All posts in Treatment Modalities

How to fix a slipped rib?

How to fix a slipped rib?

What is a slipped rib?

Costovertebral Joints

Costovertebral Joints (where slipped rib occurs)

When I first wrote this blog in 2017, this condition was very common.  It continues to be even more common in the post-COVID era.  I recently updated this blog to reflect the current situation in 2024. A slipped rib or in other words slipping rib syndrome occurs when the joint(s) that form between your ribs and spine and/or between your sternum and ribs move out of proper alignment.  The condition is also referred to as tietze’s syndrome or Chostochondritis (usually referring to the joints between the sternum and ribs located in the chest wall). After this injury occurs, the ligaments that hold the joint(s) together get stretched.

This “stretch” creates irritation, pain, discomfort or “pinched nerve feeling” in the upper back (and sometimes down the arm) and the opportunity for the rib to slip out of place again and again. Often times, it can feel as if a dagger or sharp object is digging in between the shoulder blades and can cause shortness of breath (appearing like a heart attack or panic attack).

What causes a slipped rib to become slipped?

Slipping Rib Syndrome or slipped ribs occur frequently in life.  Often slipped ribs go misdiagnosed and thus under-reported. They are caused by various reasons.  Bending, twisting, lifting, reaching, pulling can cause the rib to slip. Furthermore,  they may be caused by trauma to the body such as being tackled from the side in sports, jumping, or getting hit in a car accident, prolonged or forceful coughing, uneven lifting of heavy objects (furniture, heavy backpacks, luggage, lifting winter/summer tires, etc).

How Can I Treat my Slipped Rib(s)? 

There are many approaches to treat a slipped rib: anti-inflammatories, chiropractic care, physical therapy and strengthening, and sometimes prolotherapy (Prolotherapy, also called proliferation therapy or regenerative injection therapy is an alternative medicine treatment of tissue with the injection of an irritant solution into a joint space, weakened ligament, or tendon insertion to relieve pain).

How does Dr. Luciano Di Loreto (Chiropractor) treat a slipped rib using Chiropractic care?

Slipped ribs can be treated by various techniques.  One technique is to relax the musculature with heat, interferential current (muscle stimulation that assists in pain reduction), acupuncture, and registered massage therapy.  Recently, I have also been exploring the using of shockwave therapy to treat this conditions. These techniques may assist in soothing the pain or realigning the rib(s) and vertebrae.  A second technique and the one preferred is to adjust the rib(s).  This will also assist in realigning the rib and vertebrae into a ‘normal’ or more comfortable position.

What is an adjustment?

The Ontario Chiropractic Association defines an adjustment as a highly skilled and precise movement usually applied by hand to a joint of the body.  Adjustment loosens the joint to restore proper movement and optimize function. When a joint is adjusted, a gas bubble escapes causing the popping noise you may have heard about. Chiropractic adjustment techniques have been researched extensively. Complications are rare and side-effects, such as temporary soreness, are usually minor.    

How is a slipped rib adjusted by Dr. Luciano Di Loreto?

One technique is to have the patient lie on his/her stomach on a chiropractic table.  The adjustment is applied by the chiropractor to the area where the slipped rib(s) is/are irritated.  The adjustment to the area is very quick.  Following the adjustment, the patient usually knows whether or not that rib(s) is/are still irritating them.  Most of the time the pain goes away.  Sometimes, the muscles around the slipped rib remain tender to the touch.  Another techniques is to have the patient sit at the end of the chiropractic table.  The patient sits facing away from the table.  The patient is lowered onto the table and will usually feel the pop or click once he/she reaches the table.  A third technique that is is to have the patient lay on their side facing the practitioner.  In this case, Dr. Luciano Di Loreto, will apply his hand along the area of concern.

Next Step: 

While in this position, patient will relax and take a deep breath.  A small and quick amount of pressure/force is applied and the rib should adjust into alignment.  Following these adjustments (only one maybe used), the patient should feel relief and be able to take a deep breath without the sharp dagger like pain in the back.  After the adjustments, it is always good practice to use a heat pack to soothe the muscles in the region. Trained Chiropractors and other trained practitioners can perform these rib adjustment procedures in various ways.  Always consult a trained health practitioner when contemplating treatment.

Please note that I have NOT exhausted and/or discussed all the options for dealing with a slipped rib.  I have only touched on a few that I find work for my patient’s.  Do your  own research and if you have any questions, please send them along and I will do my best to address them.  Look forward to comments.

Hope you found this information on the slipped rib syndrome interesting. If you would like to book a consultation and treatment, please contact us or book online.

MEDICAL DISCLAIMER: The following information is my personal notes about this subject matter. It is intended for informational purposes only. Consult a health practitioner to help you diagnose and treat injuries of any kind.


About the Author:








Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada (Fit for Life Wellness and Rehabilitation Centre located at 3865 Major Mackenzie Drive W., Woodbridge, Ontario., L4H 4P4), Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports (tennis, padel and soccer).




Ice or Heat? What do I use for my injury?

Ice or Heat? What do I use for my injury?

Today, I thought I would touch upon a question that I get asked quite often in practice.   When should I use Ice and when should I use Heat?  What is the difference between ice or heat for treating my injury?

These are both interesting questions and something that I would like to address in this blog.

When to use ICE or Cryotherapy?

Ice or cryotherapy is usually used for pain relief and inflammation immediately post injury (acute phase of injury).  With ice usage, inflammation, edema (swelling), hemorrhage, as well as how fast your nerves conduct decreases, while pain tolerance increases.  Generally, ice should be used throughout the inflammatory process (acute phase of injury).  This process typically begins immediately post injury and lasts between 3 to 5 days.  Along with ice, individuals may use a technique called RICE. 

What is RICE?  

Rice stands for rest, ice, compression and elevation.  For instance, when one presents with an acute ankle sprain, this technique can be used. By resting, one avoids aggravating the area further, by icing and compressing, one can decrease swelling, and by elevating one focuses on draining swelling back towards the heart.  Cold/ICE should be applied during the first 4 hours post injury at intervals of 10 minutes every 30-60 minutes.

When do I use HEAT Therapy?

Heat is generally used for increasing blood flow to the area and helping muscles and tendons to relax during chronic phases of injury – in other words, an injury that has been around for long periods.  By using heat, we are better able to relax tight muscles. Heat has been thought to increase the inflammatory process and thus is usually not advised during the acute phase (immediate post injury phase).

What cold treatments are available?

We may use the following cold treatment in practice: cold packs, gel packs, ice tape, compression units, menthol compounds and even vapo-collant spray.  One of the most common and arguably the best way to cool down an area is to use a baggie filled with ice/cold water.  Some individuals may use a bag of peas from the freezer – which will work as well.

What heat treatments are available?

Heat can be administered using a variety of ways including: hot packs, hydrocullator pads (we use this quite often in our practice), paraffin baths, whirlpools, and hot towels.  No matter which way is utilized, it is important to monitor the skin for inflammation via redness.  The main concern is that the individual may burn themselves if not monitored.

Before using heat or ice, always be sure to consult with your health provider.

Although, it may seems fairly simple, there is quite a bit of confusion out there when it comes to ice and heat.  Hope this post clears up some of the questions between heat and ice!

Dr. Luciano Di Loreto