The third trimester of pregnancy—you’re fast approaching meeting your little one who may currently be treating your ribs as their own personal trampoline. That feeling of not being able to fully breathe or that you are getting drop-kicked in the ribs is pretty common. While it’s common, it doesn’t mean you are stuck with it for the next 12 weeks. 

Causes of Rib Pain During Pregnancy

There are plenty of reasons as to why you may have this pain. The good news is that also means there are things you can do to help relieve the pain/pressure. Here are a few reasons why mamas have right rib pain during pregnancy:

1. Baby Position
   According to Spinning Babies (an amazing resource if you haven’t check it out already), the ideal position is for the baby’s back to be on the mother’s left side with the baby’s feet on the right. While it may be less than enjoyable, the baby kicking your ribs can be a GOOD thing because it means they are in the best position for a natural birth.

2. The Breath and Diaphragm
   An interesting fact is that during normal quiet respiration, the diaphragm moves downward about 1.5cm and this increases to 7-13cm with deep inhalation. As the uterus increases in size to accommodate for the growing baby, it will actually cause the diaphragm to move 5cm upwards. That means by 37 weeks pregnant, your diaphragm is still 3.5cm shy of where it normally moves to during breathing! As we inhale the diaphragm should naturally move downward and outward, almost massaging the muscles of the lower ribs, all the organs (hello, bowel health), and pelvic floor. 

3. Stress
   Pregnant or not, when we are stressed we tend to take shallow breaths that moves our chest upwards. This form of breathing reiterates the fight or flight mechanism in us and we end up mostly chest breathing and further shortening how much the diaphragm can move downwards and outwards. When this happens, we decrease the natural “massaging” of the  muscles of the lower ribs. We actually want this movement so we can fully inhale, fully stabilize and fully mobilize!

4. Muscles and Ligaments Stretching during Pregnancy / Posture
   During pregnancy, the rectus abdominis and transverse abdominis muscles are both interconnected/related to the lower ribs and diaphragm and their movements. The rectus and transverse abdominis muscles naturally stretch during pregnancy. This change that comes with the baby growing will pull on the lower ribs and can cause both increased or decreased mobility of the ribs and pelvis. I’m sure you have noticed but with these changes in the body, our posture also changes during pregnancy. 

   
   It’s common for mamas to sit on their sacrum rather than their sitz bones (the often times pointy bones under the butt). Sitting on the sacrum causes the upper half of the body to compensate and puts us into a crunch-like position. When standing, we have 4 frequent positions - the mama who likes to lean forward a ton, the mama that tucks her butt and has a big curve in her low back, the mama who has a big curve in her back and sticks her booty out or the mama who has an “ideal” posture. The jury is still out on if posture causes pain, but during pregnancy I have seen a lot of mamas who have decreased discomfort when standing and sitting with intention.

Relieving Rib Pain During Pregnancy

The first step to decreasing rib pain during pregnancy is to see a chiropractor or physical therapist trained specifically in helping pregnant mamas. I see this regularly in the office and if you are in the Western Suburbs of Chicago, I’d be happy to help. In the meantime, here are some tips you can do at home to get the little elephant from trampolining on your ribs.

1. Proper Diaphragmatic Breathing
   One great way to get the ribs moving regularly is through proper diaphragmatic breathing. Unfortunately, it is not as easy as simply breathing. We want to inhale and allow our diaphragm to gently descend and move outwards — this should gently push the lower ribs outward and downward along with our abs, back and pelvic floor. 
   *Note: If you are feeling pressure in your pelvic floor when you do this exercise, you are most likely bearing down instead of creating intra-abdominal pressure. This is a sign you should see a qualified professional to help you breathe optimally.

2. Manual Therapy/ Trigger Point Release
   As the baby grows and the abdominal and back muscles move in order to adapt for the baby, it’s not uncommon for these muscles and ligaments to get tight or lose the ability to full move and relax. Manual therapy, massage therapy and trigger point release are all great ways to increase the movement that should be happening when we breathe and move. 

3. Movement & Posture Modification 
   We are standing or sitting the majority of the day. Standing and sitting with appropriate posture (neutral spine with a small, natural curve in the low back with the diaphragm and pelvic floor stacked above each other) is a great way to keep the diaphragm moving optimally and also help stabilize the low back and core.

   As for movement, we want to continue moving in a way that nourishes and supports the changes that come with pregnancy rather than fighting against them. A few great movements are the Spinning Babies daily activities and dead bugs, bird dogs, cat-camel, side planks. Additionally, it can be helpful to keep the mid-back and chest moving be doing Pec Mobility, Child’s Pose, triplanar psoas release (the psoas goes from the mid-back to the hips and is often tight during pregnancy), and thoracic rotation exercises. 

4. Meditation / Prayer / Mindfulness Practice / Acupuncture

   This one indirectly helps by allowing the “rest and digest” part of the nervous system to take over and calm the breathing. In Traditional Chinese Medicine the upper abdominal area is where unkept emotions are stored so it may be helpful to acknowledge stressors you are currently fighting (or hiding from). The calmed breathing of meditation and mindfulness help create the massage effect for the ribs and allows the ribs to full expand and relax. Do what you feel most comfortable with - for some mamas that is taking time to pray each morning, for others it is focusing on mindfulness while enjoying a cup of coffee or tea, and others enjoy listening to apps like Expectful which help guide expecting mamas through meditation.

And mama, I hope you start feeling relief soon so you can fully enjoy your pregnancy. Your little one will be on the outside soon enough and deserve to feel good even when you are pregnant.

References:

1. LoMauro A, Aliverti A. Advances in pediatrics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818213/. Published December 2015.

2. http://files.academyofosteopathy.org/convo/2018/Presentations/Lossing_VisceralOMT-SAAO.pdf 

Disclaimer: The information by Dr. Lauren Keller of Elemental Chiropractic, Inc. is provided for general information only and should in no way be considered as a substitute for medical advice or information about any particular condition. While every effort has been made to ensure that the information is accurate, Dr. Lauren Keller nor Elemental Chiropractic, Inc. make no warranties or representations as to its accuracy and accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. If you have any specific questions about any medical matter or think you may be suffering from any medical conditions, you should consult your doctor or other professional healthcare provider. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.