Treatment for Bruised Ribs (Rib Contusion)
For a bruised rib (rib contusion without fracture), begin with scheduled acetaminophen 650-1000 mg every 6 hours as the foundation of pain management, add NSAIDs if pain persists, apply ice packs for 15-20 minutes several times daily, and perform gentle deep breathing exercises 3-4 times daily to prevent chest tightness. 1
Pain Management Algorithm
First-Line: Acetaminophen
- Take acetaminophen 650-1000 mg orally every 6 hours on a scheduled basis, not just when pain occurs. Scheduled dosing provides superior pain control compared to as-needed dosing. 1, 2
- Oral acetaminophen is equally effective as intravenous formulations for pain control. 1, 2
Second-Line: NSAIDs
- Add ibuprofen 400-600 mg or naproxen 500 mg if acetaminophen alone does not achieve adequate pain relief. 1, 3
- Avoid NSAIDs if you have kidney disease, active stomach ulcers, aspirin-induced asthma, or are taking blood thinners. 1
- If you are elderly and NSAIDs are prescribed, request a proton-pump inhibitor to protect your stomach. 1
Third-Line: Tramadol (if needed)
- Tramadol 50-100 mg every 4-6 hours (maximum 400 mg/day, or 300 mg/day if over 75 years) can be added if acetaminophen plus NSAIDs are insufficient. 1
- Do not use tramadol if you have a history of seizures, as it lowers the seizure threshold. 1
- Avoid tramadol if you have uncontrolled depression or are taking other sedating medications. 1
Reserve Opioids
- Stronger opioids should only be used for severe breakthrough pain unresponsive to the above regimen. Elderly patients are particularly vulnerable to respiratory depression and oversedation from opioids. 1, 2
Non-Pharmacological Measures
Ice Application
- Apply ice or cold compresses to the painful area for 15-20 minutes several times daily. This provides additional pain relief when combined with medications. 1, 3
Breathing Exercises
- Perform gentle deep breathing exercises 3-4 times daily to prevent chest tightness and maintain lung function. 3
- Use incentive spirometry while sitting, taking slow deep breaths and holding for 3-5 seconds before exhaling. 2
- Continue these exercises for at least 2-4 weeks to prevent respiratory complications. 2
Activity Modification
- Gradually return to normal activities as pain allows, but stop if pain worsens. 3
What NOT to Do
Do not use rib belts or circumferential chest wrapping. A prospective randomized study found that rib belts do not significantly reduce pain severity but are associated with increased complications including bloody pleural effusion, atelectasis, and contact dermatitis. 4
Expected Recovery Timeline
- Most rib contusions resolve within 6-8 weeks with appropriate pain management and activity modification. 3
- Pain typically improves significantly by 4 weeks with proper treatment. 1, 3
- Complete functional recovery usually occurs within 8-12 weeks for straightforward cases. 3
Warning Signs Requiring Immediate Medical Attention
Seek emergency care if you develop:
- Increasing shortness of breath or difficulty breathing 1, 3
- Fever above 100.4°F (38°C) 3, 2
- Chest pain that suddenly worsens or feels different from the rib pain 1, 3
- Productive cough with yellow, green, or bloody sputum 3, 2
- Dizziness, fainting, or confusion 1, 3
Follow-Up Care
- Schedule a follow-up appointment within 1-2 weeks to reassess pain and ensure proper healing. 1, 3
- If pain persists beyond 4-6 weeks despite treatment, request a physical therapy referral for manual therapy techniques and targeted exercises. 1, 3
Common Pitfalls to Avoid
- Under-treating pain leads to shallow breathing, muscle guarding, and prolonged recovery. Inadequate pain control causes patients to avoid deep breathing and coughing, which can lead to atelectasis and pneumonia. 1, 2
- Do not ignore worsening symptoms. New or different chest pain requires immediate evaluation to rule out complications. 1, 3
- Do not start with tramadol or opioids. Always begin with scheduled acetaminophen as the foundation. 1