Ribcage Biomechanics, Assessment, and Treatment

Many people are concerned about how their ribcage looks, feels, or moves. 

Issues like rib flares, slouched posture, barrel chest, and even conditions such as pectus excavatum can affect both mobility and comfort. Ribcage problems go beyond aesthetics and posture—they can influence breathing, movement, and even cause pain.

Having spent the last 13 years as a physical therapist working with thousands of patients on this area, I’ve found that each person’s case is unique. No one-size-fits-all solution works for everyone. Even if ribcage postures seem similar, we all have different bodies, so the way we improve mobility must be personalized.

In this blog, I’ll guide you through simple self-tests to understand which areas of your ribcage are restricted. Then, I’ll provide specific exercises to help you improve posture, mobility, and comfort in those areas.

The Ribcage’s 4 Quadrants 

We can divide the ribcage into four quadrants to better understand and address mobility issues:

1. Upper Chest (involving the sternal ribs)
2. Lower Chest (involving the lower ribcage)
3. Upper Back (between the shoulder blades)
4. Lower Back (lower part of the ribcage)

Restrictions in any of these areas can affect not only breathing and trunk rotation but also everything connected to the ribcage, such as the shoulders, neck, and even posture. The following tests will help you pinpoint where your restrictions are and which exercises you should focus on.

4 Mobility Tests

You don’t need to watch yourself breathe awkwardly in the mirror to figure out which areas of your ribcage are restricted. 

Instead, you can test shoulder range of motion. Each quadrant is related to certain movement directions. Here’s how you can test to see where your restrictions are. 

1. Shoulder External Rotation at side (Upper Back)

This test evaluates your upper back’s expansion, which influences ribcage movement.

How to Test:

1. Lie on your back with your arm at your side. 
2. Elbow bent to 90º
3. Let your arm fall to the side
4. Normal is 60º

What It Reveals:

If you can’t hit 60º, you are limited in upper back mobility. 

2. Shoulder External Rotation at 90 Degrees (Lower Chest)

This test helps you assess the expansion of the lower chest.

How to Test:

1. Lie on your back with your knees bent.
2. Extend your arm out to the side, forming a 90-degree angle with your body.
3. Bend your elbow so your forearm points toward the ceiling.
4. Let your arm fall toward the floor without arching your back.
5. Normal is 90º

What It Reveals:

If you can’t reach the floor with your wrist, you likely have lower chest mobility limitations.

3. Reaching Behind the Back – Upper  (Lower Back)

This test looks at lower back mobility. 

How to Test:

1. Look straight ahead
2. Reach one arm overhead to touch the opposite shoulder blade.
3. Keep your head straight and avoid looking down, arching your back, or shrugging your shoulder.

What It Reveals:

Limited ability to touch your shoulder blade, or back arching, indicates a restriction in your lower back/ribcage region. 

4. Reaching Behind the Back – Lower  (Upper Chest)

This test measures upper chest mobility and how easily your shoulder blade can be reached.

1. Reach behind your back and try to touch the bottom of the opposite shoulder blade.
2. Watch for any arching of your back or significant winging of your shoulder blade.

What It Reveals:

Difficulty reaching the opposite shoulder blade without compensating with your back or shoulders indicates upper chest restrictions.

Identifying Patterns

We will not improve each test individually. Most people have a cluster of restrictions that fit a pattern. Once you know your pattern, you can spend a few weeks focusing on exercises for that area. Afterward, retest yourself to track progress.

One of three things will happen:

1. Great results: Move on to other limitations.
2. Slight improvements: You may need more advanced exercises.
3. Still tight: Check your technique, or you may belong to the “hella stiff” category and need more passive exercises.

Common Patterns and Solutions

1. For Hella Stiff Ribcage (Limited in All Directions)

If you’re limited in all directions, the aim is to open up all areas of the ribcage to create space for movement. We focus on exercises that expand both the front and back of the ribcage.

Exercise 1: Sidelying Block Decompression

Purpose: Expands the ribcage front-to-back by compressing the sides.

