The costovertebral joints are the joints between the ribs and vertebrae in the spine. Dysfunction
of a joint is often caused by acceleration or deceleration injuries, such as in a car accident or
contact sports, blunt trauma to the chest or back, or as an overuse injury. It is the connective
tissue structures within this joint, such as ligaments, that are usually injured and this leads to
pain. Twisting or bending the back, particularly when done very quickly, can lead to a sudden
pain in the back of the chest.

Potential causes:
● Looking behind you quickly when reversing the car can cause strain on the joint
● Lifting of heavy objects, or lifting and twisting simultaneously
● Muscle strength imbalance in the upper back area
● Repetitive movements of twisting or bending the back
● Repetitive lifting of objects
● Trauma: direct contact to the chest or back
● Trauma: indirect injury of the joint after quick acceleration or deceleration

Symptoms of costovertebral joint dysfunction:
● Pain or discomfort on the side of the spine over the rib cage area
● Muscle spasms in the upper or middle back
● Pain with twisting or bending the back
● Decreased movement of the spine
● Decreased movement of the rib cage, such as when breathing deeply
● Referred pain into the chest
● Tightness in the chest
● Difficulty maintaining an upright posture
● Pain with coughing or sneezing

Initially a period of rest is recommended, but can be combined with early-stage physiotherapy.
The main aim of the initial treatment will be to decrease any pain and stiffness that is present.
This might mean treating surrounding muscle spasms and mobilising the ribs or vertebrae. Your
physiotherapist can help you with activity modification strategies and will educate you on how to
prevent further injury. This will be followed by a prescribed exercise programme that addresses
any weakness or tightness, and will also include strengthening of your core stabiliser muscles. It
is also important to prevent re-injury and this will also be addressed appropriately to each