Rib Subluxation in Hypermobility: A Practical Guide - The Fibro Guy (2023)

rib subluxations

Let's talk about the dreaded hypermobility rib subluxation and the current subluxation exercise that is out there. It's no secret that subluxations and dislocations are more common in the hypermobile population, meaning the ribs can be an unfortunate victim of subluxations. A subluxation of the ribs can make us feel like we've been shot, which immediately slows us down and makes us incredibly afraid of any future movement. While it makes sense to create pain to stop further injury or damage, it causes problems down the road. In fact, the more we protect our movements from subluxation pain, the more we increase the risk of them reoccurring.

Hypermobility places a lot of emphasis on stability, and while that's important, it's just a small part of a much larger picture. Most of the hypermobility rehabs we've seen related to the ribs seem to focus on non-transferable exercise. Similar to when you asked me to teach you piano but I asked you to practice on a guitar. Both are essentially music, but they are very different. The same goes for hypermobility exercises for rib subluxation. You practice on a guitar to learn piano.

It's important to understand that stability comes more from the neurological system than ever from the musculoskeletal system. This is essential when it comes to proper hypermobility rehabilitation, and in our case with this article, hypermobility rib subluxation exercises.


The different sections of our ribs have slightly different inherent stability as not all ribs are connected to an anchor point:

Rib Subluxation in Hypermobility: A Practical Guide - The Fibro Guy (1)

True ribs, defined as ribs 1-7, connect to the sternum, or what is also commonly referred to as the sternum. These ribs have the greatest stability as they are anchored by thoracic vertebrae and sternum attachments.

(Video) Hypermobility Rib Subluxation: A Practical Guide

False ribs, defined as ribs 8-10, connect indirectly to the sternum via their attachment to the costal cartilage of the sternum.

Floating ribs, defined as ribs 11 and 12, connect only to the thoracic spine and float at the front of the rib cage, hence their name "floating friction".

The thorax must compensate for a degree of stability in order to gain much-needed mobility. A bit like your shoulders. Using the attachments to cartilage and tendons, the ribs are able to move to accommodate lung expansion. However, since collagen makes up 2/3 of cartilage and collagen is the protein involved in conditions like EDS, these ribs are a little less stable than they naturally should be.

Problems associated with hypermobile rib subluxations

We mentioned early on that there are other issues associated with hypermobility rib subluxation and some that we find in our new Hypermobile customers are:

Fear of movement and chest stiffness

Fear of moving after a rib subluxation is incredibly common and, more importantly, it's a very understandable reaction. People will do almost anything to avoid the threat of pain, and rib subluxations are no different. One of the reasons pain is such an effective defense mechanism is that it is such a terrifying experience that we will always try to avoid it.

The problem we face, however, is that as our fear of movement increases, we tend to adopt various protective mechanisms to protect ourselves while providing a sense of stability. While this might seem like a good idea in the short term, it causes a multitude of problems later on.

(Video) Hypermobility Rehab: Why people get it wrong

Those in pain can enter what is called amechanically coupled guarding response. This is where the pelvis and rib cage connect and lock to slow the rotation of the trunk. This means there is more stiffness in the core, resulting in stiffer tissues and less room to move. For those with hypermobility, stiffness is not their friend, as in archers it allows muscles to connect with each other and create greater tensile forces that ligaments and cartilage don't handle very well in people with hypermobility. Therefore, with a rigid trunk and rib hypermobility, problems can easily arise when the tip of the rib slips under the overlying rib, resulting in impingement of the intercostal nerve that runs along the underside of the adjacent rib.

While engaging in protective postures, those with hypermobility rib subluxation will also find that they walk more slowly because they lack the counter-rotation of the ribs and hips as they move to create an easier gait. Think of the differences people experience when taking a brisk stroll versus a slow stroll through a museum. The latter is much more strenuous and this is due to the lack of efficiency when we are not counter rotating during our gait cycle.

Another issue we often find in our hypermobile customers is chest stiffness. As we mentioned above, adopting protective postures to prevent pain can essentially cause individuals to block. This also applies to the thoracic spine as the ribs are connected to the spine and we often find that people avoid simple movements like bending and stretching to avoid moving their ribs, as well as often adopting shallow breathing patterns. However, much like the ribs, the spine is meant to move, twisting, flexing and hydrating tissues. When individuals lock and stop moving, it can lead to hypoxic and inflammatory conditions that can easily become a triggering factor for increased stiffness and pain.

sleep disorders

If the last few decades of sleep and pain research have taught us anything, it's thatlack of sleepcome inPrevalence for more pain.Disturbed sleep leads to hyperalgesic pain changes, meaning your brain becomes far more sensitive to noxious stimuli, lowering the pain threshold and even to the point of interfering with our body's ability to recognize painkilling chemicals. When you're dealing with a rib subluxation, sleeping becomes a tedious task and can easily lead to more pain. Finally, sleep is a natural analgesic that can help manage and relieve pain, and hypermobility rib subluxation will definitely interfere with sleep!


