Fascia guide
Fascia release for the ribs usually means rolling the back and side of the rib cage, breathing into the lower ribs, or a therapist's "diaphragm release" under the lower ribs. It can make the rib cage feel freer for a while. It doesn't change lung function, put a rib back in place or fix rib flare.
The honest headline: chest and rib pain come first, because the heart, lungs and clots must be ruled out before anyone treats the ribs.
This guide explains how the ribs move when you breathe, what diaphragm release did in small trials, a 15-minute rib cage routine, who shouldn't press on the ribs, and the rib pain that needs help today.
Pain from the chest wall causes about a quarter to a half of chest pain in general practice, but pain you can press on doesn't rule out the heart: heart disease is present in 3% to 6% of adults with chest pain and a tender chest wall.
The diaphragm is the main breathing muscle. The muscles between the ribs and some neck muscles lift and widen the rib cage as you breathe in.
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In one trial of 20 people with chronic obstructive pulmonary disease (COPD), 6 sessions over 2 weeks improved diaphragm movement and walking more than a fake treatment, and in healthy women one session widened chest movement straight afterwards. Nobody measured whether it lasts, and manual therapy didn't change lung function in reviews of COPD trials.
We found no trial of rib or upper back rolling against a fake or no treatment. Seven minutes of trunk rolling raised trunk range about as much as stretching, as rolling does elsewhere.
It is mostly the shape of the rib cage, sometimes with a chest wall deformity, and can occur on its own. We found no study linking it to fascia, or showing that release pulls the ribs in.
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With osteoporosis, a cough or sneeze can break a rib, and rib stress fractures happen in rowers and golfers. Rib pain that builds with training needs a GP, not rolling.
This page is for a stiff rib cage, not for chest or rib pain. Never treat chest pain yourself. A&E means accident and emergency.
Call 999 for any of these signs even if your chest is sore to press: pain you can press on can still come from the heart or a clot (our suggestion, from the studies in this guide). Heart disease is present in 3% to 6% of adults with chest pain and a tender chest wall.
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The diaphragm is the main muscle for breathing in: as it contracts, its dome moves down. The muscles between the ribs (the intercostals), including those beside the breastbone, and the scalene muscles in the neck lift and widen the rib cage, and the tummy muscles and inner intercostals pull it down when you breathe out hard. Our diaphragm and intercostals guides cover the muscles.
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The chest, back and side muscles that sit on the ribs, such as the pecs, serratus anterior, the lats and the muscles between the shoulder blades, have their own fascia. There is no separate "rib fascia" that tightens and holds the ribs. We found no study measuring fascia stiffness around the ribs, or linking it to pain or breathing.
Pain from the muscles, joints and cartilage of the chest wall is the commonest cause of chest pain in general practice: 46.6% of 1,212 people in one German study, and 24.5% to 49.8% across studies, against 1.5% to 3.6% for an acute heart problem. More than half still had some chest pain at 6 months. Costochondritis is inflammation where the ribs join the breastbone.
Pain at the lower front edge of the ribs when reaching, coughing or leaning, from loose cartilage of ribs 8 to 10 catching soft tissue and nerves. Our rib pain guide covers it.
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With osteoporosis, a cough or sneeze can cause a broken rib. Rib stress fractures affect 8.1% to 16.4% of elite rowers, and in a series of 19 golfers they mostly affected beginners, two of whom were first told they had a back strain. Of 54 people with rib fractures from coughing, 85% had a cough lasting 3 weeks or more, and 65% of those scanned had low bone density. A past rib fracture predicts more fractures, and in older men about half of rib fractures followed a fall from standing height or less.
Rolling briefly dampens spinal reflexes, more with harder pressure and even with fake rolling, and they return to normal straight afterwards. Rolling one calf raised pain thresholds in the other calf too, which points to the nervous system. Dense fascia doesn't change shape at these forces.
A therapist's hands hook under the cartilage of the lower ribs and follow the diaphragm as you breathe, typically for 2 sets of 10 deep breaths. It is a clinic technique: we found no trial of doing it on yourself.
In 20 people over 60 with stable COPD, 6 sessions of manual diaphragm release over 2 weeks improved diaphragm movement by 18 mm, the 6-minute walk by 22 m and the amount of air they could breathe in by 330 ml, more than a fake treatment. That is one small trial over 2 weeks, which we read as a summary (abstract), and nothing was measured afterwards. A crossover trial in 20 people found a diaphragm stretch and diaphragm release similar straight afterwards, with no fake treatment, and a review of diaphragm techniques in obstructive lung disease found only 2 studies and called the evidence preliminary.
