Let’s first understand the anatomy of these structures, as most patients are surprised to hear that they have ‘ribs’ in their back. The thoracic wall, formed by 12 ribs on the left and 12 ribs on the right, each have two articulations (joints) that connect to each of the 12 thoracic vertebrae. This is the only true connection of the ribs to the axial (spinal) skeleton, as the ribs wrap around to the front of the chest wall attach to the sternum (chest bone) via a cartilaginous form of joint, called the costal cartilage. These types of rigid connections have very little give or movement, so essentially almost all of the joint mobility for the rib attachments are found at the two connections of the rib at the spine. Any joint of this type has the risk of irritation or sprain, depending on the stressors or dysfunctional movement patterns that are imposed upon it. Most commonly, postural changes occur gradually in the neck and upper back, particularly from prolonged computer use, cell phone use, or improper sleeping positions or support. As tissue dysfunction builds slowly over time, the joints also start to lose mobility, and eventually get irritated and inflamed. Because these joints are located just below a couple of layers of muscle and fascia (connective tissue) in the upper/middle back, the enlarged, irritated joint(s) can be mistaken for knots in the muscles. Even though the muscles are also involved in the problem, ultimately addressing the rib joint irritation is the key to having the problem resolved effectively.