What is a rib flare and how to correct it?
Did you notice a shift in your bra size after babies?
Me too.
After both of my pregnancies there was one thing big thing I noticed — none of my bras fit. My cup size had increased when my milk came in, but the diameter of my ribcage had also shifted. Prior to pregnancy I was in a 32C, and suddenly I needed a 36. But why? Let’s dive in, and add this to our list of postpartum sh*t people don’t talk about.
What is a rib flare?
Firstly, your rib cage will get wider in pregnancy to accommodate for a growing human :) As the baby grows your internal organs are pushed upwards, and the rib cage becomes wider and tips upward to accommodate the demand. Some women naturally go back to their pelvis and rib cage resting position after baby, and some don’t.
We can think of rib flare presenting two ways during pregnancy and postpartum (as my colleague Laura noted here):
The entire ribcage flares up as a unit (more of a bilateral presentation), creating a hinge point in the spine. I like to think of this as an “open scissor” presentation.
The rib cage angle (infrasternal angle) itself becomes wider.
As the belly grows, the body shifts to accomodate. You may notice a more ribs flared position.
What is a rib flare? Continued.
A rib flare is an external rotation of the rib. Sort of like your rib is popped open — almost as if you could fit a hand under there!
Your rib cage is meant to be dynamic, meaning it can change shapes depending on the task at hand. We need to be able to expand and compress different parts of the rib cage. So, when we inhale the rib cage can open, and when we exhale the ribcage should be able to close (think closing the front door). The angle on the front side of the rib cage (infrasternal angle) becomes small on exhales and bigger on inhales.
With a rib flare, getting a good exhalation can be tricky! This could be bilaterally (both sides) or perhaps just on one side. Oftentimes, more so on the left. Most people have some left rib flare due to the diaphragm attaching lower on the right side. It’s easier for our body to keep that right rib in check and tucked in.
Rib flare postpartum, often more pronounced on the left
When the ribs are not in an optimal position, air will take the path of least resistance. If, for example, we have a left rib flare / rib popped open, that’s an easy path for air to travel. Breath will pop up on the left front, which may lead to arching and compression through the left low back. We’re then never really able to stabilize and “own” that left side and the obliques.
Is a Rib Flare bad?
A rib flare isn’t inherently bad, but it is something we want to address. Rib flare both bilaterally and on one side leads to muscular imbalances, possible pelvic floor symptoms, and other aches and pains.
Low back pain: if the ribcage is flared upward (on one side or two) the abdominal muscles are in a stretched state. In the case of the left rib flare, the left obliques are not working as they should. We need that exhalation to get them on board ;) And if we are open and flared on the front left, we are then compressed on the back left. Do you have a low back that feels tight all the time?
Breathing gets tricky / pressure management: if the ribcage is flared up, the body (or possibly one side) is stuck in a greater state of inhalation, which impacts the diaphragm’s function. The diaphragm is a key player in spinal stability as a member of our core team. And if the pelvic floor / diaphragm are not able to function as a team, you may notice pelvic floor symptoms that seem to stick around, such as diastasis recti, pelvic floor tension, prolapse symptoms, or leaking.
How to address rib flare: breathing is powerful
One of the best ways to improve rib flare is through breath. More specifically, focusing on the exhale. If you get a great exhale, then it’s easier to take a good inhale.
Tune in to HOW you exhale: In an effort to get a good exhalation, sometimes we may OVERuse the six pack muscles (rectus), almost “crunching down.” This gives the impression of closing the ribs, but often brings the chest and pump handle down and may contribute to pressure leaks in the system (e.g. leaking, pelvic organ prolapse). I like to cue exhaling the ribs back versus exhaling the ribs “down” towards the pelvis. Starting in a supine position (on your back) or against the wall can be helpful for references and feedback.
Exhale and Pause: A progression
When focusing on the exhalation, we want to focus on getting a full exhalation.
Controlled inhalation versus popping open and flaring the ribcage
Long “haaaa” exhalation (soft, long, and controlled) until you’ve run out of air, then pause (watch for any bearing down).
When we exhale completely and with control we can use our obliques to get the full closing of the ribs. You can progress to adding a pause at the end of your exhale. 1 Mississippi, 2 Mississippi, then inhale again. You should then feel more expansion on the inhale.
Exercises to address rib flare
1.Breath and body position: The first step (as noted above) is to work on the breath and tuning into your position throughout the day. Do you notice your rib cage flared up? Focus on a soft long exhale as described above. Watch that you do not grip your glutes or abdominals in an effort to get your ribs “down.” Relax and breathe yourself into position.
Feeling stuck when trying to inhale?
2.Posterior Expansion: Being able to expand well through the front, back, and sides during inhalation, and then take a FULL exhalation is huge for addressing rib flare, pelvic floor symptoms, and feeling like you can get in a good breath.
Below is are a few of my favorite breathing exercises for expansion on the back and sides.
3. Work on pelvis position: Oftentimes with a rib flare we are in a more extended posture (open scissor). Not only do we want to look at the rib cage, but we also want to look down at the pelvis. Working on something like 90/90 breathing can help reposition the pelvis front to back, recruiting both the deep abs and hamstrings. Being in a supine position can also provide feedback from the floor for your exhales.
Additional Strength Work
Below I have included three exercises to incorporate to address rib flare. Give these a try, tuning into good rib position and pelvis position. Move slowly and focus on long exhalations.
Supine Pullover with Exhale
I love practicing the exhalation, but with a pullover. This one I am really working on in my own body :)
Side Plank for Rib Flare
I love a side plank for addressing rib flare, especially working the side where the rib flare is present. You can start with 2 sets of 3-5 breaths.
3. Diagonal Pulldown Exercises
Overall we are looking at movements to promote more internal rotation of the ribs, especially on the affected side. You can pull across and hold and breath OR go for a rep count. Tune in to rib position and exhale the ribs back versus crunching down.
Other exercise ideas include:
Bridge March with Pulldown: adding in a pulldown from overhead can also encourage the ribs down position, but watch out for the crunching down sensation. I like adding the cross knee press to really bring in the diagonal pattern.
How long does it take to fix a rib flare?
Hard to give a specific timeline. But, you can make big improvements through purposeful breath work, mindful strength training, and body awareness. If you’d like to learn more I recommend connecting with a Pelvic Floor Physical Therapist or a coach, like myself. I’d love to chat and learn more about supporting you in your Postpartum Fitness journey.
xoxo,
Erica