• Steps:
  1. Lie on your side with a block or mat placed under your ribcage and pelvis.
  2. Reach your top arm toward the ceiling with a bent elbow.
  3. Breathe in slowly through your nose for five counts, then exhale softly through your mouth for five counts.
  4. Hold this position for 2–5 minutes, focusing on slow, controlled breaths.

Exercise 2: Sidelying Armbar with Kettlebell

Purpose: Adds lateral pressure to further expand the ribcage.

• Steps:
  1. Lie on your side, holding a kettlebell or dumbbell in your top hand.
  2. Rest your top leg on a foam roller, bent at 90 degrees of hip flexion.
  3. Roll slightly forward, keeping your chest and pelvis parallel to the wall.
  4. Hold the position for 60 seconds per side, breathing in through the nose and out through the mouth for five counts.

Exercise 3: Clamshell Slide Roll

Purpose: Enhances lateral ribcage expansion while maintaining pelvic stability. 

Steps:

1. Lie on your side with knees bent to about 60 degrees, feet stacked.
2. Rest your head on a pillow, arms extended forward at shoulder height.
3. Slowly slide your top arm over your bottom arm, reaching toward your chest.
4. As you roll, lift your leg up in the air
5. Roll for 2-5 minutes. Nasal breathe throughout.

Exercise 4: Side Hang

Purpose: Works the abs to open the front and back side of the body

Steps:

1. Straddle a bench or glute ham raise, positioning your torso parallel to the ground.
2. Cross your arms over your chest.
3. Hold for 30-60 seconds per side, aiming for 3-4 sets.
4. Slow, controlled breaths, inhaling for five counts through the nose and exhaling for five counts through the mouth.

2. For Rib Flare (Limited Lower Back and External Rotation)

People with rib flare tend to arch their lower back and experience flaring of the ribs. These exercises aim to create space in the lower back and bring the ribcage into alignment.

Exercise 1: Prone Breathing with Pads

• Purpose: Aligns the lower ribcage and reduces rib flare.
• Steps:
  1. Lie on your stomach with a pad or firm pillow under your lower ribs and pubic bone.
  2. Rest your arms overhead with your elbows and wrists pressing lightly into the ground.
  3. Focus on keeping your lower ribs in contact with the pad.
  4. Inhale slowly for five counts through your nose, and exhale softly through your mouth.
  5. Repeat for 3–4 sets of 60 seconds.

Exercise 2: Sidelying Swiss Ball Breathing

Purpose: Promotes ribcage expansion through pressure applied by the ball. 

Steps:

1. Lie on your side with a Swiss ball between your knees and hands.
2. Rest your head on a pillow.
3. Gently press the ball with your hands and knees at a 2-4 out of 10 effort.
4. Hold for 60 seconds per side, completing 3 sets.
5. Maintain slow nasal inhalations and mouth exhalations, five counts each.

Exercise 3: Supine Frog Breathing with Reach

Purpose: Engages the abdominals to shift weight and align the ribcage.

Steps:

1. Lie on your back with your hips and knees bent at 90 degrees, feet together.
2. Place your hands on a ball between your knees and press down gently.
3. As you inhale, let your belly rise. Exhale while maintaining gentle pressure on the ball.
4. Hold this position for 60 seconds, focusing on breathing slowly and deeply.

Exercise 4: Flutter Kicks

Purpose: Improves lower ribcage expansion and engages the lower abs. 

Steps:

1. Lie on your back with hips bent at 90 degrees, arms raised to 100-120 degrees of shoulder flexion.
2. Straighten your knees, flattening your low back against the floor.
3. Slowly move your legs up and down while keeping your back flat.
4. Breathe in through the nose and out through the mouth for five counts, aiming for 3-4 sets of 60 seconds.
5. Progress by going lower to the ground without losing back position.

3. For Slouched Posture (Upper Chest Restriction)

In slouched or kyphotic postures, the goal is to open the front of the ribcage without causing excessive strain on the back. This helps to improve posture by freeing up the upper chest area.

Exercise 1: Block Breathing with Hand Overhead

Purpose: Opens up the front of the ribcage, especially the upper chest.

