Rib flare is a term that you may often hear in the postpartum rehab world, but what is it exactly? If you are newly postpartum you have likely experienced rib flaring as a result of your body’s natural instinct to push the ribs up and open to make room for baby. Rib flare is easily identified when you can see your bottom ribs protruding. Rib flare can refer to two different things. One is rib positioning, and one is rib angle.
Rib positioning is when your posture affects the positioning of your rib cage. Sometimes posture is affected by tightness and restrictions forcing it into different positions, and sometime it is simply a habit of how we hold our bodies. Although, there is no such thing as perfect posture, having the rib cage line up with the pelvis improves the ability of the pelvic floor and diaphragm to work as they should, in unison. Pelvic floor Physiotherapist Sarah Duvall uses the analogy of rib cage and pelvis malalignment to that of an engine belt in a car being “off”. “The car will still run, but you get that annoying squeaking noise. If you have less than optimal posture most of the day, your body will start to squeak at you in the form of aches and pain or perhaps diastasis and pelvic floor issues that won’t improve”.
Rib flare caused by the rib angle can be harder to address as it involves changing how your muscles fire. The small muscles that run between your ribs are called your internal intercostals and they work with the abdominals to produce a forced exhale. When your ribs are flared, there is no integration between your diaphragm and the abdominal muscles and you become “stuck in a state of inhalation”. When you have good rib positioning, the overlap of your diaphragm and abdominal muscles is called a ZOA, or zone of apposition. Duvall states that "when your ribs are flared, the ZOA is lost, causing poor diaphragmatic pressure (aka not so great breathing) and poor activation of your abdominals”.
When your ribs are stuck in a flared position, it is impossible to completely exhale. This in turn causes your upper back, or thoracic spine, to be pulled forward into extension-compromising scapular glide as well as your shoulder range of motion and stability. Not being able to fully exhale can also lead to low back pain and pelvic floor dysfunction. In order for your pelvic floor to function properly, you must be able to breathe properly. With flared ribs, your diaphragm is generally being pulled back not allowing you to take a proper full breath. If you are unable to complete your exhale, your lumbar spine is pulled forward into extension and your pelvis into an anterior tilt which may result in tight hip flexors, back extensors and weak abdominals, glutes and hamstrings.
In conclusion, everything is connected. Rib flare doesn’t allow you to expand properly through the front, back and sides of your diaphragm during inhalation, and take a FULL exhalation. Getting your ribs down and in and getting a great exhale can go a long way for your overall health. I hope this helps explain what rib cage flare or rib cage angle means and gives you a helpful point of reference for reflecting on your posture.