One session in 75 healthy women widened chest movement by 0.49 to 1.44 cm and improved a forward-reach flexibility test against a placebo, straight after; breathing muscle strength didn't change. A review of 9 studies found immediate gains in diaphragm movement and rib cage expansion and called for studies of longer-term effects. In 24 people with low back pain, who all also had electrical nerve stimulation (TENS), 3 sessions eased pain more than a sham at 1 week, but chest expansion didn't change.
Across 6 trials of manual therapy in COPD, no effect on lung function was found, and results for exercise capacity conflicted. Adding manual therapy to rehabilitation improved walking a little, on low-quality evidence, with no change in lung function.
Pulmonary rehabilitation, a course of exercise and education, improved breathlessness and added about 44 m to the 6-minute walk across 65 trials, and the National Institute for Health and Care Excellence (NICE) recommends it for COPD. Breathing exercises on their own had no consistent effect on breathlessness or quality of life. Our COPD guide covers both.
Don't push a ball or your fingers under your ribs: our stomach guide keeps rollers, balls and guns off the tummy, and nothing shows self-release works. Crocodile and lateral breathing let the lower ribs widen without pressure.
We found no trial of rib or upper back rolling against a fake or no treatment. In 25 people, 7 minutes of trunk rolling or of stretching raised trunk bending and turning range by similar amounts straight after, with no untreated group. Six weeks of upper back exercises including roller extension improved rotation, but not the curve of the upper back, in 42 footballers. Rolling elsewhere gives a few minutes of extra range.
Clinical trials of treatment are lacking. A case series of 8 patients treated with manual therapy and exercise reported less pain, which is the weakest kind of evidence.
In 115 people, chiropractic care helped chest wall pain more than self-management at 4 and 12 weeks, but not at 1 year.
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Nothing has tested rib rolling against a fake treatment, the diaphragm release trials are small and short, and we found no study of fascia stiffness around the ribs. We read most studies' summaries (abstracts), not their full texts.
The doses are the move pages': the rolling doses come from a review of rolling studies (Hughes & Ramer 2019), the crocodile breathing page gives 5 minutes as its editorial starting point, and the others are the pages' own starting points. This sequence makes the rib cage feel freer for a while; it doesn't change rib position, rib flare or lung function. No trial has tested this sequence.
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The movement on the figure: Side-lying open book
Each dose names its source or is our editorial starting point. Doses are starting points, not prescriptions.
Crocodile breathing for 5 minutes, about 4 seconds in and 6 out, is its move page's editorial starting point. Lateral breathing, 5 to 8 breaths, is its move page's suggested starting point, and the breath reach, 5 breaths breathing out for longer than in, is its move page's dose.
Pursed-lip breathing, 5 to 10 breaths sitting once or twice a day to learn it and then whenever you're breathless, is its move page's editorial dose. For COPD, pulmonary rehabilitation is the treatment with the evidence.
About 90 seconds for the back of the ribs and for each side, the move pages' dose from a review of rolling studies, at a pressure you can breathe through: harder pressure added nothing in a trial.
The open book, 8 to 10 each side with a 2-second pause; thread the needle, held for 30 to 60 seconds (5 to 10 breaths) each side, 2 rounds; the side-lying floor stretch, 20 to 30 seconds, 2 to 4 times each side; and the mermaid, 3 each direction each side. These are their move pages' editorial starting points.
There's no rib cage routine of its own. The fascia release for the back routine rolls the upper back and lats and includes the open book, and our breath pages teach slow breathing that widens the lower ribs.
In medicine, flaring lower ribs appear with chest wall deformities such as a sunken or pigeon chest, and can also appear on their own with no other abnormality.
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We found no study linking rib flare to fascia, or showing that release or exercise pulls the ribs in. Our rib flare guide found no study linking it to weak abs and no trial showing breathing exercises move the ribs. Rolling and breathing can make the rib cage feel freer, but they don't change its shape. The rib flare guide also covers when ribs that stick out on one side need a check for scoliosis.
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Breathe into the sides and back of the lower ribs; pursed-lip breathing is for breathlessness with COPD.
About 90 seconds for each area, off the neck and out of the armpit; skip rolling with osteoporosis, a rib injury or costochondritis.
Slow turns and side bends, breathing out into each one.
3D demoSide-lying open bookBeginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoThread the needle (Parivrtta Balasana)Beginner · No equipment
3D demoOverhead side bendBeginner · No equipment
3D demoSide-lying side-body stretchBeginner · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipmentStart with the fascia release for the back routine, which rolls the upper back and lats and opens the rib cage, and pair it with a breathing practice.
Gentle rolling for the upper back and lats, rotation and segmental spine work, then two easy strength moves. Exercise is what back-pain guidelines recommend.
15 minBeginner11 movesA foam rollerA 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.
12 minBeginner8 movesA foam roller, A wallA tight chest from desk work or pressing: a minute of ball release each side, a doorway stretch, then the back and shoulder-blade work that changed posture.
