ribs: broken or bruised, it doesn’t matter

Monday, November 26, 2012

Predicting winning lottery numbers is a lot like guessing when the body is going to heal and I would bet that Rex Ryan and the New York Jets coaching staff haven’t had a winning Powerball ticket in a long time. Tim Tebow, their backup quarterback, hurt his ribs a couple of weeks back and continues to have pain. It’s no surprise to most people who have suffered broken or bruised ribs that it takes a long time to get better and one cannot rush time. But to the Jets’ coaches, it came as a surprise that a pro football player couldn’t muster mind over body.

The basics about rib injuries:

  • Broken, fractured or cracked all mean the same thing.
  •  A bruised rib usually refers to the structures surrounding the rib, like bone and cartilage and not necessarily the rib itself. Regardless of whether the rib is broken or the area is bruised, damage has occurred to the rib area and that disrupts the ability to breathe easily.
  • We breathe like a bellows; the ribs spread wide and the diaphragm pushes down sucking air into the lungs.
  • Pain can prevent deep breaths, preventing the lung underneath the damaged area from completely expanding.
  • The lung is a dark, warm place and if air isn’t moving through every nook and cranny, infections can sprout. Pneumonia is the major complication of a chest wall injury that can develop in a few hours or a few days.

Patients and doctors are on different pages when it comes to diagnosis. Patients want to know if a rib is fractured and expect x-rays to look for the break. Doctors are more interested in what else might be damaged due to the injury. A plain chest x-ray is all that is needed, not necessarily the multiple views and radiation exposure that comes with a detailed rib series. The CT and MRI scans that Mr. Tebow underwent seem like overkill.

The ribs also protect the upper abdomen where the liver (on the right) and the spleen (on the left) live. This is where a CT scan is helpful, if the suspicion of abdominal organ damage exists and the diagnosis can be confirmed, the need for an operation may be potentially prevented. Often solid organs, like the spleen, heal themselves (see Jason Witten of the Dallas Cowboys).

But rib injuries hurt and take time to heal, only because they cannot be rested. If you hurt an arm, it can be placed in a sling. If a leg is injured, it can be rested by using crutches. But a person can’t stop breathing and 12-14 times a minute, the injured rib is forced to move, stretching the muscle fibers or bone edges, delaying their ability it mend. The only treatment is adequate pain control so that a deep breath can happen and pneumonia can be prevented.

Aside from breathing, the muscles that surround the chest help move the arms and twist the trunk. It usually takes time at night for the patient to get comfortable enough to fall asleep. Usually, they prop themselves up with pillows or sleep in a recliner. Lying flat makes the pain worse because the chest has to rise against gravity to get that deep breath in and sitting upright takes gravity away. Morning is perhaps the worst time of day. After a few hours of sleep, the chest wall muscles have become tight and the first twist or turn to get out of bed can be excruciating to the point that the same move on morning two is dreaded.

The bottom line is that rib injuries take 4-6 weeks to heal and there is no rushing Mother Nature. The Jets’ coaches should not have expected a football player to suit up and play in 10 days and Mr. Tebow was a victim of wishful thinking. Mind over matter doesn’t work when the mind is more interested in how much the next breath is going to hurt, not whether that linebacker is closing in for the tackle.

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48 Responses to ribs: broken or bruised, it doesn’t matter

  1. Me says:

    How do you explain Tony Romo playing last year (2011) with injured ribs?

  2. bwedro@charter.net says:

    It took Tony Romo 8 weeks to heal while playing through his injury. It also took repeated anesthetic injections at the fracture site to allow him to function. Pro athletes subject themselves to many treatments that would not be offered to the regular patient. -BW

  3. john says:

    Good info… are you familiar with Ben Roethlisberger’s current rib injury? And how it could puncture an aorta? I would *assume* there would be no possibility to use pain injections to be able to play…

  4. bwedro@charter.net says:

    Roethlisberger fracture his first rib and because of the anatomy, there are critical structures that lay underneath that can be damaged, including the subclavian artery and vein, the brachial plexus and the to part of the lung. It has been rarely reported that an aortic arch aneurysm may form. While this is not a “punctured” aorta, it is definitely a potential disaster.

    Check out the DocTalk column from January 2012 about first rib injuries https://mddirect.org/2012/01/18/the-first-rib/ -BW

  5. Gary says:

    Could it take less time for the rib to heal? And can you workout with it ..if you can take the pain or is that counter productive?

