Everything You Need to Know About a Costovertebral Joint Sprain

What is a Costovertebral Joint Sprain?

A costovertebral joint sprain is a painful injury that occurs where a rib connects to the spine in the upper back (thoracic spine). These joints help your ribcage and spine move smoothly, especially during breathing and twisting. When the joint is overstretched or compressed too much, it can cause inflammation, pain, and stiffness, this is known as a sprain.

An analogy…

Imagine your ribs are door hinges connecting to the spine. When they’re working well, the door opens and closes smoothly. But if the hinge gets yanked or forced, it jams and becomes sore. That’s what happens when the costovertebral joint gets sprained, it’s not broken, but it’s irritated and inflamed.

What are other names that a costovertebral joint sprain can be referred to?

Thoracic Joint Sprain, Rib Joint Sprain, Thoracic Facet Irritation, Rib Dysfunction, Thoracic Spine Dysfunction, Rib Subluxation, Intercostal Joint Strain

What causes a costovertebral joint sprain?

Each rib in your upper back connects to a vertebra at the costovertebral joint. These joints are lined with cartilage to cushion movement and wrapped in connective tissue for support. When there’s excessive force, like a sharp twist, poor lifting technique, bad posture, or a forceful cough or sneeze, the joint can be overloaded. This can lead to damage in the cartilage or a small tear in the connective tissue, which results in a sprain.

What are the signs and symptoms of costovertebral joint sprain?

Localised pain in the upper back or just beside the spine
Pain worsens with deep breathing, coughing, sneezing, or twisting
Sharp or stabbing pain when moving or turning
Stiffness in the upper back or ribcage
Muscle tightness around the injured joint
Sometimes pain refers slightly around the ribs or chest
Tenderness when pressing on the area

What tests are used to diagnose costovertebral joint sprain?

Palpation: The practitioner presses on the joints and surrounding muscles to find the painful area.

Range of motion testing: Movements like twisting, side bending, or deep breathing may reproduce the pain.

Postural assessment: To see if poor posture is contributing to uneven stress on the ribs or spine.

Imaging (if needed): X-rays or scans are rarely required unless there’s concern about other conditions like a rib fracture.

How long does a costovertebral joint sprain take to heal?

With the right treatment, most people recover from a costovertebral joint sprain in 1–3 weeks. In milder cases, it may improve in just a few days. More stubborn or recurring cases may take longer if not properly managed.

How does a costovertebral joint sprain happen?

Sudden twisting or awkward upper body movement
Heavy lifting with poor technique
Poor posture over time
Repetitive overhead reaching
Forceful sneezing or coughing
Weak or tight muscles around the upper back and shoulders
Sports that involve rotation (e.g. golf, swimming, tennis)

What treatment can help a costovertebral joint sprain?

Gentle joint mobilisation to restore movement
Soft tissue massage to reduce muscle tightness
Heat therapy to ease discomfort and improve circulation
Postural correction to reduce stress on the joints
Stretching and mobility exercises once pain improves
Breathing retraining if deep breaths are painful

What exercises or stretches can I do for a costovertebral joint sprain?

Thoracic extensions over a foam roller
Wall angels
Rib cage breathing exercises
Shoulder blade squeezes
Side bends and gentle twists

What products can help with a costovertebral joint sprain?

Lateral pulldown with one arm

Stand upright with your affected elbow at your side, flexed at 90 degrees and rotated outwards, make sure it does not move further than 90 degrees.
Squeeze your arm inwards, as if your are trying to put your elbow into your back pocket.
Hold briefly in this position before returning to the starting position.
You can use an elastic band or cable pulley to progress the exercise.

PROM GHjt ER(N) stretch in doorway

Stand up straight facing the edge of a stable structure with the elbow of your affected hand tucked into your side, bent to 90 degrees.
Place the palm of your hand against the stable structure.
Keeping your elbow tucked into your side, rotate your body away from your affected arm by stepping your feet away from the wall.
Feel the stretch across the front of your shoulder.
Hold this position.

Thoracic rotation – kneeling

Start on hands and knees, moving your body back over your legs a little and straightening your arms out in front.
Place one hand on the back of your neck, keeping the elbow pointed out.
Rotate your body, leading with the elbow, so that your elbow comes down towards the middle of the floor, and then rotate back up.
As the elbow comes up, you will get a twist in the middle of the back.