When Shoulder Pain Starts in the Rib Cage — The Overlooked Cause of Shoulder Dysfunction

By Dr. Rhiannon Dickison | Founder of RouteHealth & Creator of the AiMS Process

Why Shoulder Pain Isn’t Always a Shoulder Problem

Many people with shoulder pain focus on the joint itself — stretching, strengthening, or massaging around the deltoid or rotator cuff. But what if the real problem starts beneath the shoulder? The rib cage forms the foundation for scapular movement and stability. When this foundation is restricted, every shoulder motion becomes compromised.

The Rib Cage–Shoulder Connection

The scapula doesn’t float in space — it glides over the rib cage. The rib cage provides the base for shoulder stability and movement efficiency. If the ribs are stuck, rotated, or elevated, the scapula can’t move as it should. This leads to:

• Poor upward rotation or posterior tilt.

• Increased tension through the upper traps and levator scapulae.

• Impingement-type symptoms or anterior shoulder pain.

Common rib dysfunctions include:

• Fixation at the costovertebral or costotransverse joints (especially ribs 2–6).

• Elevated ribs from chronic chest breathing or stress.

• Loss of thoracic rotation limiting overhead reach and arm swing.

Breathing and Posture: The Hidden Drivers

Breathing and posture dictate rib movement.When you breathe shallowly or hold tension in your chest, the upper ribs stay elevated and the diaphragm can’t descend fully. This creates a cascade:

1. The ribs stop moving.

2. The scapula becomes unstable.

3. The shoulder compensates with excessive tension and faulty movement patterns.

At RouteHealth, I address this by retraining breathing mechanics and rib mobility before adding strength work.

Symptoms That Suggest Rib Involvement

• Shoulder pain that worsens with a deep breath.

• Pain behind or under the shoulder blade.

• Clicking or catching when raising the arm.

• Pain lying on the affected side.

• Stiffness in the upper back or mid-thorax.

How to Fix It: The AiMS Framework

The AiMS Process (Activate, Integrate, Mobilize, Strengthen) restores shoulder health by addressing the true source — rib and thoracic dysfunction.

1. Activate

   • Breathing drills (90/90 rib expansion).

   • Intercostal release and diaphragm activation.

   • Extension over foam roller.

   
   

2. Integrate

   • Scapular wall slides with controlled exhalation.

   • Quadruped rotations or reach-roll-lifts.

3. Mobilize

   • Rib and thoracic extension drills (foam roller, open book).

   • Tall Kneeling

4. Strengthen

   • Serratus anterior, lower trap, and rotator cuff integration.

By restoring rib movement, the shoulder regains its stability, strength, and effortless mobility.

The Takeaway

Shoulder pain rarely lives in isolation. When the rib cage becomes rigid, the shoulder loses its foundation. By restoring breath, mobility, and integration, we can eliminate chronic shoulder pain and build true resilience. If your shoulder hasn’t responded to traditional care, it’s time to look deeper — at your ribs, your breathing, and your foundation.

Ready to restore shoulder freedom? Work with me through to uncover and correct the real source of your shoulder pain.

Dr. Rhiannon

Founder of RouteHealth