    • bwedro@charter.net says:

      Rib injuries take 4-6 weeks to heal, give or take. Pain medication should be used to allow deep breaths to prevent pneumonia. Activity should take place as tolerated.

  6. Renee Moore says:

    Hi i got beaten about 4 weeks ago, most damaged was sustained on both sides of my ribs, until 4 days ago, was not having to much pain unless coughing or lifting! However have developed a cold, and now am in absolute agony it hurts really really bad, I cam barely breathe and honestly hurts to much, please help me!

  7. Pat says:

    I fell hard on my ribs and the pain feels like a break. However, I have no bruising; can you have a broken rib if there is no bruising? This is only the day after; is it necessary to see a doctor? I am already doing slow deep breathing. Thanks for the informative article.

  8. Karen Stahl says:

    Delayed response but ribs can be broken without any bruising present. I wondered the same thing until yesterday- no bruising and two of my ribs are broken. Doctors where I am (Texas) I wish would realize pain mess are for people in pain. You have not been forbidden to prescribe them so if your patient is having a lot of pain breathing, please give them something better than tramadol. Second night and hurting too much for deep breaths or sleeping

    • Con says:

      Reason, opioids slow breathing, plus rib pain causes shallow breathing, which cause less air flow clearance and can develop lung infection which causes a lot more pain such as coughing.
      Pain meds given are mostly over counter for a reason.

  9. Sam the Sham says:

    Does pain from cracked ribs fade gradually or in spurts. I’m on my 8th day & it hurts about the same as day 1. Any chance of a noticeable difference anytime soon?

    • bwedro@charter.net says:

      The pain may last a couple weeks or more, because the rib edges continue to move everytime you take a breath.

  10. Ralph Dyson says:

    68 year old with a broken ‘floating’ rib. Best information of all sites I’ve found all evening. I will sleep better tonight and be far less worried.
    Thank you.

  11. Lori Fahnestock says:

    I have read multiple articles on ribs and this by far has been the most informative, thank you, I think the comparative article was more informative for my mind frame at this time for me and my injured rib, again thank you.

  12. Nina Johnson says:

    thank you for your help

  13. Serina says:

    Yes this was good info for me too… Hurt my ribs leaning over a boat…felt a pop and instantly was in so much pain…went to er and the done xray and cat scan and said nothing was broken just bruised ribs but this is day 3 and it still hurts but seems to be getting better with the good Lords help and I’m taking 2 Aleve every 12 hours which seems to help better for then pain than ibruprophen… I also was prescribed robaxin muscle relaxer…I have tramadol but I haven’t had o take any tramadol..I winded up going to er twice bc of the pain and they gave me tordoil both time which also helped the pain…it would hurt so bad just trying to take a deep breath and to cough…it seems like its starting to get some better now…still hurs and I have to wLk really slow holding my left rib cage…it feels better when I’m in bed propped up then laying flat down…I practice slow deep breathsto try to prevent pneumonia and it still hurts some but tolerated with my pain medicine…I hope this might help someone with same problem.

  14. JMC says:

    When your ribs hurt they hurt bad and you need the reassurance that one day soon the pain will be gone. The original post from
    2012 is timeless. Knowing that it’s not hopeless to be pain free from a rib injury is such a relief. That’s what those of us who seek out articles on the internet for medical information are looking for. Yes, I too find myself waking up at 2:30am hurting worse than after the fall I took. I am starting week 3 following the accident. I appreciate finding the above information and hope it stays up on the internet for others to find when they are hurting and don’t know what to do. What I learned from those who posted before me…take Aleve (if you aren’t allergic to NSAIDs) and be patient. Feel better everyone!

  15. Toni Tiger says:

    June 7, 2017 I totalled my car. I hydroplaned crossing railroad tracks..going the speed limit or under which was 45 mph..I was knocked unconscious and did a 360 spin and ended up down in a deep ditch on the other side of the road..windshield side down which shattered. Thank God I did not hit any other cars. My question is I am in extreme excruciating pain on the right side of the front of my ribcage. In the ER they did a CT of my head, abdomen and thorax..( I don’t know what the thorax is..but anyways..nothing damaged there) I was in and out of it when they released me..I was there 4 hours and remember nothing really. They released me to my husband and father. That happened on Wednesday..I woke up Friday evening at home..oblivious to what happened …Anyways.. my question is how would I know if I have broke.. fractured or bruised ribs? I cannot lay down due to the severe pain..when I cough the pain is too intense to describe. Would it even be worth going back and getting xrays or something? I mean there is nothing they can do anyways… Right? I am taking Ibuprofen 800 every 4 hours which helps…and not moving my right arm because of such intense pain. Should I get checked? Would it even be worth my time? Is there anything else I can do at home to help me? Thanks in advance if I get any advice..have a blessed day.