• Steps:
  1. Lie on your side with a block or firm pad under your ribcage and pelvis.
  2. Place your top hand behind your head, keeping your elbow slightly flared out.
  3. Press down on your head lightly, engaging your bicep muscles.
  4. Breathe in through the nose and exhale softly through the mouth for five counts.
  5. Hold for 60 seconds per side, focusing on controlled, deep breaths.

Exercise 2: Pad Prone Press Up

Purpose: Expands the lower ribcage and relieves tension in the lower back. 

Steps:

1. Lie on your stomach with a pad or firm pillow under your lower ribs and pubic bone.
2. Extend your arms overhead, resting them on the ground with elbow creases at eye height.
3. Press the base of your wrists and elbows gently into the ground (3-4 out of 10 effort).
4. Lift your chest slightly while keeping your lower ribs in contact with the pad.
5. Hold this position for 60 seconds, performing 3-4 sets.
6. Breathe slowly, inhaling through the nose for five counts and exhaling through the mouth for five counts.

Exercise 3: Swiss Ball Backward Bend

Purpose: Expands the chest and stretches the front ribcage.

Steps:

1. Lie on your back over a Swiss ball with your head tipped backward.
2. Place your hands on your head, letting your elbows flare outward until you feel a light stretch.
3. Press your elbows gently into your head, activating your biceps.
4. Breathe deeply for 3–4 sets of 60 seconds.

Exercise 4: Bar Hang

Purpose: Enhances shoulder and ribcage decompression. 

Steps:

1. Grip a bar with your feet supported, letting your body sag downward.
2. Keep your chest relaxed and arms extended.
3. Hold for 60 seconds, performing 3-4 sets.
4. Maintain slow nasal breathing throughout, inhaling for five counts and exhaling for five counts.

4. For Dowager’s Hump or Forward Head Posture (Upper Back Restriction)

For people with forward head posture or a Dowager’s hump, the focus is on releasing tension in the upper chest while expanding the upper back.

Exercise 1: Block Breathing with Hand Overhead

Purpose: Opens up the front of the ribcage, especially the upper chest.

Steps:

1. Lie on your side with a block or firm pad under your ribcage and pelvis.
2. Place your top hand behind your head, keeping your elbow slightly flared out.
3. Press down on your head lightly, engaging your bicep muscles.
4. Breathe in through the nose and exhale softly through the mouth for five counts.
5. Hold for 60 seconds per side, focusing on controlled, deep breaths.

Exercise 2: Crime Scene Pose

Purpose: Opens up the upper back to release tension.

Steps:

1. Lie on your stomach with one arm out to the side and your leg bent outwards.
2. Press your wrist, elbow, and knee gently into the ground.
3. Keep your ribs in contact with the floor.
4. Breathe in through your nose for five counts, then exhale softly for five counts.
5. Hold this position for 60 seconds, alternating sides.

Exercise 3: Incline I Breathing

Purpose: Encourages upper back expansion.

Steps:

1. Lie on an inclined surface, such as a bench, with your arms at your sides and palms facing upward.
2. Hold light weights in your hands for added resistance.
3. Keep your chest open and relax your neck.
4. Hold for 60 seconds, breathing slowly and deeply through the nose and out through the mouth.

Exercise 4: Swiss Ball Backward Bend

Purpose: Expands the chest and stretches the front ribcage.

Steps:

1. Lie on your back over a Swiss ball with your head tipped backward.
2. Place your hands on your head, letting your elbows flare outward until you feel a light stretch.
3. Press your elbows gently into your head, activating your biceps.
4. Breathe deeply for 3–4 sets of 60 seconds.

5. For Barrel Chest (Lower Back and Upper Chest Restrictions)

People with barrel chest have a more rounded ribcage, which limits their ability to expand properly. These exercises help to decompress the ribcage and improve overall mobility.

Exercise 1: Face Down Swiss Ball Breathing

Purpose: Promotes lower ribcage expansion and abdominal engagement. 

