Rib pain on both sides can be caused by inflammation of the cartilage known as acute costochondritis (chest wall syndrome), atypical chest pain, or normal occurrence of chest pain. Read on below for more information on causes and relief options.
6 most common cause(s)
Symptoms of rib pain on both sides
Ribs are the long, curved bones which form the rib cage which functions to protect precious organs like the heart and lungs. The rib cage is composed of 24 rib bones in total — 12 on each side — which are joined by cartilage to the backbone in the back and the sternum or breastbone in the front. Each rib bone is attached to the one above and below it by muscles which help form and move the chest wall. Dysfunction of any of these components of the rib cage including the bone, cartilage and/or muscles or the underlying organs can result in rib pain on both sides. Fortunately, most causes of rib pain are benign and easily treatable, but some require evaluation and intervention by a medical professional.
Common characteristics of rib pain on both sides
Depending on the cause, rib pain can have varying characteristics including:
- Sudden or gradual
- Persistent (continuous) or intermittent (comes and goes)
- Acute (sudden and temporary) or chronic (continuous or recurring)
- Mild or severe
- Sharp and stabbing or dull and achy
Common accompanying symptoms
Rib pain can be associated with other symptoms including:
- Difficulty taking full or deep breaths
- Pain with full or deep breaths
- Pain with certain movements
- Bruising
- Difficulty sleeping
Causes of rib pain on both sides
Your rib cage functions to protect some of your most vital organs and so can often be the first body part affected after a traumatic injury. However, trauma is only one of the potential causes of rib pain. Because your rib cage is composed of multiple different components, rib pain can also be due to inflammatory and systemic causes. Rib pain can also be caused by injury to some of the underlying structures beneath the ribs that when inflamed or irritated cause a pain that mimics rib pain. While some causes of rib pain are not serious and may resolve on their own, you should be examined by a healthcare professional who can identify the right diagnosis and the best course of treatment.
Traumatic
Trauma to the rib cage or chest wall can result in multiple injuries that can cause rib pain.
- Bone fracture: Trauma to the chest wall like the kind that occurs with a severe fall, car accident, or direct blow to the area can cause fracture of either the ribs, sternum (breastbone), or clavicle (collarbone). Any of these fractures can cause pain that feels as if it is coming from the ribs. Rib fractures, in particular, cause pain that is worsened with breathing and coughing.
- Lung bruise: Trauma to the chest wall can also cause injury to the underlying lung resulting in pain that mimics rib pain. When trauma causes bruising of a lung this is known as a pulmonary contusion.
- Muscle strain: The muscles that join the ribs together are called intercostal muscles. Intercostal muscles can be strained or pulled when overexerted either during heavy lifting or intense coughing.
Inflammatory
Rib pain can be caused by inflammation which is the body’s normal response to injury or infection.
- Rib joint inflammation: The rib cartilage that joins the rib bones to the sternum or breastbone can become irritated or inflamed in a condition known as costochondritis.
- Infection of the lung or airway: Pneumonia is an infection of the air sacs that compose the lung. Pneumonia can lead to irritation of the lining of tissue, also called pleura, that surrounds the lung. This tissue lining is situated close to the ribs and irritation or inflammation of the lining, also known as pleuritis, can mimic rib pain. Bronchitis, inflammation of the airway, and upper respiratory infections can also cause rib pain due to prolonged coughing.
- Pulmonary embolism: A pulmonary embolism (PE) or blood clot in the lung can also lead to irritation of the lining of the lung, also known as pleuritis, which can mimic rib pain.
Systemic and other causes
Some diseases or illnesses are systemic meaning they can affect multiple parts of the body including the ribs and rib cage. Cancer, for example, can spread to many bones in the body and sometimes spreads to the rib cage leading to rib pain. Sometimes rib pain is due to a non-physical cause like stress or anxiety that manifests as the physical symptom of chest pain.
This list does not constitute medical advice and may not accurately represent what you have.
Tuberculosis
Tuberculosis, or TB, is a lung infection caused by the bacteria Mycobacterium tuberculosis. In some cases, it can affect other organs such as the brain or kidneys.
