Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group lateral rib pain - any ideas

Well, just when I though I knew all this diseases tricks, along comes a new one. I have acute pain, like a broken rib, on my lower right hand side. I can barely move. Have skipped 2 days of work as laying in bed is the only place that is painless. Standing up hurts and I can't lift anything (my job).

Any ideas appreciated. ta

Scott J

Sounds like intercostal neuralgia, which is caused by inflammation that affects the nerves along the costal cartilage that connects the ribs. It's a somewhat rare complication of AS. I've had it before, and it was some of the worst pain ever. Mine would spasm, feeling like my lower rib was twisting inside of me. It usually just took time and NSAIDs to get over it. Sometimes, a muscle relaxer, like Flexeril, would also help. I hope you get past it soon.

Wow, exact same thing happened to me last week! Same place. I rested, took anti inflammatories which I usually avoid, rested, and tried to walk and do some very gentle yoga stretches just to keep circulation going. But when I tried to sweep, doing some housework, I actually yelped and doubled over with pain. I scheduled a massage, and I think that helped a great deal, but the pain was already on the way out. I know the wrong type of massage can make things worse, but this felt so very good. I'm now about 90% better and I hope your pain fades as quickly. Best wishes!

i never used to know why, but now that i am working with a chiro, whenever my ribs really really hurt, its usually a problem where they attach at the spine and that translates all the way along the rib, even out to the front, as things don't position right, bones rub up against other bones with nerves trapped inside. finding its either where a vertebrae in my spine gets twisted / misaligned and has to be pressed gently back into position. or where the rib subluxates out from the side of the spine it should be to the other side, and again has to be gently pressed back (when that happens, a rib will get caught under my shoulder blade and nerves trapped in between and that is the worst pain i get (my body goes into "panic attacks" from the pain).

it was like that for 3-6 months the year prior to me finding my chiro, to the point that i was not working and home bound for 3 months and part of the next 3 months. the PT, rheumy, GP, physiatrists (2 of them) could not figure out what was wrong. of course no one tried to feel my back to see if they could feel the problem, not even the PT. my old PTs back in virginia probably would have found the problem as quickly as my chiro did. all one would have to do, is use one's hands and feel; my chiro found it in about 30 seconds once he started examining me. a shame i had to suffer so badly the year before, but at least i found him when i did. i was within days of having to go on disability.

and when it was the my upper ribs subluxating, i had very bad inflammation where those ribs attached out front at the sternum.

and when it was misaligned vertebrae where the lowest (floating ribs) attached, they were so inflamed right there in the front; as you described, felt like broken bones they were so painful. though of course i've never broken a bone, so that probably does feel a lot worse than what i felt.

have no idea if this is what you are experiencing. but if someone on here had put that out there as a reason for why i was in so much pain, maybe i wouldn't have had to suffer so badly that year before i met my chiro. so i make sure i always mention it as a possible reason for rib pain. as it seems to be my main reason, i'm finding.

and word of caution: not talking about chiro "back cracking". i'm simply talking about gentle pressing to get things unstuck, realigned, and moving again when things are stuck in a bad way.

hope you figure yours out and get relief soon. as i did, i'd probably try to find a good manual PT and/or a physiatrist at a pain center. the only reason i moved on to a chiro was because the PT and physiatrist couldn't even tell what the problem was, let alone treat it. but the PT and physiatrist i left back in virginia probably could have.

Hi Scotty,

That is a dreadful pain. I had it for years on and off and it would stab me with painful back spasms in my lower left ribcage. Every position seemed to aggravate it and it was hard to find any way to be comfortable. At it's worst I used to take extra pain pills and hold a pack of ice against my ribs, trying to numb it into submission, which would work... temporarily. It would come and go for weeks at a time and, next to neck pain, it's probably the pain I hate the most!

I am pretty sure that it stems from inflammation of the thoracic vertebrae, (the costovertebral (facet) joints, ligaments/cartilage) which causes pain to radiate out. So even though the pain seems to be away from the spine, it definitely was my spine. I'm not sure that it would be rare (?) in AS but it sure is grim.

Be kind to yourself and maybe slightly quieter with your movements and hopefully it will calm back down for you soon. I would try not to lay in bed too much, if you can tolerate a bit of movement. I wish I could think of something better to suggest.

Just " wipe away the pain " thats what my shrink said to do. I told him let me punch you in the ribs and see if you can wipe it away.
I don't really have any advice because It has been going on for years now.
one side will spasm and I try to bend or twist my way out of that spasm and I wind up making another spasm by trying to run from my own body.
Other times no spasm no warning and it will make me yelp as well. I was visiting a friend and talking and my sentence was like yeah thats a nice dog you got there, is his name....yelp! kinda ruins the train of thought.
the AS can come at you in many varieties and assorted flavors.
The only advise I would have is stay with the forum, be a friend when you can.
on your good days come here and see if you can be of help to someone else.
my doctor explained it as radiating pain, but to me pain is pain.
I don't have a favorite or worse, my feet used to hurt as bad as my neck does now.

as mig had suggested, that year that none of the doctors or PT could figure it out, walking did seem to be the only thing that gave me any relief some days. ice (and ultrasound) also helped a bit. and heat made it flare more when it was at its worst.

The very first symptom I ever had was a very acute (but localised) pain in my lower ribs. I just thought it was a strained muscle and rode it out. Couldn't lie down for two weeks and had to sit in an arm chair each night. The pain subsided in two weeks.
A couple of years later after involvement of toes was more obvious a bone scan was ordered and to my surprise there was a hot spot where the rib pain had been. Because there are many muscles attaching to the ribs that enable breathing then it is not surprising that attachment site inflammtion (typical of spondylarthropathies) can occur at points on the rib cage.
If I knew then what I know now I would have used a strict NSD (which fortuneately works for me) and perhaps a short course of celebrex to get the inflammation and pain under control.

me too! it was so nice to see a visual correlation between pain and inflammation. at the time, it was so tender where the ribs attach to the sternum (2nd or 3rd rib from the top, i think). and it lit up!

the radiologist said that he had never seen such a bright spot there before and thus had me turn in several directions so they could get that area imaged from all angles to make sure it wasn't an artifact. it was no artifact!

so pain = inflammation = bright spots on nuclear bone scan.
its a nice piece of data to have in one's files.