Broken Rib: Understanding Worsening Pain & Healing Time (+ Tips)

How to tell if you have broken or cracked ribs?

If you’re experiencing pain in your chest, torso, abdomen, or back and wondering if it could be a sign of broken or cracked ribs, let’s first understand the concrete differences between these two types of bone injuries:

A cracked rib involves a partial fissure in the rib bone; while a broken rib (= fracture) means the bone is separated into two distinct parts (or more).

Symptoms of a broken rib vs. a cracked rib?

Here are the symptoms and clinical signs that may suggest a fracture or crack in one or more ribs:

• Significant pain in the rib area, on the side, or in the back. This pain occurs not only at rest but also when moving, coughing, or laughing;
• Swelling, edema, bruising in that area;
• Respiratory discomfort, especially during inhalation, due to pain;
• Sometimes, a visible deformation of the ribcage.

X-rays can also determine which ribs are broken, whether there are displaced fractures (when there is a large gap between the two ends of the broken rib), and if floating ribs are affected or not (ribs that do not attach to the back).

But X-rays are not always performed, even if a rib fracture is suspected. Why?

Because in 50% of cases, it may not show if there’s a fracture, even if there is one; Because it doesn’t provide more treatment insights; Because an X-ray is not without risks, and if it can be avoided, that’s better.

If multiple fractures or other associated problems are suspected, a CT scan, which is more precise, may be recommended.

If you’ve had an X-ray or a scan, you’ll probably see notations like:

• Fracture K8: This means the 8th rib from the top is broken;
• Fracture K6-K7-K8-K9: This means all these ribs are broken, from the 6th to the 9th.

When ribs K1, K2, or K3 are fractured, it indicates a significant trauma because they are challenging to break

Feel like you have a cracked rib that’s making a cracking sound?

This sensation is often experienced, and there are three possible explanations for it:

1. It could be related to the release of air or fluid in the tissues, causing a cracking or popping sound;
2. Or it could be the tissues, ligaments, or muscles around your ribs causing this noise;
3. More rarely, it could be associated with a displacement of bone fragments, but in this case, there are other associated symptoms.

What are the causes of a broken or cracked rib?

It can be surprising when it happens, but it’s possible to break a rib “without doing anything.” At least without identifying an event like an impact or blow that could explain the fracture!

You can also have a broken rib due to coughing, especially if you’ve had bronchitis or pneumonia that caused a lot of coughing or in cases of chronic cough (especially in COPD).

“Spontaneous” fractures, without any apparent cause, are more common in people with osteoporosis or a lung disease. Sometimes they can also be stress fractures.

How is it possible to break a rib just by coughing?

Coughing intensely and repeatedly can cause sudden and intense muscle contractions in the chest. This can exert significant pressure on the ribs, especially if the muscles are tense or fatigued. If the bones are already weakened (for example, due to osteoporosis), this can increase the risk of a fracture.

It is possible to break a rib without direct impact, for example, due to coughing, or even “without doing anything,” although it is rarer. However, fractures related to a car accident or trauma (such as sports injuries or falls) are more common.

Having multiple broken ribs or just one: does it make a difference?

It is common to break several ribs at the same time. In this case, the healing time and pain may be a bit more significant, although it’s not systematic.

You may also experience a flail chest: this occurs when several ribs, situated next to each other, are fractured in two different places. The segment between these two fractures can become detached from the rest of the ribcage and move independently during breathing. This creates a kind of “flap” that moves opposite to the rest of the ribcage when you breathe.

A flail chest can be very painful and may lead to breathing difficulties as the abnormal movement of the flap can interfere with the normal mechanics of breathing.

It’s something that doesn’t go unnoticed.

What to do with a broken or cracked rib?

How to “fix” a broken rib? First, know that our bodies are quite adept at consolidating a broken bone on their own.

Time is your best ally to recover from these fractures or cracks, but there are certain things you can do to alleviate the pain while waiting for “natural” healing.

What is the usual treatment?

Most often, the treatment is conservative: you let the consolidation happen naturally.

If the fractures are severely displaced, if you have a flail chest, or if the broken ribs do not consolidate, surgery is sometimes performed.

Sometimes other issues are associated with rib fractures, such as a pneumothorax or hemothorax. In this case, you will receive specific treatments, such as the placement of drains.

How to relieve back and rib pain?

Rib fractures are known to be often very painful (unless you’re fortunate enough to be an exception!).

As a physiotherapist, we are accustomed to trying to find personalized solutions with our patients to relieve pain:

• Find a more comfortable position, often using cushions to support the arms, back, or legs. For example, using a maternity/nursing pillow;
• Suggest using a hospital sheet, for example, to apply a kind of compression at the fractured area for relief. Or use a rib support belt, also called a thoracic belt;
• Apply cold (or heat to relax the area around); Change your breathing pattern: adopt more of an abdominal breath (through the belly);
• Try TENS, which often works better for acute, punctual pain than chronic pain;
• Stay as active as possible by finding less painful activities. This helps to shift attention away from the fracture and avoid complications related to decreased mobility, such as constipation or blood clots;
• Take prescription (e.g., anti-inflammatory NSAIDs) or over-the-counter (e.g., acetaminophen) pain medications.

Sometimes, doctors may suggest stronger pain relievers, especially in the first few days and for complex fractures involving many ribs: intercostal nerve blocks, morphine, etc.

It’s entirely understandable that the pain felt in the back with a rib fracture may seem counterintuitive, as the ribs are located at the front of the body.