The disease spreads when an infected person exhales, speaks, or coughs and someone else inhales the bacteria. Tuberculosis is not transmitted any other way. Some patients carry TB without ever showing symptoms, though the disease may become active if something happens to weaken the immune system.
Most susceptible are those with weakened immune systems; infected with HIV; living or working in homeless shelters, correctional facilities, or nursing homes; and children under age 5.
Symptoms include severe cough that may bring up sputum and/or blood; chest pain; weakness; weight loss; fever; chills, and night sweats.
Diagnosis is made through skin tests, blood tests, sputum tests, and chest x-ray.
Treatment involves a course of specialized antibiotics under close medical supervision, along with rest and supportive care.
There is a vaccine for tuberculosis, but it is not entirely effective and not routinely given in the United States.
Rarity: Rare
Top Symptoms: fatigue, cough, shortness of breath, rib pain, dry cough
Urgency: In-person visit
Pulmonary embolism
An embolus is a blood clot that forms in the bloodstream, breaks loose, and is carried by the blood to become lodged elsewhere in the circulatory system. If this clot (embolus) blocks part of the bloodstream in the lungs (pulmonary system,) this condition is called pulmonary embolism.
It is most often caused by blood clots in the deep veins of the legs, which can form after long periods of inactivity or bedrest.
Other risk factors include smoking, obesity, and female hormone replacement therapy.
Symptoms include sudden difficulty breathing; chest pain; coughing, sometimes with blood; anxiety; lightheadedness; and fast, irregular heartbeat.
Pulmonary embolism is a life-threatening medical emergency, because it causes high blood pressure in the pulmonary arteries and lack of oxygen in the blood. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through patient history, physical examination, blood tests, and chest x-ray.
Treatment involves anticoagulants, or blood thinners; "clot-busting" medications; and surgery to implant a filter to help prevent clots from traveling through the bloodstream.
Panic disorder
Panic disorder means a generalized set of symptoms involving sudden, unexplained feelings of anxiety and overwhelming fear. The physical symptoms are very real and consist of sweating, pounding heart, and shortness of breath.
The cause is not known. It may involve changes in brain chemistry that cause a person to perceive danger where there actually is none. Severe and ongoing stress, as well as post-traumatic stress disorder (PTSD) may be factors.
Panic disorder is most common among women. It can affect anyone, however, especially with a family history.
This condition does not improve on its own. If left untreated, the patient may become isolated and even suicidal.
A doctor will do a complete workup, including blood tests, to rule out any physical causes for the symptoms. A psychological workup will also be done.
The first line of treatment is talking with a professional who can help with coping and stress management. Medication, including some antidepressants and calming drugs, may be used temporarily but can cause dependence and unpleasant side effects if used for too long.
Normal occurence of chest pain
Sometimes chest pain is not a sign of a heart attack. The following symptoms are usually typical of more benign conditions:
If the pain is brief, like a short shock, and subsides right away, it is most likely from an injury such as a broken rib or pulled muscle in the chest.
Sharp pain in the chest that improves with exercise is probably from acid reflux or a similar condition, and will be eased with antacids.
A small, sharp pain anywhere in the chest that actually feels worse on breathing is probably from a lung inflammation such as pneumonia or asthma.
An actual heart attack involves intense, radiating chest pain that lasts for several minutes; worsens with activity; and is accompanied by nausea, shortness of breath, dizziness, and pain in the arms, back, or jaw. Take the patient to the emergency room or call 9-1-1.
If there is any question as to whether the symptoms are serious or not, a medical provider should be seen as soon as possible.
Rarity: Common
Top Symptoms: chest pain, rib pain
Symptoms that always occur with normal occurrence of chest pain: chest pain
Symptoms that never occur with normal occurrence of chest pain: being severely ill, shortness of breath, fainting, severe chest pain, crushing chest pain, excessive sweating, nausea or vomiting
Urgency: Phone call or in-person visit
Hypertensive crisis
Hypertensive crisis, also called malignant hypertension, means there has been a sudden increase in blood pressure to dangerously high levels. Any reading higher than 180/120 is enough to cause serious health problems.
High blood pressure, or hypertension, can be due to stress, poor diet, lack of exercise, obesity, sleep apnea, or use of illegal drugs. Untreated hypertension can lead to a hypertensive crisis.
