Why You Should Assess The Rib-cage With Every Lower Back Pain Patient

Posted By: Andy Barker

You may have heard about physio’s assessing the rib-cage as part of their patient assessments.

This might seem complicated…

But it’s really not.

If you can understand what the ribs do when we breathe in and out, and how this relates to movement at the lower back…

You will be able to see how poor rib-cage movement can heavily influence lower back pain.

This is really important because a failure to assess and treat a rib-cage problem might stop you getting your lower back pain patient pain-free or keeping their pain away once they have left your clinic.

Let me explain this…

The ribs move to help you breathe in and out.

You breathe around 22,000 times a day.

That’s a lot of reps and many more reps than most of the rehab you will prescribe i.e. 3 x 10 of this or that exercises, a couple of times a day.

Therefore, doing something poorly 22,000 times a day will undo almost any rehab plan, no matter how good it is.

To understand this a little better firstly you need to understand what the ribs do (and their influence on the lower back) when you breathe. 

Take a big breathe in.

Then take a long, slow breathe out.

When you breathe out your ribs will drop (or more accurately depress and retract).

If you can’t feel that happening, put your hands on your lower ribs and do this again.

When you breathe in, the reverse happens and your ribs move up (elevate and protract).

But why is this important for lower back pain patients?

When you breathe out, and the ribs drop down, this movement is combined with a posterior pelvic tilt and lumbar spine flexion.

When you breathe in, the ribs move up, this movement is combined with anterior pelvic tilt and lumbar spine extension.

In short, every time you breathe in or out, there is movement at your pelvis and lower back.


If you have poor movement of your ribs, this could be too little or too much movement, this is a problem…

Because it is going to change how your pelvis and lower back work.

Therefore it makes sense to assess the rib-cage with any patient you see with lower back pain.

After all the ribs (and the back and pelvis) are moving 22,000 a day when you breathe in and out…

Which is many more reps than the 3 x 10 exercises you prescribed.

In almost all cases, poor rib-cage mechanics will undo any rehab plan, no matter how good it is, solely due to the sheer volume of times your ribs move per day when breathing.  

Failure to address issues at the rib-cage is one of the biggest reasons why so many lower back pain patients fail rehab…

Or at best get better at the start, but then plateau…

Their symptoms improved but never gone…

And a big reason why so many lower back pain patients tighten up again, or even re-injure, after they have left your clinic room.

Want to know how to assess if your patient has a rib-cage issue and how to treat and rehab this sort of issue?
I’ll be showing you how on my upcoming FREE lower back pain webinar…


How To Make Sense of Lower Back Pain So You Are Safe & Feel Confident Even With More Complex Cases

Alongside rib-cage assessment, treatment and rehab I’ll also be covering…

– The #1 Red Flag Question You Need To Ask To Rule Out Serious Lower Back Pathology So You Feel Safe & Confident Your Patient Does NOT Need A Quick Onward Referral

– How To Easily Differentially Diagnose Lower Back Pain Patients & Without Having To Complete #101 Special Tests!

– Why Most Lower Back Exercises (And Treatments) Do NOT Work & What You Need To Do Differently If You Actually Want To See Your Patient Progress & Not Flare Them Up

Plus I’ll be holding a live Q & A session at the end to answer any of your questions! 

The webinar is happening THIS Wednesday…

Wednesday 23rd February 2022 at 7 PM (UK Time).

Book your FREE place here.


The New Grad Physio Mentor

PS. Everyone attending will receive a CPD certificate just for turning up!

PPS. This is a live event and no recording will be made available after the event outside of my new grad physio membership.

You must be registered if you want to watch this webinar for FREE.

So do this now and secure your seat!

>>>Book My Free Place Now <<<