The pain in the back with a rib fracture is the result of the complex interaction of nerves, muscles, and protective reflexes in the body. Moreover, even though the ribs are primarily located at the front of the body, they insert into the spine (= the back).

Pain in the back with a rib fracture is, therefore, something usual; it is not a sign of a complication (although, I agree, it’s very inconvenient!). It will decrease over the days, at most weeks.

Why is my broken rib pain getting worse after 1 or 2 weeks?

The increase in pain after 1 or 2 weeks in the context of a broken rib can be explained by the dynamic and evolving nature of the body’s response to injury.

It’s verry common: thousands of people in the United States alone inquire every month to their search engine why the pain increases 1 to 2 weeks after breaking a rib (see below).

Here are some reasons why pain might intensify during this period:

1. Inflammatory Response Peaks: After an injury, your body initiates an inflammatory response to promote healing. In the initial stages, the release of inflammatory mediators and the influx of immune cells contribute to swelling and pain. The inflammatory response typically peaks around the second or third day but can continue for several weeks.
2. Delayed Onset of Pain: Pain perception is complex, and it may take some time for the brain to fully register the extent of the injury. The initial shock and adrenaline rush can temporarily mask your pain, and as your body’s defenses settle, the perception of pain may become more apparent.
3. Activity Levels: As you begin to resume normal activities, there could be a reactivation of pain due to increased stress on the healing rib.

These pains are rarely a sign of a complication, although you can, of course, discuss them with your doctors, physiotherapists, or nurses if they worry you.

Broken Rib: To Bandage or Not?

When you break a bone in your leg or arm, you often get a cast or at least a splint to aid in the healing process by restricting movement in that part of the body. It’s natural to wonder if you should use a bandage when you have a broken rib (since you can’t cast or splint this part of the body).

However, a bandage is much less rigid than a cast or splint, so it’s challenging to imagine it serving the same purpose.

Moreover, when we breathe, the volume of our ribcage varies. If you compress the ribcage by bandaging it tightly, it can interfere with breathing and lead to other complications.

Thoracic bandages are not particularly recommended nowadays. Rib bones heal on their own without needing containment, as they are less stressed than leg and arm bones.

However, you might be suggested to wear a more elastic support belt, similar to those used for sciatic or lumbago pain. The purpose of this belt is not to facilitate healing but simply to alleviate pain by applying gentle compression.

Can You Walk with a Broken or Fractured Rib?

Yes, it is possible to walk with broken or fractured ribs, and it’s even recommended. Walking helps reduce the risk of pulmonary, cutaneous, or constipation complications, often associated with prolonged immobility.

Walking does not hinder the healing process. Initially, you might need assistance or support with mobility aids like a walker or cane. However, after a few days, you can gradually return to more normal walking.

Transfers, especially getting out of bed, can be challenging due to pain. Your physiotherapist can demonstrate techniques to turn in bed as a unit or rise with minimized pain. Some people also opt to rent a hospital bed for increased autonomy during transfers.

Is Physical Therapy Necessary?

Physical therapists are healthcare professionals who can:

• Address your questions after your fracture.
• Provide personalized advice on what you can or cannot do to facilitate recovery.
• Help you find less painful positions, setups, transfers, or movements.
• Instruct you on using an incentive spirometer—an apparatus you can purchase or will be provided with at the hospital if you want to specifically work on your breathing. Using these devices is thought to prevent respiratory complications like pulmonary atelectasis, where lung areas don’t fully inflate, leading to potential infections or oxygen deficiency.
• Encourage you to remain as active as possible (if you agree with it).

The severity of your rib trauma may determine if physical therapy sessions are prescribed. A physical therapist often visits you in the hospital if you’ve been hospitalized, and you can continue with outpatient or at-home physical therapy if you don’t go to a rehabilitation center or nursing home.

Constipation Due to a Broken Rib: Why and What to Do?

Constipation is very common after a rib fracture, and it’s a topic that people might hesitate to discuss with their healthcare professionals, making it even more important to address here.

Why can constipation be linked to a broken rib?

• Pain associated with a broken rib can make deep breathing and coughing painful, causing individuals to unconsciously avoid these movements to prevent pain.
• This avoidance of respiratory movements can reduce diaphragm (the primary respiratory muscle) mobility, disrupting normal bowel movements.
• Immobility due to pain can also slow down natural contractions of intestinal muscles (which occur when walking or standing), potentially leading to constipation.

How to prevent constipation or minimize its duration:

• Implementing measures against pain.
• Trying to move as much as possible, even in short sessions.
• Adjusting your diet.

What is the healing time for a broken or fractured rib?

It is entirely normal to be concerned about how long it takes to recover! Please note that predicting this with certainty is impossible, as many factors come into play:

• The type of fracture, whether you broke one or multiple ribs, or if you had other injuries like a pneumothorax.
• Your overall health condition.
• Whether you smoke or not.
• Your weight.
• And more.

Here are the average timelines I have observed.

Stage	Typical timeframe from the day of the fracture
You leave the hospital	For hospitalized individuals, the average length of stay is 6 days (in the Netherlands) (Peek 2022)
You have significantly less pain	A few weeks
Your bones are well consolidated	4-8 weeks
Swelling and bruising around the fractured area disappear	Sometimes several weeks
You resume walking	Immediately, sometimes with the support of canes or a walker, and walking a bit less initially
You return to normal walking	A few days to a few weeks
You can drive a car	Immediately to a few days or weeks
You return to work	A few weeks or months
It’s the return to sports!	A few weeks to a few months
You have fully recovered functionally and musculature	A few months