Rib Pain And Chiropractic Treatment

Costotransverse Sprain

A costotransverse sprain is an injury that people often wake up with. Sometimes it is caused by an awkward sleeping position or caused by turning in bed, or something that happened the day before but was too mild to cause significant pain right away.

We deal with rib pain on a regular basis and do it successfully. Rib pain tends to be acute in nature and therefore respond very quickly, usually within 2-3 chiropractic treatments. If you have had it before and it is recurring, it might take longer to recover. Rib dysfunction does not only cause pain in the rib cage, it can also be felt deep inside the chest simulating pain from the heart, lungs, stomach and food pipe (oesophagus or gullet). It can also give arm symptoms and frequently affects people with breathing difficulties such as asthma.

Recurrent And Chronic Rib Pain

For some people, the pain can become recurring and ongoing, and for these people, the problem can be a source of great frustration. When we see them they have often had a number of chronic pain interventions such as long-term non-steroidal anti-inflammatory painkillers, spinal facet and rib joint injections (corticosteroids), which often gives only short-term relief.

When chiropractors see patients with chronic rib pain there are other indicators such as a slouched posture with forward drawn shoulders. In our chiropractic clinics, we often find that the pain is located at the apex of the curvature of the mid back (kyphosis) or if you have scoliosis. It makes sense for us since that is the point under most load and strain, making the muscles fatigue resulting in chronic strain of the supporting ligaments.

This is often seen in people who are generally unfit with:

• poor thoracic core muscles
• increased thoracic curvature (kyphosis)
• sedentary occupations
• women with large breasts
• people who carry loads for prolonged times
• scoliosis of the mid-back

To help these patients in the long term, apart from treating the underlying spinal problem with specific chiropractic adjustments, it is extremely important to address the postural problem and core muscle weakness. Some of our female patients have had breast reductions, which has helped them to reduce the strain on the muscles in the mid back.

Why Do I Feel Pain In The Front When The Injury Is At The Back?

Referred pain is a concept well known by chiropractors and is an important consideration in chiropractic treatment. Pain from the neck either goes up to the head or down the shoulder or arm. Referred pain from the lower back tends to go down the hip and leg, and referred pain from the mid back and ribs are usually felt along the ribs and even in the front of the chest.

If the condition is severe enough the cartilage between the rib and the sternum (breast bone) can become irritated and inflamed. This creates a very sensitive area in the front of the chest, which is aggravated by movement and even breathing. Because of the location of the pain, it is extremely important that more serious conditions are checked for and ruled out before treatment starts. Chiropractors are trained in medical diagnosis and can do this confidently. If there is any suspicion of a heart-related problem or other problems that chiropractic treatment can’t help, the chiropractor will refer you to your doctor or hospital immediately.

Other Conditions That Can Cause Rib And Chest Pain

Costotransverse sprain is a condition that often mistaken for pleurisy, it is also known as pleuritis or pleuritic chest pain. Pleurisy is inflammation of the lining of the lungs, which may develop when you have lung inflammation due to infections such as pneumonia or tuberculosis.

There are similarities in symptoms such as pain on taking a breath, coughing and chest movement. But the thing that will differentiate it from a costotransverse sprain is the presence of a, so called, friction rub. This is a rough, grating sound caused by the rubbing together of the roughened lining of the lung. You can hear this using a stethoscope. Blood tests and chest x-rays will also help to diagnose the problem.

Here is a list of some other medical conditions that can cause rib and chest pain. This list is not exhaustive but covers the most common and some less common conditions that a chiropractor must consider before the treatment starts.

• Chronic cough
• Broken rib
• Infection of the rib
• Rib cartilage injury
• Rheumatoid Arthritis
• Osteoporosis
• Vitamin D deficiency
• Chronic steroid use
• Osteochondritis
• Pneumonia
• Tuberculosis
• Lung cancer Multiple Myeloma Rib cancer (bone)

The Anatomy

Ribs attach to your middle back (thoracic spine) and at the front at the breastbone (sternum). The thoracic spine is made up of 12 thoracic vertebrae with 12 ribs on each side.

Each rib has two joints at the back the spine and the top seven ribs have a joint at the front attaching to the breastbone (sternum). The last two ribs do not attach to anything at the front and are therefore called floating ribs. Each rib connects to the body of the vertebra and to a bone on the side of the vertebrae called the transverse process and sometimes to the disks. The joints are stabilised by ligaments and muscles.

There are muscles found between the ribs and there are many muscles overlying the ribs. There is also a nerve between each rib which extends from the spine to the sternum along the course of the rib. An injury to the ribs can involve all of these tissues.

What Is Rib Dysfunction?

Rib dysfunction is a term used by chiropractors to describe a mechanical problem affecting the joint between the rib and the thoracic spine. Injuries can cause the normal smooth gliding motion of the joint to jam causing pain.

The pain may be so severe that you can hardly breathe and sleeping may be next to impossible. The surrounding muscles go into spasm and become very tender. Usually, the pain is localised to the affected rib and is described as sharp or stabbing which is aggravated by movement and even breathing.

How Does Rib Dysfunction Affect Other Problems?

The ribs have an important role in protecting the internal organs and form anchoring points for the muscles. Sometimes arm and shoulder pain is caused by a rib problem. Some of the neck muscles attach into the first three ribs.

Upper rib dysfunction and associated muscle spasm can cause what is called a ‘Thoracic outlet syndrome’, which can cause impaired blood flow and irritate the nerves travelling down the arm causing numbness in the arm and hand. The upper ribs also work in tandem with the shoulder and shoulder blade (scapula). Full shoulder movement requires the scapula to glide over the ribs, called scapulothoracic movement. Rib dysfunction can cause restricted scapular mobility with pain on shoulder movements. Poor scapulothoracic movement can lead to rotator cuff injuries and should be evaluated when rehabilitating any shoulder injury. Poor chest expansion can also cause more serious complications such as pneumonia and breathing difficulties.

Chiropractic Treatment And Rib Pain

The chiropractic examination is first aimed at ruling out serious medical problems. It is then followed by a detailed examination of the joints and muscles. The chiropractor assesses the movement of the individual ribs.

There are two types of movement of the ribs, calliper movement and bucket-handle movement. The aim of the treatment is to restore the movement, reduce pain and reduce the muscle spasm. This is done using a variety of different ‘hands on’ techniques and exercises. Chiropractic is such a versatile treatment that it does not matter how old you are, if you are affected by osteoporosis or other medical problems. There is always a suitable treatment method the chiropractor can use that is safe and effective for you.

We usually combine the chiropractic treatment with a combination of Low-Level laser and TECAR therapy, which will speed up healing, reduce inflammation and pain, and are painless treatments.

Chiropractic treatment is always worth considering if you have any chest, shoulder or arm pain. Never delay having a check-up. The longer you leave the problem the more difficult it will be to treat.