during pregnancy and into postpartum (although it can also occur outside of these instances).

It is characterized by the protruding or flaring out of the lower ribs on one or both sides. In other words, the lower ribs face upwards and protrude forward (outwards from the body).

Rib flare can vary in severity, but can sometimes be visible simply by looking in the mirror or watching how your ribs react to breathing movements while laying down.

Unfortunately, the effects of this condition are not limited to just a change in appearance. Rib flare can cause many uncomfortable symptoms that disrupt daily function and movements, such as the following:

• Tightness in the upper abdominal area
• Bras and tops feeling tighter postpartum (regardless of any changes in weight)
• A wider-feeling rib cage
• Breathing that feels strange, restricted, or requiring more effort (particularly during an exhale)
• Difficulty with deep breathing
• Shallow breathing
• A dysregulated nervous system (constant fight-or-flight response)
• Difficulty with engaging the core during movements or exercise
• Low mobility in the back or neck
• Stiffness
• Poor posture
• Increased risk of injury
• Lowered body image
• And more

Rib flare after pregnancy is very common, as the body naturally makes shifts to allow more room for a growing baby. However, many people may not realize that their ribs are the cause of their symptoms and restricted movements. 

For some, the ribs may return to their natural state post-labor—but for many, the ribs don’t always return to their natural position. Typically, rib flare shouldn’t persist into postpartum past a few weeks. Luckily, it’s never too late to start addressing rib flare!

Despite what many people may say, postpartum symptoms or bodily changes are not necessarily just “a part of life” or something that cannot be fixed. In actuality, your body may just need some additional love and care to return to its pre-pregnancy function!

Start Healing with Hive

To understand how rib flare occurs, you’ll need to better understand your ribs and the important roles they play in your overall health!

You may think that it is strange that the ribs can move forward or upwards like they do with rib flare. This is possible because the lower ribs are actually a bit flexible.

Typically, you have 12 ribs on each side. Ribs 1 through 7 connect directly to the sternum. The next three ribs are called “false ribs,” as they do not directly connect to your sternum the way the upper and middle ribs do.

These false ribs actually connect to the ribs above them via cartilage, which indirectly attaches them to the sternum. Finally, the last two ribs are known as floating ribs, as these two do not attach to the sternum or other ribs at all.

Your “false ribs” are typically the culprit of rib flare, as the cartilage they are attached to is flexible, and can therefore create the protruding associated with rib flare.

While it may seem surprising, your ribs play a significant role in posture and movement. They work together with your neck, shoulders and back to allow for comfortable posture and a variety of movements. Additionally, the ribs house your breathing system!

The ribs, diaphragm, abdominals, and pelvic floor all contribute to effective breathing. Effective breathing helps regulate stress, which is important not just for your mental state, but also your physical health, too.

Injury, chronic poor posture, spinal misalignment, and poor breathing habits can all contribute to the risk of rib flare. Most commonly, rib flare is caused by pregnancy.

Rib Flare During Pregnancy and Postpartum

During pregnancy, your body begins making space for a baby. Your uterus grows in size and pushes upward into the diaphragm. Your center of gravity shifts as the weight in your uterus increases, and you’ll begin to experience a variety of musculoskeletal changes.

The curvature of your spine and lower back shift—along with your pelvic tilt—in order to support the growing weight towards the front of your body.

The muscles and ligaments of your hips, abdomen, back, diaphragm, and pelvic floor are all affected, too. This causes extra stress and tension on these areas, often resulting in pain and many other pregnancy symptoms.

Additionally, the body releases hormones such as relaxin, progesterone, and estrogen during pregnancy. These hormones loosen many structures and ligaments within the body, making you more susceptible to rib flare, misalignment, and joint pain.

Even the center of gravity and pressure on your lower body are altered during pregnancy. All of these factors will significantly affect your posture and movements, which in turn affects your ribs, too!

Rib flare is a common side effect of pregnancy, but there are many reasons why you shouldn’t just leave it be if it does not subside on its own after labor.

As we discussed with the list of symptoms earlier, rib flare affects many major areas of your health, many of which have something to do with breathing, movement, or posture.