Symptoms of dangerously high blood pressure can include chest pain, severe headache, blurred vision, nausea and vomiting, shortness of breath, and blacking out.
Blood pressure at these high readings, with these symptoms, can damage blood vessels and cause a stroke. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through physical examination and blood pressure measurement.
Treatment involves oral medication to reduce the blood pressure. Hospitalization is usually not required unless the medication is not effective, in which case intravenous medicine will be used.
The best prevention involves proper use of blood pressure medication along with lifestyle changes to reduce stress and improve physical fitness.
Bacterial pneumonia
Bacterial pneumonia is an infection of the lungs caused by one of several different bacteria, often Streptococcus pneumoniae. Pneumonia is often contracted in hospitals or nursing homes.
Symptoms include fatigue, fever, chills, painful and difficult breathing, and cough that brings up mucus. Elderly patients may have low body temperature and confusion.
Pneumonia can be a medical emergency for very young children or those over age 65, as well as anyone with a weakened immune system or a chronic heart or lung condition.
Complications may include organ failure and respiratory failure. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through blood tests and chest x-ray.
With bacterial pneumonia, the treatment is antibiotics. Be sure to finish all the medication, even if you start to feel better. Hospitalization may be necessary for higher-risk cases.
Some types of bacterial pneumonia can be prevented through vaccination. Flu shots help, too, by preventing another illness from taking hold. Keep the immune system healthy through good diet and sleep habits, not smoking, and frequent handwashing.
Rarity: Common
Top Symptoms: fatigue, cough, headache, loss of appetite, shortness of breath
Symptoms that always occur with bacterial pneumonia: cough
Urgency: In-person visit
Atypical chest pain
Atypical chest pain describes the situation when someone's chest pain is unlikely to be related to heart or lung disease. There are many other possible causes that could explain chest pain, like sore chest wall muscles or psychological factors like stress and anxiety.
It looks like your chest pain is atypical, however further testing might be needed. Therefore, you should schedule an appointment within two days with your primary care physician who can coordinate these further tests. These will likely include a stress EKG (electrocardiogram), which is a readout of the heart's electrical activity during exercise.
Rarity: Common
Top Symptoms: chest pain, shortness of breath
Symptoms that always occur with atypical chest pain: chest pain
Symptoms that never occur with atypical chest pain: fever
Urgency: Primary care doctor
Acute costochondritis (chest wall syndrome)
Acute costochondritis is also called anterior chest wall syndrome. It is an inflammation of the flexible cartilage that connects each rib to the breastbone.
Costochondritis is caused by excessive coughing or by straining the upper body, as with weightlifting. It is a common occurrence and is seen in children, teenagers, and adults.
Symptoms include a sudden, sharp, aching pain anywhere in the chest wall, especially near the breastbone where it connects to the ribs. The pain gets worse with deep breathing or with almost any movement.
Any sort of chest pain should be seen by a medical provider, especially if the person is over 35 and/or has had any cardiopulmonary symptoms. Heart attack symptoms can be mistaken for costochondritis in some cases.
Diagnosis is made through physical examination. X-rays or CT scans may be done to rule out any other causes for the pain.
Treatment involves rest along with over-the-counter, nonsteroidal anti-inflammatory drugs. Injection of corticosteroid medication to ease pain and inflammation is occasionally done.
Rib pain on both sides treatments and relief
At-home treatments
If your rib pain is persistent and/or particularly bothersome, you should be evaluated by a medical professional to determine the diagnosis and the best course of treatment. If your rib pain is associated with trauma or injury, some at-home treatments may help while you wait to be examined by a medical provider.
- Rest: Some causes of rib pain, especially those associated with injury or straining of the muscles between the ribs, improve with rest.
- Exercise and stretching: Some causes of rib pain such as injury to the muscles between the ribs may improve with gradual exercise and stretching maneuvers.
- Over-the-counter pain medication: Pain-relievers like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin can help reduce pain from injury, inflammation, and infection because they work by reducing inflammation in your body. Acetaminophen (Tylenol) can also help with pain and fever.
