Rib Stress Fracture Overuse Injury

Women sitting in a canoe rowing
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A rib stress fracture can affect any athlete, and they are more common with certain sports and activities including rowing (crew), baseball, backpacking, dance, and windsurfing. Stress fractures occur when bone cannot withstand the accumulated physical stress of a particular activity. Unlike acute fractures where a high-energy injury causes the bone to fail, a stress fracture is the result of a repetitive low-energy injury-causing accumulating damage to the bone.

Upper extremity stress fractures, including stress injuries to the rib cage, are not common. Most overuse bone injuries occur in the lower extremities, often they occur in the foot, leg, or hip. 

Symptoms of a Rib Stress Fracture

Rib stress fractures cause vague symptoms, which often delays the diagnosis. The most common symptom of a rib stress fracture is gradually increasing pain directly over the injury.

A rib fracture typically causes pain that is focal (not widespread). The pain may be worse with exertion, deep breathing (pleuritic pain), or coughing.

The symptoms of a rib stress fracture can be confused with symptoms of other ribcage conditions. The two most common causes of rib pain in athletes, other than a stress fracture, are costochondritis and muscle strains of the intercostal muscles. Early treatment of any of these conditions is the same— allowing the rib to rest and the injury to heal. 

As athletes return to activity, recurrent rib pain may be a reason to consider further imaging, which can help determine if a stress fracture may be present.

How Is a Rib Fracture Diagnosed?

Diagnosis of a rib stress fracture can be difficult to confirm with a regular X-ray. Even when there are severe rib fractures, X-rays often don't show the injury.

Other tests can confirm the diagnosis. The two tests most often used to assess rib fractures are bone scans or MRIs

Advantages and disadvantages of bone scan and MRI for rib stress fracture diagnosis:

  • The advantage of a bone scan is that it is fast and easily interpreted. However, this test only examines the bone and it will not pick up other problems in the chest.
  • MRIs can be more difficult for you because you have to lie still for about 20 minutes. The images from this test may show other causes of pain, including inflammation of soft tissues.

Treatment of Rib Stress Fractures

There is often little that can be done for the treatment of a rib stress fracture. Giving the ribs time to heal and avoiding exertion will allow the bone to recover and the injury to completely heal. Trying to come back from the injury too soon, before adequate healing has occurred, can delay healing and lead to prolonged symptoms of pain.

Every athlete wants to know how long the injury will take to heal. Unfortunately, there is no way to know for certain when the injury will be fully recovered, but most rib stress fractures will heal within 3 months, although some may take 6 months, or even longer if athletes don't allow the ribs to adequately rest.

Often athletes can stay active with sports and exercises that don't aggravate the healing stress fracture. For example, a rower may not be able to row but may be able to do other activities to maintain fitness, such as cycling.

A Word From Verywell

Rib stress fractures are incredibly frustrating injuries and can be difficult to cope with. Treatment often takes many months for full resolution of symptoms, and many athletes struggle to come back to sports. One of the most challenging aspects of returning to sports is the psychological component of being worried about a recurrence of the injury. The best approach is not to shortcut the healing process. Once symptoms have fully resolved, and then a period of rest has taken place, you can talk to your doctor and physical therapist about safely returning to sports.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.