When Rib Pain Isn’t a Rib Problem: A Pregnancy Case Study
Show Notes:
What’s the connection between rib pain when the origin of the rib pain doesn’t begin in the rib cage?
In this episode, Lynn Schulte, PT walks through a recent pregnancy case where she saw just how interconnected the growing uterus, uterine ligaments, diaphragm, and rib cage can be – even before the baby is large enough to physically push upward into the ribs.
A pregnant client of approximately 17 weeks presented with a painful, “vice-like” sensation around the left anterior rib cage. As Lynn assessed her body, she discovered something unexpected: the uterus was growing significantly toward the right side. This discovery had her questioning why and if there was a connection to the rib pain her client was experiencing.
Key Discoveries from this Episode:
- How looking for connections rather than isolated restrictions can help you find the cause of pain and dysfunction
- Why the position and direction of uterine growth may be an important clinical clue
- What to watch for when comparing rib cage mobility side-to-side
- Why pregnancy can reveal or amplify pre-existing movement and tissue restrictions
- The importance of re-assessment after every meaningful intervention
Clinical Takeaway
Sometimes your client’s rib pain and the restriction you feel may be responding to what is happening much farther down in the pelvis. An expanding uterus may be a contributing factor.
When you find rib pain, rib cage tension or diaphragm restriction in a pregnant client, don’t automatically treat it as a rib cage problem. Check what is happening below it.
If the uterus is growing or being pulled toward one side, assess the tissues that may be influencing that position – including the uterine ligaments and surrounding abdominal/fascial tissues.
Then reassess the rib cage after addressing the pelvic restriction.
Frequently Asked Questions
Can the uterus affect the rib cage before the baby is large enough to reach it?
Potentially, yes. The uterus begins expanding well before the third trimester, and its changing position can alter tension through its supporting tissues and surrounding abdominal structures.
This case suggests that uterine position and tissue tension may influence rib cage and diaphragm mechanics earlier than we typically expect.
Why would the uterus grow more toward one side?
There can be many reasons for uterine asymmetry, including the position of the uterus, surrounding soft-tissue tension, ligamentous restrictions, abdominal/fascial relationships, and fetal positioning. A uterus favoring one side isn’t automatically pathological. The clinical significance comes from the overall pattern – pain, restriction, asymmetry, tissue tension, and how the body responds when those restrictions are addressed.
Why assess the rib cage when a pregnant client presents with pelvic or uterine restrictions?
Because the pregnant body is an interconnected system. Changes in the position and mobility of the expanding uterus can influence tension through the abdomen and trunk, while diaphragm and rib cage mechanics can also influence how the client moves and breathes. Assessing both regions can help you identify which restriction may be driving the other – or whether they’re responding to a shared underlying asymmetry.
How can I learn to work with the uterus and the pregnant body?
If you want to expand your clinical toolbox for treating the uterine ligaments, abdominal tissues, rib cage, and diaphragm, check out the Holistic Treatment of the Pregnant Body live training or online course.
Connect With Lynn
Have a comment or question about today’s episode? Message Lynn on Instagram or Facebook, or Email Lynn.
Subscribe to the Birth Healing Summit Podcast
Don’t miss an episode! If you enjoyed today’s podcast and are interested in more topics to support your clinical practice and treatment sessions, find us on your favorite podcast app. Follow or Subscribe to the Birth Healing Summit Podcast on:
To learn more visit: InstituteforBirthHealing.com
Love Dr. Rachael! She is such a gem in the Metro Detroit area. She was my pelvic floor PT during my first pregnancy and postpartum and inspired me to pursue pelvic health certification (coming from an Ortho PT clinic). I’m now working through Holistic Treatment of the Pregnant and Postpartum Body.
Thank you so much for this presentation…I am an osteopath and also trained in SER (love love Upledger!)…the piece about ‘freeze’ related to transgenerational trauma was very informative and a reminder to look further…I have had a client who lost a baby and when I treated her she felt she needed to give birth to this child…and then went back several lives and saw that she had also lost a baby many lives prior! This relieved her of some stress…so every piece of the puzzle counts…keep the nuggets coming, so appreciative! Best, Judith
Great interview, Lynn and Susanne, for pushing us beyond “hands on, hands in”, confirming our need as therapists, for wide, grounded personal presence for our clients to feel safe and then willing to bring forth those physical/emotional/transgenerational, traumas/beliefs that lead to more complete healing and return to function. Appreciate the shout out, and listened delightfully to two of my favorite teachers and mentors. All of this was gold!