Broken ribs: symptoms, treatment and how long they take to heal

According to the NHS, broken or bruised ribs are usually caused by a fall, a blow to the chest or severe coughing. The pain is the main symptom, and it tends to be worse when you move, breathe deeply or cough. A hospital leaflet from Queen Elizabeth University Hospital in Glasgow adds that it is difficult to rest your chest, because you move it every time you breathe and it supports you when you sit up or lie down.

• Strong pain in the chest area, particularly when you breathe in or cough.

• Swelling or tenderness around the affected ribs.

• Sometimes bruising on the skin.

• Sometimes feeling or hearing a crack if a rib is broken.

• The skin over the fracture site is tender to touch.

The NHS says broken or bruised ribs usually get better by themselves within 2 to 6 weeks. The Glasgow hospital leaflet gives a general guide of about 4 to 6 weeks for fractured ribs, with the pain more severe in the first week. It adds that the more ribs you have broken, the more painful it will be.

The amount of pain you feel and how long it lasts depends on the type of injury and how badly you have been hurt, according to the same leaflet. Pain that has not improved after a few weeks is a reason to contact your GP or NHS 111, because you may need stronger painkillers or have a chest infection.

The NHS explains that ribs cannot be splinted or supported like other bones, so they are left to heal naturally and there is often no need for an X-ray. The Glasgow leaflet says there is no specific treatment for rib fractures; the aims are to control pain so you can breathe and cough better and stay mobile.

It adds that staff are unlikely to get you completely pain free, but want you to be able to take a deep breath and cough. In hospital, the options step up as pain demands.

• Oral painkillers: paracetamol, anti-inflammatory drugs such as ibuprofen, and morphine-based tablets, taken regularly. This is usually the first step and is enough for most people. Side effects can include constipation, nausea and drowsiness.

• Intravenous pain relief: through a drip, sometimes controlled by the patient, if pain does not respond to tablets.

• Nerve blocks: when pain is severe, particularly if breathing is difficult, local anaesthetic can be passed through a small tube placed near the nerves supplying the ribs. This can reduce the need for morphine-based drugs.

• Physiotherapy and breathing exercises, including a hand-held device called an incentive spirometer that encourages deep breaths.

• Oxygen, if the lung is damaged, if shallow breathing leaves you short of oxygen, or if you have a chest infection.

The NHS gives practical advice for looking after broken or bruised ribs yourself.

• Use painkillers such as paracetamol, or ibuprofen gel (or ibuprofen tablets if needed).

• Hold an ice pack or a bag of frozen peas wrapped in a tea towel to the ribs regularly in the first few days to bring down swelling.

• Rest and take time off work if you need to.

• Breathe normally and cough when you need to, as this helps clear mucus from your lungs and prevents chest infections. Hold a pillow against your chest when you cough.

• Walk around and move your shoulders sometimes, and take slow, deep breaths regularly.

• Try to sleep more upright for the first few nights.

• Do not lie down or stay still for a long time, strain yourself, lift heavy objects, play sports or exercise in a way that makes pain worse.

• Do not smoke.

The Glasgow leaflet names a chest infection as one of the most common complications. Pain makes it hard to take a deep breath in or cough, so breathing becomes shallower. Together with being less active than usual, this raises the chance of infection, which can make breathing worse. The NHS chest infection page lists a chesty cough with green or yellow mucus, wheezing, a high temperature and chest pain as typical features.

The leaflet also describes a collapsed lung (pneumothorax), where the lung may have been punctured and collapsed. In hospital this can be treated by placing a tube in the chest, called a chest drain, to help the lung re-expand.

The NHS splits its advice into two levels. The wording below follows the NHS page.

• Call 999 or go to A&E if the injury was caused by a serious accident such as a car crash, breathlessness is getting worse, chest pain is getting worse, you have pain in your tummy or shoulder, or you are coughing up blood. The NHS says this could mean a broken rib has damaged something else, like your lung, liver or spleen. Do not drive yourself to A&E.

• Ask for an urgent GP appointment or get help from NHS 111 if pain has not improved within a few weeks, you are coughing up yellow or green mucus, or you have a very high temperature or feel hot, cold or shivery.

The NHS covers bruised and broken ribs on a single page because the symptoms and the self-care advice are the same. "Cracked" is an everyday word for a broken rib. Either way, ribs cannot be splinted or supported, so the aim is the same: keep pain controlled and keep breathing deeply and coughing so that mucus does not build up in the lungs.

If there was no injury and the pain is unexplained, other causes need to be considered, and new chest pain with breathlessness is an emergency. See the related pages on rib pain and chest pain.

Most people with a simple broken rib are assessed in a minor injuries unit, A&E or by a GP, are given pain relief and advice, and go home. Those with several fractures, severe pain, breathing difficulty or an injury to the lung or other organs are admitted for monitoring, stronger pain relief and physiotherapy.

Private urgent care can be an alternative way to be seen, usually for faster access. For a serious injury or breathing difficulty, NHS emergency care (999 or A&E) is the right route either way.