Immediate Relief
Tennis ball against wall on lower ribs and flank area
Stand with your back against a wall and place a tennis ball between the wall and your lower rib/flank area on the painful side. Lean into the ball with comfortable pressure and slowly roll it around the area by shifting your body. When you find a tender spot, hold sustained pressure for 30-60 seconds until the tenderness begins to ease.
- Duration
- 5-10 minutes per session
- Frequency
- 1-2 times per day
- Expect
- May temporarily ease back or flank tenderness and make movement more comfortable.
Exercises
Side-lying trunk stretch
Lie on your pain-free side with a pillow under your waist for support. Extend the top arm overhead, reaching toward the wall behind you, to open up the lower rib cage on the affected side. Hold for 20-30 seconds, breathing deeply into the stretch. Repeat 5-8 times.
- Duration
- 5 minutes per session
- Frequency
- 2-3 times per day
- Expect
- Aims to improve comfortable trunk movement for bending, turning and reaching.
Exercises
Diaphragmatic breathing exercises
Lie on your back with knees bent and one hand on your chest, the other on your belly. Breathe in slowly through your nose, directing the breath into your belly so that hand rises while the chest hand stays relatively still. Exhale slowly through pursed lips for a count of 6-8. Focus on relaxing the lower ribs and flank muscles with each exhale. Perform 10-15 breath cycles.
- Duration
- 5-10 minutes per session
- Frequency
- 3-4 times per day
- Expect
- Practises relaxed breathing with comfortable rib movement.
Exercises
Trunk rotation with resistance band
Anchor a resistance band at waist height. Stand with your side toward the anchor, holding the band with both hands at your center. Slowly rotate your trunk away from the anchor, keeping hips stable. Control the return to center. Perform 12-15 repetitions on each side for 2-3 sets. Progress resistance gradually.
- Duration
- 10 minutes per session
- Frequency
- 3-4 times per week
- Expect
- Aims to build trunk strength and endurance for daily activities and gradual return to loading.
Lifestyle Changes
Core strengthening with emphasis on lateral stability
Incorporate side planks, Pallof presses, and suitcase carries into your regular exercise routine. These exercises build lateral core stability that reduces demand on the serratus posterior inferior. Start with modified versions (knees down for side planks) and progress as strength improves.
- Duration
- 15-20 minutes per session
- Frequency
- 3-4 times per week
- Expect
- Aims to build trunk strength and endurance for daily activities and gradual return to loading.
Professional Treatment
Professional assessment to rule out kidney or rib pathology
If flank pain persists beyond 3-4 weeks or is accompanied by changes in urination, fever, or blood in urine, seek professional evaluation promptly. A physician can rule out kidney stones, infections, or rib fractures. Once cleared, a physical therapist can provide targeted myofascial treatment for the serratus posterior inferior.
- Duration
- Initial evaluation: 30-60 minutes
- Frequency
- As needed based on symptoms
- Expect
- Accurate diagnosis distinguishing muscular from visceral pain and appropriate targeted treatment plan
Caution Seek immediate evaluation if flank pain is accompanied by changes in urination, fever, blood in urine, or sudden severe onset — these may indicate kidney or other organ pathology requiring urgent medical attention
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