This is because the ribs work together with many areas of the body. Let’s look at how rib flare can disrupt these bodily functions and how physical therapy can provide support.

Breathing

Breathing may seem like an obvious necessary function for the body—but outside of simply keeping you alive, your breathing actually helps maintain other aspects of health.

Effective breathing patterns maintain intra-abdominal pressure in the body, regulate stress, and even affect the muscles and functions of your pelvic floor, abdominal muscles, and of course, your diaphragm.

This is because the diaphragm, pelvic floor, and abdominals are all connected to the breathing process. When you inhale, your diaphragm moves downward to allow for the lungs to fill with air. The pelvic floor relaxes to further allow for this change in pressure, and your abdominals expand, too.

When you exhale, the diaphragm moves upward again and the pelvic floor lifts back up. Rib flare can disrupt this process, as the flared rib bones keep you in an inhaled position, making deep breathing difficult and shallow breathing more likely.

Physical therapy can help address these problems through a variety of treatments that aim to reduce rib flare, restore effective breathing mechanics, and address muscle health of your abdominals and pelvic floor.

A comprehensive approach to treating rib flare is very important, as it can cause the pelvic floor, abdominals, and diaphragm to lose their proper positioning and coordination during the breathing process. This can lead to problems like pelvic floor dysfunction and difficulties with core activation, which we’ll talk about more below.

Movement, Posture, and More

The core muscles and ribs work together to provide mobility and good posture for your entire torso. With rib flare, core engagement can become difficult, your joints may feel stiff, and you may find yourself slouching or hunching more.

These effects can be worsened by the bodily changes associated with pregnancy and core weakness. Postpartum conditions like diastasis recti may lessen the support that is necessary for proper rib health and posture, making any form of core engagement very difficult.

Core weakness, joint stiffness, and poor posture can all lead to an increased risk of injury. These aspects affect your stability and balance, so it is very important not to ignore rib flare symptoms.

Not only are you more susceptible to injury, but you’ll be more susceptible to pelvic floor dysfunction, which can cause symptoms like urinary incontinence, lower back pain, pelvic pressure, constipation, and much more. Luckily, Hive’s physical therapists are very skilled in all of these different aspects of the body, including the pelvic floor!

Read more about how physical therapy can address rib flare below.

Healing Rib Flare

As you can see, rib flare is both caused by and affected by many different aspects of pregnancy and other daily habits. Rib flare affects your posture, movement, core engagement, pelvic floor health, and breathing patterns.

Vice versa, lacking proper posture, effective breathing patterns, and sufficient core strength results in lasting rib flare. The good news is that rib flare is not permanent and can be addressed by a physical therapist for better comfort, mobility, and safety!

At Hive Therapy and Wellness, our physical therapists can address rib flare through a comprehensive treatment plan that is curated to your unique needs. Whether your rib flare is occurring during pregnancy, persisting into postpartum, or created by non-pregnancy related causes, we are here to help!

Rib flare and its causes can vary from person to person, but some common methods that may be used to address the condition include:

• Posture training to reduce tension and lower the risk of injury.
• Exercise prescription to increase core strength, pelvic floor health, back strength, and overall mobility.
• Addressing muscle imbalances through postural changes and targeted strengthening exercises.
• Improving breathing mechanics and pelvic floor coordination for effective deep breathing.
• Stretching and mobility training for the chest, back, and other necessary areas.
• Strategies and education on postpartum posture (breastfeeding, standing and sitting, lifting, and more).
• Spinal manipulation or joint mobilization to address misalignment or stiffness.
• Neuromuscular re-education to increase overall bodily awareness and pelvic floor control.
• Manual therapy to address muscle tension and stiffness.
• And more!

Hive Therapy and Wellness offers a wide variety of treatments, but the treatments that will be used depend on your unique case.

Our physical therapists work hard to create comprehensive, individualized plans of care for all of our patients; therefore, you may experience any of the following main forms of treatment while under Hive’s care:

• Neuromuscular re-education
• Manual therapy 
• Exercise prescription
• Cupping 
• Behavioral modifications
• Therapeutic activity
• Electrical stimulation
• Biofeedback
• Therapeutic modalities