Rib Bone Stress Injuries: A Narrative Review with Protocol for Rehabilitation and Prevention

Rib bone stress injury (BSI) occurs most commonly in athletes performing repetitive upper body movements and results in significant time lost from training and competition. These injuries are seen in rowing, baseball, swimming, golf, weightlifting, and other throwing sports. Similar to BSI at other anatomical locations, a rib BSI often results from multiple factors including both thoracic/upper extremity biomechanics and metabolic factors affecting bone health. Although some rib BSIs are easier to detect, other injuries may present with vague rib or shoulder pain that can be misdiagnosed and result in delayed management. Our narrative review describes biomechanical and other health factors that contribute to a rib BSI. We describe an approach to evaluation including diagnostic imaging and management strategies to guide return to sport. This includes discussion of prevention/mitigation of underlying modifiable factors, including training load monitoring, addressing biomechanical factors, and correction of nutritional/hormonal deficiencies.