    • bwedro@charter.net says:

      First, thorax is another word for chest.
      If you have pain with breathing or coughing or moving, you may have damaged your ribs. Again whether they are broken or bruised isn’y very important because it takes weeks to heal. If the pain is not controlled, you may not be able to take adequate deep breaths and a return visit to your family doctor for a recheck would be appropriate.

  16. Toni Tiger says:

    Good morning.. I have been awake since 4am simply because I hurt. I have been resting and sleeping in spurts.. when I can..no regular sleeping pattern for me right now due to the agony I am in..lol Idid do a follow-up with my Primary Dr yesterday morning.. I explained to her the horrible and unimaginable pain I am in.. she basically said what you told me.. that I would stay in pain for at least a couple more weeks. My Dad drove me to her office.. because I honestly can’t drive.. once again due to pain. On the way there we hit a dip in the road..ever since I have been in the worse pain since the accident..a week ago today. I have a new question.. when should I worry..or should I? I fear now I may have a bruised lung or something.. with a possible blood clot.. I feel I am overreacting..am I? I am taking Ibuprofen 800 mg with a Hydrocodone 7.5 every 4 hours now.. she said to add a dose of Tylenol with it. All that medicine and it is not even touching the pain.. I am in worse pain than ever before. Is this just part of the healing process..it gets worse before it gets better? If my lung is bruised I think possibly from hitting the dip.. would it change anything? How would I know if it is maybe bruised and forming a blood clot? I think I am starting to panic because I have not ever in my entire life been in this much pain..lol Should I just quit freaking out? Lol

  17. Evelyn says:

    I have injured my ribs now 3 separate times leaning over a car door/edge of a trunk and a recycling bin. in this instances I heard a pop and the pain and tightness started about 4-6 hours later and lasted as this chain notes at least 2 weeks. I had an additional injury last year when a NYC subway door closed on me and my chest. All in the last 2 years never before this. I am 54 — I am wondering now if I have developed some weakness in my rib connective tissue/muscles or is it just bad luck?

    • John Tee. says:

      Would be good to get an answer to this as I did the same today. A lot of pain but was yours broken or bruised. The pop/crack as the initial trigger was the concern.

  18. Stacey says:

    Do we goto a doctor basically to get drugs in order to breath deeper and be able to function while Broken ribs heal? Because taking 3 weeks off and sitting around, I think I would go crazy just sitting around for 3 weeks.

    I was running with my dogs and tripped on an uneven sidewalk fell hard on knee and wrist then noticed later when I got home I could barely move my upper body without crying I was in so much pain. Tried to lay down, but forget that it brought on even more pain. I started crying like a little girl and shaking I was so scared. For 5 days I have been trying to lay low, taking ibuprofen every 6 hrs, sleeping in a recliner, having my partner walk the dogs and take care of me… feels like my ribs under my left breast are broken or not connected somehow. I am fine if I just sit around but when I get up I take shallow breaths and find that I am holding my breath… protecting the ribs somehow. This is crazy and it sounds like it will Be this way for a few weeks…

    • bwedro@charter.net says:

      First reason to see a doc is to make certain that the lung underneath the rib injury is not damaged (bruised, collapsed). Second is for pain control to take deep breaths and prevent pneumonia.
      Hope you’re better

  19. Lara King says:

    I’m currently writing a book and the main character has broken his ribs, but his girlfriend had passed out and has no choice but to carry her to a hospital a few blocks out at 3 in the morning. How would that affect his condition?

    • bwedro@charter.net says:

      Unless there is a com0lication associated with the fractured ribs, like a collapsed or bruised lung, the major issue is pain. Lifting, carrying and for that matter taking deep breaths, would be a challenge. In times of crisis, though, people often overcome pain to do what needs to be done.

