Pelvic obliquity and rib, shoulder…breathing dysfunction?

December 19, 2009 – 1:46 pm

Anybody have thoughts on rib pain? How about the relationship of pelvic obliquity to rib, shoulder and breathing dysfunction?

  1. 11 Responses to “Pelvic obliquity and rib, shoulder…breathing dysfunction?”

  2. I would suggest that virtually every client that comes into our clinics have some sort of rib dysfunction. There are 100’s of costochondral joints therefore 100’s of areas for dysfunction to arise
    It may be due to a depressed manubrium, faulty costal angles, poor respiratory patterns and even being rectus abdominals dominant. Which commonly leads to 1st rib and scalene dysfunction due to the antagonistic relationship between QL, obliques and the scalenes. The big core muscles depress the low ribs and the poor little scalene have to lift them commonly leading the elevated 1st, trigger points and faulty shoulder mechanics.

    Diane Lee talks about poor force closure of the thorax, she uses a straight arm raise which is very similar to the SIJ stability test when the straight leg raise is used. I commonly see poor thorax stability and mobility which is always improved by hands on muscle facilitation techniques. This is great way to “show” the client they have dysfunction.

    By Danny Christie on Dec 19, 2009

  3. The rib cage can be a very sensitive and sometimes painful area to palpate. A guarded response is often noted when palpating certain areas particularly if articular stretching techniques are performed incorrectly, i.e., too quickly, too deeply.

    In the presence of pelvic obliquity (SI and iliosacral dysfunction), compensatory rib cage and shoulder joint distortions often lead to inefficient breathing patterns.

    Regrettably, rib cage and shoulder girdle asymmetry is compounded by secondary vertebral dysfunction. A catch 22 arises as ribs and spinal articulations lock each other down into what I refer to as a “dual fixation”.

    With prolonged fixation, pain-spasm-pain cycles and protective muscle spasm create a situation where it’s difficult to know where to begin. But this is where the science of spinal biomechanics becomes exciting.

    By Erik Dalton on Dec 19, 2009

  4. I find a number of people with these problem, a majority as a matter of fact.

    By Geoffrey Bishop on Dec 19, 2009

  5. I really like that Diane Lee SI joint test where the supine client lifts the extended leg as high as possible and then again with the therapist compressing both ilia against the sacrum. One of the most accurate tests I’ve found for true SI joint dysfunction.

    Never performed it on the thorax. I’m assuming the test is executed in a similar manner????

    By Erik Dalton on Dec 19, 2009

  6. I see more external and internal rib torsions than any other non-traumatic rib dysfunction (externals are more symptomatic).

    These torsions have roots in vertebral fixations. For example, if the right T3 is stuck closed on T4; during thoracic flexion, the right T3 rib must externally rotate. Prolonged T3-4 facet fixation (ERSR) often “roughs-up” the costovertebral and costotransverse demi-facets and the T3 rib becomes fixated in external rotation.

    Protective muscle guarding is first palpated in the spinal groove muscles (particularly rotatores) and then in iliocostalis.

    One must first correct the vertebral dysfunction and then move out to the iliocostalis attathment at the rib angle at T3. If it is exquisitely tender…the T3 rib is stuck in external rotation (externally torsioned).

    Usually easy to fix by using the bones as levers to release myospasm in the deep transversospinalis and erector spinae groups.

    Recall that the nerve, artery and vein run along the groove at the bottom of each rib so keep the client in flexion, localize to the superior aspect of the rib with thumb or extended fingers, and ask the client to slowly increase neck flexion as you apply slow, sustained pressure on the rib shaft.

    Recheck for tenderness at the rib angle to see if you fixed it. This “between-the-blade” pain is very common and usually blamed on tight muscles or trigger points.

    By Erik Dalton on Dec 19, 2009

  7. We all like to talk about rib pain but it seems few therapists have developed successful strategies for assessing and (myofascially) correcting the numerous dysfunctions that can occur in the costal cage. Or…maybe some “normal” folks are enjoying the holidays instead of obsessing on social networks (I have an excuse…we’re snowed in).

    Suffice to say that a common source of upper back and even chest pain is rib dysfunction. Oddly, some still believe that ribs are non-moving bones fused to our spine and sternum. Actually, every breath and every torso movement requires ribs to move. Just as other bones and joints in our body are susceptable to injury and irritation, so too are ribs.

