What Are Flared Ribs?
If you have ever looked in the mirror and noticed the lower edge of your rib cage jutting forward or sticking out more than the ribs above it, you are seeing what is commonly called flared ribs, sometimes written as rib flare or rib flaring. In this article i will go over exactly what are flared ribs, the causes, and how to best treat them.
What Are Flared Ribs in Anatomy?
Anatomically, the human rib cage is a ring of bones and cartilages that attaches to the breastbone in front and the spine in back. The lower ribs are more mobile because they end in cartilage rather than directly on the sternum, so changes in posture, muscle balance, or the shape and growth of the cartilage can make the lower margin of the rib cage appear to “flare” outward. When that prominence is particularly marked it alters the chest silhouette, can make clothing fit oddly, and cause the appearance of a ‘pot belly’.
What aren’t flared ribs?
Some people may worry they have flared ribs when in reality they only have poor posture. A normal rib cage may appear to flare out if the abdominal muscles are weak and the upper posture is overly protruding. This is not what is defined as ‘flared ribs’ but rather just poor posture. Flared ribs are defined as an abnormal growth in the shape of the lower ribs which cause them to protrude outward in the presence of normal posture, although poor posture can make the condition appear worse.
What Are Flared Ribs in Pectus Excavatum?
Flared ribs are commonly, though not exclusively, seen alongside pectus excavatum, which is the medical name for a sunken or “funnel” chest. In many people who have pectus excavatum, the breastbone and costal cartilage grow in a way that pulls the center of the chest inward while allowing the lower ribs to splay outward, making the rib flare particularly noticeable. Rib flaring therefore can be both an aesthetic issue and a structural consequence of how the chest wall developed in those individuals.
Symptoms of Flared Ribs
People notice flared ribs for different reasons. For some, the concern is cosmetic: the lower ribs are visible beneath clothing, or the chest looks asymmetric when arms are raised. For others, the concern is functional: rib flare can change posture, and reduce core stability. If flared ribs are part of a pectus excavatum deformity, symptoms such as shortness of breath, chest pain, or reduced exercise tolerance may also be present.
Causes of Flared Ribs
Causes of flared ribs are usually a mix of structural and functional factors. Structural causes include congenital or developmental differences in the shape of the sternum and costal cartilage, which often show up during the adolescent growth spurt. Postural contributors include weak or imbalanced core and abdominal musculature, habitual anterior pelvic tilt and rounded shoulders. For people who have pectus excavatum, the underlying abnormal growth of cartilage that alters the sternum’s position can make rib flaring much more likely.
Diagnosis: How Are Flared Ribs Identified?
A medical evaluation for flared ribs starts with a careful physical exam and history. A specialist will look at chest shape at rest and during movement, check for asymmetry and for how the rib flare changes when you lie down or raise your arms, and assess posture and core strength. If the flared ribs are suspected to be part of a larger chest-wall deformity such as pectus excavatum, imaging such as chest X-ray or CT scan may be used to quantify the deformity and to measure indices that judge severity. A proper diagnosis will help rule out rib flare caused by bad posture versus a chest wall deformity such as pectus excavatum.
Treatment Options for Flared Ribs
Treatment depends on what is causing the flare and how much it affects function or body-image. For many people, a program of targeted physical therapy that includes progressive core and oblique strengthening can reduce the prominence and improve posture. For younger patients with flexible chest walls or those seeking non-surgical correction, external bracing or rib-flare straps and braces are used by some centers to apply gradual pressure and guide the ribs toward a less prominent position.
For people whose flared ribs are part of a significant pectus excavatum deformity, treatments aimed at the central deformity, such as vacuum bell therapy in suitable candidates or surgical correction are considered. Surgical correction may address the sternum and ribs and can improve both function and appearance in appropriately selected cases. Discussing options with a chest-wall specialist is the first step to getting appropriate treatment.
Realistic Expectations With Flared Ribs Treatment
When rib flare accompanies pectus excavatum, correction of the central chest depression with surgery often fixes rib flare, but not always. Sometimes it doesn’t fully resolve the rib prominence unless the rib flare is treated directly at the same time or with adjunctive measures (such as bracing). Pectus surgeons often forcibly push the ribs inward and bend them back to shape during the Nuss procedure.
If you have rib flare and are seeking surgery for Pectus Excavatum, it may be worth talking to your surgeon about rib flare treatment during the surgery.
Conclusion: What Are Flared Ribs?
In brief, flared ribs describe an outward prominence of the lower rib cage that can appear alone or as part of pectus excavatum. The condition can be managed through abdominal strengthening and bracing for selected patients, or surgery when the deformity is severe or associated with pectus excavatum. Getting assessed by a chest-wall specialist is the best step to determine the cause of the rib flare and find the best treatment method.
References
NHS England. Evidence review: Surgical correction for pectus deformity (all ages). NHS England; 2019. Review of outcomes and indications for Nuss and Ravitch procedures. NHS England
Kelly RE Jr., Goretsky MJ, Nuss D. Analyzing outcomes of Nuss and Ravitch repair for primary and recurrent pectus excavatum. The Annals of Thoracic Surgery. 2020. Comparative outcomes and complication data for adult and pediatric repairs. Annals of Thoracic Surgery
Martinez-Ferro M, et al. Ravitch versus Nuss procedure for pectus excavatum: systematic review and meta-analysis. Annals of Cardiothoracic Surgery. 2016–2017. Meta-analysis comparing open and minimally invasive approaches. Annals of Cardiothoracic Surgery
Jansen SM, et al. Vacuum bell therapy for pectus excavatum: retrospective study and long-term follow-up. BMC Pediatrics. 2023/2024. Assessment of non-operative vacuum bell outcomes and factors associated with correction. BioMed Central
Long-term experience with vacuum bell therapy for pectus excavatum. Journal of Pediatric Surgery. 2024. Fifteen-year single-center data describing durability and selection criteria for vacuum bell non-surgical therapy. jpedsurg.org
Pulmonary/Cardiothoracic centers & physiotherapy resources: Physiotherapy information after pectus surgery. Royal Papworth Hospital (NHS). Patient information leaflet describing chest-wall growth, rehabilitation and breathing retraining. 2016–2018. Royal Papworth Hospital
Kiliç D, et al. Physiotherapy in addition to vacuum bell therapy in patients with pectus excavatum. Interactive CardioVascular and Thoracic Surgery. 2019. Study examining benefits of adding physiotherapy to vacuum bell treatment. Oxford Academic