Steps:

1. Lie face down over a Swiss ball, with your chest and abdomen draped over it.
2. Rest your forehead on your hands for support.
3. Allow your belly to sink into the ball, feeling gentle pressure against your abdomen.
4. Take slow breaths, inhaling through the nose for five counts and exhaling through the mouth for five counts.
5. Maintain this position for 60 seconds, completing 3-4 sets.

Exercise 2: Seated Posterior Expansion with External Rotation

Purpose: Expands the back of the ribcage.

Steps:

1. Sit upright with a mini band around your wrists.
2. Rest your elbows on a table at about a 60-degree angle.
3. Rotate your arms outward, focusing on keeping your chest parallel to the wall.
4. Maintain light tension and breathe deeply for 3–4 sets of 60 seconds.

Exercise 3: Shoulder Roll with Rib Expansion

Purpose: Enhances mobility in the upper back and ribs.

Steps:

1. Sit upright and slowly roll your shoulder blades together.
2. Keep your chest open and breathe deeply, expanding your back as much as possible.
3. Perform this movement for 3–4 sets of 60 seconds.

Exercise 4: Cicinelli Turtle Roll

Purpose: Enhances trunk rotation and overall core stability, while facilitating ribcage mobility. 

Steps:

1. Sit on the floor with a yoga block placed between your knees and elbows.
2. Keep your knees together and elbows pressed against the block.
3. Start by rolling backward while inhaling slowly, keeping the block between your limbs.
4. As you roll forward, exhale slowly, maintaining contact with the block.
5. Perform 10 attempts per set, aiming for 3-4 sets total.
6. Move slowly to prevent dizziness and ensure smooth, controlled breathing.

6. For Asymmetrical Rib Flare (One-Sided Rib Flare)

If you have an asymmetrical rib flare, where one side is restricted while the other side moves more freely, the goal is to correct this imbalance by working on the restricted side first.

Exercise 1: Salamander Pose

Purpose: Targets the restricted side of the ribcage.

Steps:

1. Lie on your stomach with one knee bent to the side and the opposite arm extended.
2. Press your inner knee and elbow into the ground gently.
3. Keep your ribs in contact with the ground as you breathe deeply.
4. Hold for 60 seconds, alternating sides.

Exercise 2: Side-Lying Armbar Roll

Purpose: Aligns the ribcage and corrects asymmetry.

Steps:

1. Lie on your side holding a kettlebell in your top hand.
2. Roll slowly to your back, focusing on breathing deeply.
3. Maintain alignment and hold the position for 60 seconds before rolling back.

Exercise 3: Get Up to Elbow

Purpose: Builds core stability and initiates controlled ribcage rotation. 

Steps:

1. Lie on your back with one arm extended overhead and the other arm resting by your side.
2. Bend the knee on the same side as the extended arm, keeping the other leg straight.
3. Inhale deeply, then exhale as you push through your bent leg and down arm to roll onto your side.
4. Continue to rise onto your elbow, keeping your chest open and shoulders relaxed.
5. Hold for 2-3 seconds before lowering back to the start position.
6. Perform 3-4 sets of 6-8 reps per side, maintaining slow, controlled breathing.

Exercise 4: Bird-Dog Slide to Bear Dog Slide

Purpose: Improves core and ribcage stability, while challenging full-body coordination.

Steps:

1. Start on your hands and knees, maintaining a neutral spine with shoulders stacked over wrists and hips over knees.
2. Inhale as you extend one arm forward and the opposite leg backward (bird-dog position).
3. Exhale and slowly shift your weight forward, raising your knees off the ground into a bear dog slide.
4. Keep your back flat and core engaged as you slide one arm and opposite leg outward.
5. Inhale to return to the start position, keeping the knees elevated if possible.
6. Perform 3-4 sets of 6-8 reps per side, focusing on controlled breathing and movement.

Final Thoughts

It’s not uncommon for ribcage issues to coincide with shoulder problems. If that’s the case, you might want to address both. Check out our guide on fixing shoulder issues for more detailed steps on improving shoulder mobility alongside ribcage restrictions.

Start working on your cluster of restrictions today, and with consistent practice, you’ll see improvement in how your ribcage moves and feels!