Floating rib syndrome

In floating rib syndrome, pain occurs in the lowest ribs of the rib cage. These ribs are called 'floating ribs' because they are not connected to the breastbone at the front of the body. Floating ribs normally do not lead to symptoms. If they do, we speak of 'floating rib syndrome'.

Anatomy of the floating ribs

The human body has 24 ribs, 12 on each side. Some people have a congenital variation, giving them one pair more or fewer ribs. Fortunately, this does not always lead to physical complaints.

At the back of the trunk, all ribs are connected to a vertebra. The ribs curve forward; due to the shape, this is also called the rib cage. At the front, only the first 10 ribs have a cartilaginous connection with the breastbone. This means that the 11th and 12th ribs are not fixed at the front; they therefore float.

Causes leading to painful floating ribs

Everyone has floating ribs. They usually only become painful in combination with other physical issues.

A common cause of painful floating ribs is a scoliosis. This is a sideways curvature of the spine. This reduces the distance between the lowest ribs and the pelvis. A consequence of this curvature can be that the tip of the floating rib touches the pelvis, which leads to irritation and pain.

Another possible cause is bone loss (osteoporosis). The vertebrae are weakened and collapse slightly. This also reduces the space between the lowest (floating) ribs and the pelvis.

A third possible trigger for floating rib syndrome is a (long-standing) poor posture.

Characteristic pain in floating rib syndrome

In floating rib syndrome, pain is usually triggered by activities such as prolonged sitting, standing, walking, and twisting of the trunk. But also with specific movements in which the rib cage is stretched or tensed. For example, by coughing or deep breathing. The pain can be felt on one or both sides of the body. In both cases, the pain is often felt at the level of the pelvic rim.

The importance of the right diagnosis

It is important that in the case of such symptoms the correct diagnosis is made. Conditions that should be excluded are kidney stones, gallstones, and stomach or bowel problems.

Additional tests with an MRI scan or an röntgenfoto (X-ray) can show the distance between the ribs and the pelvis and the alignment of the spine. Any damage that has occurred also becomes clear with these tests. Referral to a pulmonologist or internist may be made.

Treatment and prognosis of floating rib syndrome

In practice, floating rib syndrome rarely has serious long-term consequences. Based on the symptoms, the physical therapist can draw up a treatment plan to address the cause(s) of floating rib syndrome. Think, for example, of learning to maintain a correct posture using exercise therapy.