A cramp in the ribs feels alarming because it sits so close to the heart and lungs, but most of the time it starts in the muscles, joints and lining of the chest wall itself. What you were doing just before it struck, whether running, coughing, twisting or slouching, is usually the best clue to the cause. A smaller set of causes comes from cartilage, nerves or organs beneath the ribs, and those tend to announce themselves with different patterns of pain.
The Side Stitch That Strikes During Exercise
The classic exercise rib cramp is the side stitch, a sharp, well-pinpointed pain usually felt at one side of the abdomen just below the ribs. Experts have suggested many causes, including reduced blood flow to organs, organs jolting, tired or cramping breathing muscles, posture and stress.1Health & fitness journal of Canada. The endurance athlete’s “stitch”: Etiology and management of exercise-related transient abdominal pain The leading explanation, though, is irritation of the thin lining that covers the inside of the belly wall and the underside of the diaphragm.2PubMed Central. Exercise-Related Transient Abdominal Pain (ETAP) Irritation of the part under the diaphragm can also send pain to the tip of the shoulder.3PubMed Central. Exercise-Related Transient Abdominal Pain (ETAP)
The lining is anchored most firmly down the middle of the belly, so the sides move the most, which fits with stitches being felt at the side.4PubMed Central. Exercise-Related Transient Abdominal Pain (ETAP) Standing tall and arching back stretches the lining tighter.5PubMed Central. Exercise-Related Transient Abdominal Pain (ETAP) Children have proportionally more of this lining, which may be why stitches are so common in young people.6PubMed Central. Exercise-Related Transient Abdominal Pain (ETAP)
When a stitch strikes mid-run, slow to a walk. The pain usually settles within minutes once the jolting stops, though it can linger a little longer. Breathe slowly and deeply from the belly rather than in short, shallow gasps, and press firmly on the sore spot or bend gently toward it, which many runners find helps.
Some habits make stitches more likely. Eating a large meal or drinking a lot shortly before running is a common trigger runners report, and jolting, bouncing activities such as running and horse riding are typical settings. Building up distance gradually tends to make stitches less frequent.
Fit, experienced runners get stitches as well as beginners. Pain in the middle of the chest, or pressure that spreads to the arm or jaw, is not a stitch and shouldn’t be put down to exercise.
Strained or Tight Muscles Between the Ribs
The muscles between your ribs let your ribcage expand and shrink as you breathe.7Cleveland Clinic. How to Cope with an Intercostal Muscle Strain When they are stretched too far or torn, you get a strain that hurts with each breath.8Cleveland Clinic. How to Cope with an Intercostal Muscle Strain A strain can happen suddenly, or it can build up from repeating the same movement.9Cleveland Clinic. How to Cope with an Intercostal Muscle Strain
Common triggers include:
- Forceful or repeated coughing and sneezing during a cold or allergies.10Rose Physical Therapy Group. Why Am I Getting Cramps in My Ribs?
- Heavy lifting with a twist or jerk.11Rose Physical Therapy Group. Why Am I Getting Cramps in My Ribs?
- Sudden trunk rotation in sports such as golf, tennis, rowing and throwing.12DT Chiropractic. Intercostal Muscle Strain: Rib Pain When Breathing
- Overuse from a new training program or a job with lots of twisting.13DT Chiropractic. Intercostal Muscle Strain: Rib Pain When Breathing
- A direct blow to the ribs, which can also mean a rib injury rather than just a strained muscle.14DT Chiropractic. Intercostal Muscle Strain: Rib Pain When Breathing
A strain feels different from a stitch. It stays sore after you stop moving, and it often hurts to press on one spot between two ribs. Deep breaths, coughing, sneezing and twisting tend to set it off, and it usually starts after a specific movement or a bout of illness.
At home, rest from the movement that caused it while staying gently active. Ice helps in the first days, then warmth can relax the muscle. Hold a pillow against your ribs when you cough or sneeze, and consider simple over-the-counter pain relief, which can help you keep breathing deeply. Most mild strains settle over a few weeks.
Posture and a Stiff Upper Back
Each rib connects to the spine at the back, so the spine and ribs move together as one spring-like unit. When your posture collapses forward, the vertebrae drag their attached ribs with them.15SpineCentral. Rib Pain & Chest Tightness From Posture | Causes + Real Fix Some rib joints stiffen, and nearby ribs overwork to compensate.16SpineCentral. Rib Pain & Chest Tightness From Posture | Causes + Real Fix You may then feel a sharp catch with a deep breath, twist or sneeze, or an ache beside the spine that wraps around a rib.17SpineCentral. Rib Pain & Chest Tightness From Posture | Causes + Real Fix
For desk and phone posture, raise screens to eye level so your upper back isn’t rounded for hours. Every half hour, stand up, roll your shoulders and arch gently backward. Slow belly breathing can ease tension in the ribcage muscles. If pain keeps returning, a physiotherapist can loosen stiff rib joints.
Pregnancy brings its own rib discomfort. Pregnancy hormones loosen ligaments so the ribs can expand, and that stretching can feel like pressure or cramping under the ribs. Sitting upright and changing positions often usually helps. Sudden severe upper-right pain in pregnancy needs prompt medical advice.