  20. Char Maguire says:

    THANK YOU!!! This is the most informative article I have been able to find after HOURS of reading! I tripped over a tree root 9 days ago while hiking, and came down hard with my rib hitting another tree root. Figured it was just bruised, continued my 8 mile hike. Got home and it just kept getting worse. Y’all know where I’m coming from here. After 9 days, I can take a deep breath without passing out, but it does still hurt. Walking hurts each time my left foot comes down (I hurt my left side). Hoped it wasn’t broken, but when I realized I’m still in quite a bit of pain after 9 days, figured I should check for some info on ribs. Your article was exactly what I needed! Now that I know it’s going to take a long time to heal, I can work around it. Great article, thanks so much!!!

  21. K says:

    About 3 months ago, I fell from about 10 feet onto a hard surface. Landed on my tailbone (which only hurt for a couple days, got better each day) But I also noticed after falling it hurt to breathe and immediately had a nurse at the scene check me out (I was at a gymnastics meet) she gave me some Advil told my mom to take me to the doctor. My mom said she would take me to the doctor the following morning, but my dad suggested we wait. So about 2-3 weeks later, I was still in pain so we finally went to get it checked out. The doctor asked me what hurts the rib (now keep in mind it didn’t hurt to breathe anymore, just do normal activities) and he felt around to make sure there was no damaged lungs and such. He ruled bruised rib. The injury occurred March 11, 2018. It is now June 2, 2018 and I’m still experiencing pain. I lost many of my gymnastics skills which has honestly put me in a somewhat depressed state. It hurts to bend or twist my body and do most of my skills. Sometimes it hurts to lay down. I have noticed that it hurts on the left side when I twist, but when I bend (such as a back handspring) my whole entire rib cage hurts, and I have to sit down for a few minutes to deal with the pain. I don’t think this is a bruised rib. Possible rib separation from the cartilage? Is it worth seeing a doctor again because it has been 12 weeks and I don’t want to be in this much pain anymore:((

  22. Evelyn Oliver says:

    K, i’ve Had rib injury 3 times. I had chiropractor adjustment to fix the twisted rib and this helped me.

    • bwedro@charter.net says:

      Respectfully, ribs can’t twist, but they can break. However, muscle and cartilage associated with the bony ribs can be damaged. Chiropractic care may be helpful

  23. Sally says:

    My experience nearly same as Toni Tiger from Jun 2017. I have bruised rib, not broken. Not sure if I pulled muscles in ribs or bruised lung. Pain started in front and moved to back. Also hurt shoulder. Breathing, coughing, driving (turns and bumps), laying down cause extraordinary pain. It’s been 3 weeks and I have moved from recliner to bed. I wake up each time I move. I was given same meds as Toni Tiger, but they didn’t do much and I ran out while still in significant pain. I now have lung infection, but pain is tolerable.

    I appreciate article and posts. I now know what is going on and what I can expect.

  24. Liz says:

    This seems one of the most helpful explanations I have found. Thank you.

  25. Toni Tiger says:

    I am Toni Tiger posting an update. It took me almost 6 weeks to heal… but finally heal I did..the pain stopped. In other news now I have terrible spasms in my ribs that I hurt often. The other day I had 3 spasms in a row so I just deal with it I don’t think anything can be done about it. It’s been a year and 3 months and I still have problems.

  26. Sue Anne Breen says:

    I heard my rib pop bending over washer put all my weight I guess I bruise the rib cage under my breast bone pain is gone but feels like something there when I stretch or cough but there is no pain what could it be just funny feeling

  27. LeeLund says:

    Great site.Tripped and fell one week ago. Pain migrated from back to front during past couple days. Then tonite for first time had spasms. Scary. Took breath away. Reading other shared experiences helping to relieve anxiety.

  28. Tracey says:

    I agree, best info i’ve found. I fell down my stairs 18 days ago & had immediate pain in my neck. Didn’t notice rib / side pain for about 2-3 days but it’s it hurts constantly, worse in the morning & of course when coughing. Sneezing? Forget it. I started to get concerned yesterday because I still have a horrible time sleeping & getting moving after 2 1/2 weeks. The pain radiates from the left side of my back around to the front. It’s comforting to read that this slow healing process is normal. Thanks

  29. Deanna says:

    Thank you so much, this is the best, most informative site I have found. I injured my rib during a fall while hiking about 3 weeks ago. Pain had gotten more tolerable in the last few days so I was back to work as a teacher. Then 2 days ago it flared up and got much worse. Xrays didn’t really show anything. I was given a steriod/toradol shot which only helped minimally. Starting a course of oral steroids tomorrow. Was also given a muscle relaxer, but it gives me headaches so I’d rather just use OtC pain meds. Ice pack helps some, and sleeping is difficult. I really appreciate all the comments here, thanks to everyone!