    Bottom Line: A dysfunctional rib has lost the ability to properly coordinate its movement with the rest of the ribs and spine as part of a functional unit. The rib may be “stuck” in one position, or have an impaired range of motion. This would be like a team of rowers, with one rower using his ore out of sequence with his team.

    Rib dysfunction is frequently misdiagnosed and therefore improperly treated. In a clinical setting, it’s not unusual to see clients who’ve suffered debilitating rib pain for years with no one helping them!

    In many cases, ribs lose joint-play due to ongoing physical mechanical stress (microtrauma). These types of non-traumatic joint problems result in sympathetic irritation of surrounding sensitive tissues, i.e., thoracic erectors, spinal ligaments, transversospinalis (particularly levator costalis).

    Mechanical stress can originate from poor posture, vertebral misalignment, asymmetrical muscle development, scoliosis, lifting trauma, myospasm, visceral dysfunction, etc. In cases where there’s a microtraumatic predisposition to joint fixation due to degraded costotransverse and costochondral articular cartilages, a simple coughing attack may be all that’s needed to kick off a pain-spasm-pain cycle.

    Of course, altered rib function can cause difficulty breathing, restricted shoulder movement, referred pain to other areas, and reactive muscle guarding. The misaligned ribs can also pinch intercostals nerves, sending excruciating pain through the length of the rib. A common complaint is a chronic low-grade ache, with episodes of severe sharp pain in the upper back…and, occasionally, the chest wall (the ole heart attack scare). Adios for now…back to the fam…

    By Erik Dalton on Dec 26, 2009

  8. I have suffered from rib dysfunction for 5 years. For the first two years, not one of the chiropractors, orthopedic surgeons, physical medicine/pain management docs, I saw even uttered the word “rib” to me. Finally, after turning to alternative medicine, a Rolfer told me that I had some very loose ribs that would sublux in and out of joint causing my upper back, neck and shoulder pain. Since then I have also experience pelvic dysfunction due to an injury and I have certainly begun to see the relationship between the olbiques and pelvis to the ribs. I have found osteopathic manipulation, IMT (Integrative Manual Therapy),and reflex locomotion (a manual technique from the Czech Republic) to be most helpful in managing this problem, though none of them have been able to provide a permanent fix.

    By Lauren on Dec 26, 2009

  9. In Fred Mitchell Sr’s muscle energy technique, therapists begin by correcting the single joint (non-neutral) dysfunctions and then treat out the type 1 (functional scoliotic) group curves. The erectors (including transversospinalis) are usually more hypertonic on the concave side.

    Some deep tissue therapists use extended fingers to move the shortened tissue toward the spine but I’ve had more success working the paravertebral myofascia away and then performing articular stretching routines through the apex of the curve. Of course, it’s important to restore balance to hypertonic/hypotonic tissues in the entire thoracic cage… side-to side, front-to-back and in torsional (crossing) patterns (obliques/ adductors and lats/glute max).

    Another common finding that manifests as between-the-blade pain is termed a ‘dorsal-dish’. Commonly seen is a flat spot where there should be curve. Running from about T2- T6, these fixated facets (stacked non-neutrals) can be unilaterally or bilaterally stuck closed. This is a major pain generator and can often be corrected by moving the tissue away from the spine. Ida Rolf used to say “dig a hold to allow the spine a place to come back to.” Home re-training exercises such as the wall press are pretty effective in helping correct this condition.

    By Erik Dalton on Dec 27, 2009

  10. I have these problems and need HELP, my ribs and shoulders bother me. I have pain between my shoulder blades caused by a rib and I also have constant lower back pain and pelvis misalignment. My muscles are extremily tight and I have worked hard for the last 2 years to get this corrected to little avail.

    By m reed on Jan 2, 2010

  11. Sounds like you need a good spinal biomechanical evaluation. There’s a list of Certified Myoskeletal Therapists on my website @

    If you can find no one in your area, look for a Certified Advanced Rolfer, manipulative osteopath or a good chiropractor. There are also some PTs around who do very fine hands-on alignment work. Best of luck…ERIK

    By Erik Dalton on Jan 4, 2010

  12. Hi, I am not too sure about the topic being discussed here, but it seems like my question can be answered here by the experts. A month back I was doing weight training and while lifting the weights I felt a sharp pain in my neck. Since then my neck and shoulders have been paining a lot. A friend of mine advised to opt for a neck massager from Please advise on a possible course of treatment, or do I need to visit a doctor?

    By Rodney Aniston on Nov 16, 2010

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