What Is Rib Flare and How to Fix It Properly

What Is Rib Flare?

Rib flare, also known as rib flaring, is a chest abnormality characterized by protrusion of the lower rib cage region. This occurs due to the lower ribs and costal margin (the cartilage connecting these ribs to the breastbone) being pulled upward, causing them to stick out.

The protrusion typically becomes more obvious when the arms are raised over the head. Rib flare can occur on both sides of the rib cage or just one side. In the latter case, it occurs more commonly on the left side of the chest. As with pectus carinatum, rib flare usually becomes more prominent during puberty.

There may also be rib flattening in some patients, which presents as a flattened or slightly depressed region between the sternum (upper part of the breastbone) and costal margin (the section below the breastbone). This often occurs only on one side of the body. 

Rib flare is predominantly seen as an aesthetic consideration rather than a health issue. However, effective treatment is essential for improving patients' body self-image and quality of life.

What Causes Rib Flare?

There are several possible reasons which may cause protrusion of the lower ribs and costal margin. The vast majority of rib flare cases occur in conjunction with pectus carinatum or pectus excavatum and thus are associated with overgrowth of the breastbone cartilage region.

In many cases, rib flaring may appear to be the most significant abnormality, with the pectus carinatum or pectus excavatum appearing less obvious. Rib flare may also occur by itself in rare cases.[1]

Other conditions may cause a flared rib cage, including:

• Excessive curvature of the lower spine (hyperlordosis).
• Ineffective use of the diaphragm for breathing (causing over-activity of compensatory muscles in the lower rib region).
• Weak abdominal muscles (this may occur postpartum or due to other causes).

These cases of flared ribs are not typically classified as rib flare deformities, as they are more associated with the abdominal/rib muscles rather than a physical abnormality of the costal cartilage—as is the case with congenital rib flare. Nevertheless, the treatments described in the following section may also effectively treat flared ribs in these conditions.

How Do You Fix Rib Flare?

Orthotic rib braces are the recommended choice for treating rib flare in most patients. These work similarly to braces for pectus carinatum—acting by compressing the lower rib region, causing remodeling of the costal cartilage into the desired shape.

Braces are most effective in the early pre-teen/teen years, while the costal cartilage is still pliable. However, some benefits from rib bracing can even be seen in adults. 

Some studies have shown that pectus carinatum compression braces can exacerbate rib flare in patients suffering from both pectus carinatum and rib flare.[2–3] Consequently, these patients should use a brace that treats both conditions simultaneously, like the Bison Brace.

It is important to note that rib belts or binders should not be used to treat rib flare. These belts are designed to reduce pain from fractured ribs or strained chest muscles and apply concentric pressure to the rib cage.

In other words, there is as much pressure applied to the sides as there is from the front and back, which can push the affected ribs forward, making the problem worse. Rib flare braces apply anteroposterior (front-to-back) pressure, which pushes the flaring ribs back into the rib cage, thus reducing the amount of flare.

In mild cases of rib flare, physiotherapy exercises may be an option for reducing the visual protrusion. These include abdominal exercises to strengthen the core muscles and breathing exercises to realign the ribs slightly. Although these may make the condition somewhat less visible, exercises will not fix rib flare. In addition, they require a high level of dedication and hard work from the patient to be effective.

On the other end of the spectrum, surgery is typically the last line of resort for treating rib flare. The process is generally highly invasive and involves breaking and repositioning the ribs.

However, less invasive forms of surgery have been successfully trialed for reducing rib flare.[4] Surgical procedures for pectus carinatum and pectus excavatum do not typically improve rib flare and may even worsen the flaring.

How the Dakota Brace Solutions Can Help

To be effective, rib flare braces should be comfortable, high-quality, and custom-made to your child's body shape. The team at Dakota Brace specializes in creating custom braces to perfectly fit patients using the latest 3D printing technology.

This provides the best customer experience while maintaining short turn-around times and a high level of clinical accuracy. At Dakota Brace, we offer both individual braces for rib flare and combination braces for rib flare and pectus carinatum. For more information on our custom braces, visit our brace collection page.

Everything is done remotely* in a way that fits your schedule, yet never compromises on quality. Are you ready to restore your child's health and confidence?

Get a free consultation with Dakota Brace today and $75 off your first order, and get evaluated for either our Custom Rib Flare Brace (The Rider Brace) or our Custom Pectus & Two Rib Flare Brace (The Bison Brace).

*Note: You will need access to an iPhone X or later to do your initial scan.

References

1. Haleem, A., Hanif, M. S., Majeed, F. A., Wyne, A., & Rahim, K. (2015). Frequency of anomalies associated with chest deformity in physically fit male candidates reporting for military recruitment. PAFMJ, 65(2), 170-174.
2. Haje, S. A., & Haje, D. P. (2006). Overcorrection during treatment of pectus deformities with DCC orthoses: experience in 17 cases. International Orthopaedics, 30(4), 262-267.
3. Hunt, I., & Patel, A. J. (2020). Effectiveness of Compressive External Bracing in Patients with Flexible Pectus Carinatum Deformity: A Review. The Thoracic and Cardiovascular Surgeon, 68(01), 072-079.
4. Bosgraaf, R. P., & Aronson, D. C. (2010). Treatment of flaring of the costal arch after the minimally invasive pectus excavatum repair (Nuss procedure) in children. Journal of Pediatric Surgery, 45(9), 1904-1906.