12 minBeginner7 movesA massage ball, A wallA 15-minute routine that moves your neck, upper back and lower back through bending, arching, side bending and twisting, then holds the spine steady.
15 minBeginner12 movesNo equipmentA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentA 25-minute home session for COPD: marching and light strength work, with pursed-lip and paced breathing and rests in a recovery position when you need them.
25 minBeginner12 movesA bench or box, A wallA 25-minute follow-along yoga practice for COPD: pursed-lip breathing, seated stretches, standing poses at a chair with blow-as-you-go breathing, and a rest.
25 minBeginner14 movesA bench or box, A wallWith osteoporosis, ask before rolling the upper back or ribs: the NHS notes that a cough or sneeze can sometimes break a rib. UK experts advise avoiding positions that round the spine a lot. In a case series of 3 rib fractures after spinal manipulation, the patients were aged 57 to 77 and two had thinning bones.
In later pregnancy, avoid lying flat on your back for more than a few minutes, so do rib and upper back work sitting or lying on your side.
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Keep the pressure light, or ask your doctor first, if you take blood thinners, which make bruising more likely, or have a nerve condition such as peripheral neuropathy: the NHS lists these among the reasons hands-on treatments may not be safe.
In an expert consensus of 37 researchers, open wounds and broken bones were reasons not to roll, and inflammation, a clot, a bone infection or bone forming in a muscle after an injury were at least reasons for caution.
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Soreness for a day or two is common. Bruising means the pressure was too hard. Dry needling near the chest, upper back, shoulders or neck can rarely collapse a lung; our dry needling guide covers it.
The 999 signs for chest pain are near the top of this page.
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Get urgent medical help: you're pregnant or have given birth in the last few weeks and have symptoms of pre-eclampsia, such as pain below the ribs, a severe headache that does not go away with simple painkillers, vision problems such as blurred vision or seeing flashing lights, sudden swelling of the face, hands or feet, heartburn that does not go away with heartburn medicines, being sick, or feeling very unwell. If you're pregnant, call your maternity unit if you have the number; if you've recently given birth or cannot call your maternity unit, call 111.
Diaphragm release improved diaphragm movement over 2 weeks in one trial of 20 people, but manual therapy doesn't change lung function in COPD, and pulmonary rehabilitation is the treatment.
Rib flare is the shape of the rib cage, with or without a chest wall deformity. We found no study linking it to fascia or showing that release changes it.
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A slipping rib is loose cartilage at ribs 8 to 10, assessed by a clinician, often with ultrasound. Pressure on the ribs can break them in people with thin bones.
It is inflammation where the ribs join the breastbone, no treatment has been tested in a trial, and pressing on the joints keeps them irritated. Our costochondritis guide covers what helps.
Dense fascia doesn't change shape under a roller, and rolling's effects run through the nervous system.
You can roll and stretch the muscles on the back and side of the rib cage, which eases how they feel for a while, mostly through the nervous system. Nothing shows it changes the fascia or the ribs themselves.
A therapist hooks their hands under your lower ribs and follows your breathing. In one small COPD trial it improved diaphragm movement and walking over 2 weeks, but manual therapy doesn't change lung function.
Breathe: crocodile and lateral breathing let the lower ribs widen. Don't push a ball or your fingers under your ribs; for lung disease, pulmonary rehabilitation is the treatment with the evidence.
On the back and side of the rib cage, gently, for most people. Don't roll over a rib you've hurt or with costochondritis, and ask first if you have osteoporosis, because a cough or sneeze can break a rib in thin bones.
Often from stiff upper back and side muscles, shallow breathing or a cough. Tightness with chest pain, breathlessness or a fever isn't a fascia problem: check the warning signs on this page.
No. Rib flare is the shape of the rib cage, sometimes with a chest wall deformity, and we found no study linking it to fascia. Our rib flare guide found no evidence that exercise moves the ribs.
We found no trial: no treatment for costochondritis has been tested in one. Pressing on the sore joints beside the breastbone keeps them irritated, and chest pain needs checking first.
Lateral breathing, rolling the upper back, the open book, thread the needle and side bends. They make the rib cage feel freer for a while; no trial has tested them for rib mobility.
We found no trial. Keep a gun off the bony edges of the ribs, the breastbone, the front of the chest and any rib you've hurt.
Call 999 for chest pain that feels tight or spreads to your arms, neck or jaw, sudden breathlessness, coughing up blood, or sharp pain on breathing in with breathlessness. After a serious accident, or with a broken rib and worsening breathlessness, call 999 or go to A&E.
Movement education, not medical advice. Stop for sharp or increasing pain, numbness or tingling, and get individual advice if you are pregnant, after an injury or surgery, or managing a health condition. Health disclaimer.