Cartilage, Nerve and Slipping Rib Problems
Costochondritis is inflammation of the cartilage joining the ribs to the breastbone, without visible swelling.18PubMed Central. What do we know about Tietze’s syndrome? In a related, rare condition, the tender area is also swollen.19PubMed Central. What do we know about Tietze’s syndrome? That swelling is usually at the 2nd or 3rd rib near the breastbone.20Jurnal Prima Medika Sains. Incidental detection of Tietze syndrome with costochondritis: A case report
Inflamed rib cartilage causes pain at the front of the chest beside the breastbone. It can be sharp, aching or pressure-like, sometimes on more than one rib. It is typically tender when you press on the joint between rib and breastbone, a useful clue but not proof on its own. Deep breaths, twisting, coughing or lying on that side can make it worse, so it can mimic other chest pain. It often settles on its own over weeks, though it can come and go, and gentle heat or over-the-counter pain relief can help meanwhile. Because chest pain has serious causes, a doctor usually rules out the heart first, especially when the pain is new.
A nerve running beneath a rib can also become irritated, causing burning or shooting pain along that rib. People with this often notice muscle spasms or pressure around the ribcage.21Cole Pain Therapy Group. Intercostal Neuralgia Treatment The pain tends to be burning, stabbing or electric, and it follows a band that wraps around the chest along the line of a rib. A strain, injury, or posture problem can pinch the nerve where it leaves the spine, and sometimes the cause is never found. The skin along the band may feel unusually sensitive, tingly or numb, which muscle strains don’t usually cause. A painful band with a rash on one side of the chest could be shingles, so a doctor should look at a blistering rash promptly.
In slipping rib syndrome, the front tips of the lower ribs, usually the 8th to 10th, move too much.22Rib Injury Clinic. Rib Injury Clinic A rib tip can slide under the rib above and pinch a nerve,23PubMed Central. A Comprehensive Review of Slipping Rib Syndrome: Treatment and Management so pain is felt in the lower chest or upper belly.24PubMed Central. Aberrant rib cage anatomy with false ribs attachment to the sternum: review of the literature focused on slipping ribs syndrome case reports This can follow a minor injury or repeated strain, or you may be born with it.25Rib Injury Clinic. Rib Injury Clinic It is often overlooked or misdiagnosed.26PubMed Central. Aberrant rib cage anatomy with false ribs attachment to the sternum: review of the literature focused on slipping ribs syndrome case reports A slipping rib often comes with a click or pop at the lower rib edge. If pain persists without a diagnosis, ask a doctor specifically about a slipping rib.
When the Pain Comes From Your Organs
Gallstones blocking the bile duct can cause pain under the right rib cage.27Northwell Health. 12 common causes of pain under the right rib cage Trapped bile can lead to inflammation or infection.28Northwell Health. 12 common causes of pain under the right rib cage An inflamed gallbladder causes sudden sharp upper-right belly pain that spreads toward the right shoulder.29nhs.uk. Acute cholecystitis
Gallbladder pain usually comes in the upper right belly or just under the right ribs, sometimes reaching the back between the shoulder blades. Pain from a gallstone often comes on after a meal, especially a fatty one, and can last from half an hour to several hours before easing. Unlike a stitch, it doesn’t depend on movement, and changing position or pressing on the ribs doesn’t change it much. Pain with fever, chills, vomiting, or yellow skin or eyes suggests infection or a blocked bile duct and needs same-day medical care. Gallstones are common and often cause no symptoms, so a diagnosis usually comes from an ultrasound rather than from the pain alone.
Pleurisy is inflammation of the thin layers between the lungs and chest wall.30Mayo Clinic. Pleurisy – Symptoms and causes It causes sharp chest pain when you breathe in.31nhs.uk. Pleurisy The pain is often felt on one side of the chest, can spread to the shoulder, and sometimes eases when you hold your breath. It usually comes with a cause such as a chest infection, so cough, fever or feeling unwell make it more likely. It can also come from a blood clot in the lung, so sudden sharp pain with breathlessness needs urgent care and shouldn’t be waited out. A doctor needs to find and treat the cause, since the lining itself heals once that is dealt with.
Gas trapped in the bend of the bowel under the left ribs can cause sharp, cramping pain there, sometimes spreading up into the chest.32Postgraduate Medical Journal / PubMed Central. The splenic flexure syndrome This kind of pain often eases after passing wind or a bowel movement, though persistent or severe left-sided pain still deserves a doctor’s check.
Warning Signs That Need a Doctor
Chest pain can come from the heart lining, lungs, main artery, gut or chest wall, so it can be hard to judge yourself.33PubMed Central. Atypical chest pain. Differentiation from coronary artery disease. Call emergency services for pressure or tightness spreading to the arm, jaw or back, or for sweating or breathlessness. See a doctor quickly for fever, coughing blood, yellowing skin, or pain after a fall.
Heart pain can feel like pressure, squeezing or heaviness rather than a sharp pain, and it may not be dramatic, so a mild-feeling episode can still be serious. Women, older adults and people with diabetes more often have less typical symptoms such as nausea, unusual tiredness, or discomfort in the back or jaw. If you suspect a heart problem, call emergency services rather than driving yourself, because paramedics can begin treatment on the way. Pain that is clearly pinpointed, changes with position and is tender to press is less likely to be from the heart, but that is only one clue and not a guarantee. Book a routine appointment if pain lasts more than a few weeks despite rest, wakes you at night or keeps getting worse, or if you notice swelling over the rib cartilage or recurring clicking lower rib pain.
A doctor will ask what you were doing when it started and press along your ribs to find the sore spot. They may order a heart tracing, blood tests or an X-ray if needed.