Pain originating from the costovertebral and costotransverse joints can be due to prolonged postures or positions (like prolonged sitting, cycling) or from repetitive stress (like repetitive lifting, bending). These stresses can lead to joint restriction, muscle spasms, and altered movement patterns around the thoracic spine, contributing to both acute and chronic pain.

Another contributing factor is intercostal muscle strain, which often accompanies joint dysfunction. Muscles such as the levator costae and intercostals may be overloaded due to mechanical restrictions at the costovertebral or costotransverse joints. This strain, coupled with joint restriction, may exacerbate pain and further limit mobility.

1. Patients with costovertebral or costotransverse joint-mediated pain typically present with symptoms such as:

   • Localised sharp or dull pain around the rib cage or upper back.
   • Tenderness over the affected rib joints, which may worsen with certain movements, like deep breathing, coughing, or twisting.
   • Referred pain along the rib or into the chest, abdomen, or upper limbs.
   • Restricted thoracic spine mobility, especially with rotational or lateral bending movements.

1. Physiotherapists play a crucial role in managing costovertebral and costotransverse joint-mediated pain through a variety of evidence-based interventions aimed at reducing pain, improving mobility, and restoring normal function. The following approaches have been shown to be effective in managing this type of pain:

   Pain modulation techniques

   Incorporating modalities such as heat, cold, or TENS (Transcutaneous Electrical Nerve Stimulation) can help manage pain and inflammation in the acute stages. Research supports the use of these modalities as adjuncts to manual therapy and exercise, particularly in managing acute flare-ups and reducing muscle spasm around the affected joints.

   Manual therapy

   Manual therapy techniques such as joint mobilisations and manipulations targeted to the thoracic can help restore normal movement at the costovertebral and costotransverse joints. Research supports the use of grade III and IV mobilisations to reduce pain, improve range of motion, and alleviate muscle tightness associated with joint dysfunction. These techniques target the restricted joints and can help reduce mechanical stress and associated inflammation.

   Exercise therapy

   Targeted exercises to improve thoracic spine mobility and strengthen the muscles surrounding the costovertebral and costotransverse joints are essential. Evidence suggests that a combination of mobility exercises (e.g., thoracic extension, rotation mobility) and strengthening exercises (e.g., trunk rotation and trunk lateral flexion loading) can improve mobility, build supportive strength and reduce joint strain. Strengthening the deep stabilising muscles of the thorax, such as the multifidus and transversus abdominis, can provide long-term relief and prevent recurrence of pain.