When to see a doctor
The urgency with which you should see a medical professional depends on some factors like the duration, severity, and timing of your symptoms. Make an appointment with a primary care provider and try to be evaluated in the next few days if you notice the following:
- Persistent rib pain
- Worsening rib pain
- Rib pain that is worse at night or wakes you up while sleeping
- Rib pain associated with increased fatigue, decreased appetite and/or unexplained weight loss
- Fevers and/or chills
When it is an emergency
You should seek immediate medical attention if your rib pain is associated with any of the following symptoms or factors:
- Difficulty breathing
- Leg or calf pain and/or swelling
- Pain that radiates to the shoulder or arm
- Coughing up blood
- Cold or flu-like symptoms with persistent fevers, chills and/or night sweats
- Nausea or vomiting
- Severe headache
Prevention
While many causes of rib pain cannot be prevented, the following healthy practices can reduce the chances of rib pain from preventable causes like muscle strain or infection.
- Stretching: Try stretching, especially after heavy lifting or exertion of the chest muscles.
- Frequent hand washing or sanitizing: This can prevent the spread of germs that cause infections of the lung or airway which can lead to coughing and rib pain, especially in the colder months.
- Tobacco cessation: Tobacco use is related to multiple serious medical conditions including cancer. To reduce the risk of cancer-related causes of rib pain, start a tobacco cessation plan today if you do currently use tobacco.
FAQs about rib pain on both sides
Why does my rib pain get worse with deep breathing?
The ribs and rib cage move in and out with normal and deep breathing in order to allow the lungs to expand and shrink as necessary. Because of this, if one of the components of your rib cage is irritated or injured, breathing can become painful as it puts stress on the injured part of the rib cage to move in time with the other parts of the rib cage. The tissue that lines your lungs is also in close proximity to the rib cage and moves along with the rest of the rib cage as well, so when it is irritated, breathing can further worsen the irritation and associated pain.
When will my rib pain go away?
The duration of rib pain depends on the cause. If your rib pain is due to a bone fracture or muscle strain it will most likely gradually go away on its own as the fracture or muscle heals. If due to infection or inflammation, the rib pain will subside as the infection or inflammation goes away. If due to a pulmonary embolism, your rib pain may persist until the blood clot in the lung is treated.
Is my rib pain serious?
Most causes of rib pain are benign and gradually resolve as the underlying cause is treated or improves, but some causes of rib pain are very serious, so any persistent or worsening rib pain should be evaluated by a medical provider. Rib pain that interferes with your ability to breathe can result in less oxygen reaching your body parts. Rib pain associated with infection may require antibiotics or other prescribed medications to fully resolve. Rib pain associated with cancer requires careful evaluation to determine the source of cancerous cells.
Can pregnancy be a cause of rib pain?
Yes. Pregnancy can be associated with rib pain as the growing uterus over time presses on the underside of the diaphragm which is the main muscle we use to breathe. Rib pain during pregnancy can also be due to the baby’s normal movements or kicking in the area around the ribs.
Is my rib pain suggestive of a heart attack?
Rib pain is typically not a symptom of a heart attack. Rib pain is typically sharp and stabbing or dull and achy while pain due to a heart attack can feel more like uncomfortable squeezing, fullness, or pressure in the center of the chest. Chest pain due to a heart attack is also more commonly associated with pain in the arms, back, neck or jaw, shortness of breath, nausea, vomiting, and dizziness or lightheadedness.
Questions your doctor may ask about rib pain on both sides
- What makes your chest pain hurt more?
- Do you have a cough?
- Any fever today or during the last week?
- How would you explain why your chest hurts?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
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References
- Pulmonary Contusion. University of Connecticut: Korey Stringer Institute. UCONN Link
- Costochondritis. U.S. National Library of Medicine: MedlinePlus. Updated Jan. 7, 2019. MedlinePlus Link
- Evertsen J, Baumgardner DJ, Regnery A, Banerjee I. Diagnosis and management of pneumonia and bronchitis in outpatient primary care practices. Prim Care Respir J. 2010;19(3):237-41. NCBI Link
- Pulmonary Embolism. Cedars-Sinai. Cedars-Sinai Link
- Warning Signs of a Heart Attack. American Heart Association. Reviewed June 30, 2016. American Heart Association Link