Costochondritis is chest wall pain caused by inflammation of the costal cartilage, or the area where the ribs meet the breastbone, known as the sternal joints. It can cause chest pain that can range from mild to severe, and even mimic the feeling of having a heart problem, which can not only be incredibly scary but create even more anxiety when moving. Returning briefly to trunk stiffness, we can see that the stiffness of the ribs, while still moving, has the potential to pull on the cartilage, causing inflammation and a recurrence of rib subluxation hypermobility. Ribs are meant to move, and if we deviate from their design, you'll see that we have a whole host of potential problems right around the corner.

The best exercises for rib subluxations in hypermobility

Prevention is always better than cure when it comes to rib subluxations, meaning it's far easier to focus on preventive measures than trying to recover from a subluxation or slip. We've had fantastic results in the studio by helping clients stabilize their ribs using some of our tried and tested Hypermobility Mapping techniques. However, without seeing people in the studio, it's quite difficult to teach. But that doesn't mean you can't help yourself.

Let's cover two basic principles to focus on at home when it comes to rib subluxation exercises:Simple mapping and mobility.

(Video) Hypermobility Rehab Exercises: Getting the basics right

  1. Easy assignment: If your brain doesn't know where your joints are, it can't stabilize and coordinate your movements, resulting in extra tensile forces acting on cartilage and ligaments.
  2. mobility: When your body is compromised in pain management behaviors, the ribs sag, the chest compresses, and our rate of subluxation increases.

For many of you, mapping will be a whole new concept that may overturn the current understanding of subluxations not just in the ribs but in all joints.

Hypermobility rib subluxations are caused when traction forces are applied to the rib cage that you don't have the mobility or stability to handle. Most rib subluxations occur during a lack of concentration. For example, reaching around the TV at night to turn it off, or standing up on a phone call, etc. It's much harder to get a Sublux or sprain yourself when you're thinking actively and moving a joint. However, movement is autonomous, it should happen by itself without much conscious thought.

The current rib subluxation exercises

You will have noticed that many of the rib subluxation exercises consist of gentle breathing exercises or chest mobility. However, there is a downside to following these types of exercises: they don't address the main problem, which is mapping. More importantly, they are not transferrable to everyday life. That is, once you've finished them and go about your day... "pop," your rib pops up again. Cortical mapping is one of the areas we focus on with our hypermobile customers. This has resulted in our clients' results being unmatched anywhere in the world. After spending more than 10 years researching and perfecting our mapping techniques.

While cortical mapping warrants an entire blog post in its own right, I won't delve too deeply here. Mapping can be tedious and complicated and we have to spend a lot of time covering it with our clients. Most people we see seem stuck in the old attitude of strength and stability for hypermobility rehab. And while strength and stability are somewhat important, they're far from the most important aspect of hypermobility rehab.

In short:Cortical mapping is the communication between your motor cortex and your sensory cortex. Unless they're singing from the same sheet of music, your brain and body don't know where you are in space and time. This disconnect between intention to move and action makes you much more likely to be a sublux.

When it comes to rib subluxation exercises, proprioception gets a lot of praise. However, proprioception is the effect of cortical mapping, not its cause. You already have enough muscle mass to support your joints. The problem is that it isn't recruited adequately by the motor cortex, leaving the joints feeling loose and slack. Throw loose connective tissue into the mix and it's a perfect recipe for dislocations and subluxations.

How is mapping relevant to hypermobility rib subluxations?

Because if your brain knows where your joints are when your body is relaxed, it can quickly react to movement by making predictions and keeping your joints in place. In this way, you retain not only stability but also your mobility. While your ribs won't absorb any extra force that could shift your ribs. However, this stability in softness is not a conscious act, and therefore many so-called proprioception exercises do not yield much benefit.

The first step in preventing hypermobility rib subluxation is to have it mapped! Allowing your brain to know where your ribs are gives you unconscious stability as your brain knows exactly how much movement they have and that is important. People rarely subluxate when concentrating on a joint, they subluxate during moments of reflection and lack of concentration. For this reason, slow and deliberate exercises do not stabilize the joints, since most of them cannot be transferred to the way we actually spend our days. Mapping the ribs can be a challenge, and our customers are so wary of slipping a rib that they're flat afraid to move. Mobility and mapping are some of the keys to keeping your ribs in place!

Over the course of our hypermobility rehab programs, our clients improve their mapping in all of their joints. Once the contortions stop we start building muscle tone and they keep doing what they've always wanted to do, but it all starts with mapping their joints!1:1 instructions, we recorded a short YouTube clip to help you with some of the very basic mapping points and rib subluxation exercises so you can start managing your rib subluxations.

(Video) Hypermobility Rehab: Working with Berrie

We hope you enjoy it and please let us know how you are doing in the comments.

——Das Fibro Guy-Team——

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