  30. Paul says:

    Hi,
    My horse reared and rolled back and over me (the reason I didn’t bail is that I was saving him from certain death from backing over a cliff.) Anyway it was super painful but figured I should work throughout the pain. That was a Saturday. Monday morning in ER. Two fractured ribs and large chest contusion from the saddle horn. Intense pain but learning what I can and cannot due. A week has gone by and the breaks don’t hurt unless I cough but the cartilage seems all squishy like there is nothing holding my ribs and sternum together. CT scan said everything looked ok except the bruise and breaks. Friend who is a trauma radiologist said it will just be painful. I’m hoping in a couple of weeks my chest will not feel so loose. Only taking alieve and one valume at night to help sleep. Better and better each day.

  31. julie Schmitt says:

    Crashed on my MTB. Landed on my side with my arm tucked in high. Took breath away at first, felt like a vice grip on left side of chest for awhile, but a week later I can take deep breaths and hold it. I can stretch out my arms above head, and walk trails without pain. My question is – I feel little clunking with minimal mvmt at times. Should I be concerned with this mvmt and the healing process or is this pretty normal. I know big breaths are important and I will continue to so so, but should i try to minimize mvmt otherwise or go about normal activity as best as possible.

    • Dr. Wedro says:

      The key to preventing the complication of pneumonia is taking deep breaths. Those routine and regular deep breaths are a priority.
      That clunk you are feeling May be the edges of a broken rib running against each other. This will gradually resolve with healing.
      Activity that you can do with mild discomfort is probably alright, but you may get muscle spasm and tightness the day after, if you overdo it.
      As with all advice you read online, please contact your medical provider To discuss your specific situation.

  32. Anna says:

    Fell directly on my chest on my hardwood floors 3 weeks ago, worst pain of my life. Knock the wind out of me, had to sleep sitting up, sleep with pillows around me on left side the right side was unbearable, I had to hold my chest in when walking and to get out of bed. I purposely didn’t cough or sneeze for a week. I decided not to go to the ER because of the pandemic, everything I read online said the same thing about healing. I finally was able to drive this week and I’m feeling a lot better, my left side of chest feels fine, middle sore to touch and right side still has pain. I can’t lay on my stomach or back yet. I’m practicing deep breathes. The only thing is it feels like my right side is blocked or a lot of pressure kind of tight if that makes sense.

  33. Sally says:

    Exact same experience for me a year ago.

    I did get pain meds, which at time, I didn’t think they helped. However, when ran out of prescription, I realized that they were helping significantly.

    I was in pain that kept me from normal activities for 2 months. It took 5+ months to be pain free.

  34. Kathi Moore says:

    So glad I “fell” onto this site! This article aligns with what i was told in the ER last week. I am 65, thrown from a cranky horse named Dudley and feel grateful to have escaped with fractured ribs 5-9 and a small pneumothorax. Luckily, I didn’t need a chest tube, stayed in hospital 2 days. I have a nursing background and knew what i needed to show them to be released. Luckily I have never had a broken bone, trauma or breathing issues. All that said, I am beginning week two and feel confused. Was reassured that the pain was not an indicator that i was further injuring myself, but yet i feel so guarded. Hate taking the pain meds but the emphasis on their short term benefits was stressed over and over. I relied on the oxycodone and tylenol for first two days, but felt it just made me lethargic and sleepy. Started a regimen of the ibuprofen and tylenol. I see someone above is taking aleve with good results so I may switch to that since I have used it in the past with success.
    I feel like pain has been downgraded to discomfort. Problem is I can’t get comfortable. I sleep well, but man getting out of bed in the morning is tricky at best. Can’t really bend either. Something falls on the floor, it’s dead to me [unless it’s the remote or cell phone!]. I initially came to the internet to see if I could find some recommended stretching b/c my back muscles hurt from sitting, resting and overcompensating for general muscle tension.
    Reading your experiences has been just what i needed! Thanks so much for sharing. You have lifted me up and given me real perspective. xo

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