Expert: Dr. Paul Newhart - 1/23/2008

Question
2 ½ years ago, I was working out at the gym and long story short, the cartilage at the tip of my 10th rib broke. This allowed my 10th rib to slip up underneath my 9th rib frequently. I had surgery to remove the broken cartilage, and the surgeon had to remove the cartilage along my 9th and 11th ribs on my right side too because it was damaged from the injury. A year after the surgery, I was still in pain because the 10th rib and 9th rib rubbed together often. I had surgery 3 months ago to resect 2 inches off the 10th rib. Through this entire time, I’ve suffered with back pain and nobody can tell me why. I've done physical therapy, massage therapy, gone to a chiropractor, heat/cold therapy, etc. It gets releived, but always comes back. So, I have come up with my own idea: The cartilage of the tips of my 9th, 10th, and 11th ribs are completely gone. This allows the ribs move slightly because nothing is holding them in place. This makes my back muscles and intercostal muscles try hard to stabilize everything because it knows it's not supposed to be this way. When I sit down, the ribs push up slightly due to the lack of cartilage, which in turn alters the back muscles since the ribs are connected to the spine. My back muscles are just trying to keep things right, but they get so fatigued by doing this, and therefore are continuously tired and tight. My massage therapist says that my back muscles on my right side are always somewhat tight and knotty. It's a continuous cycle! My ribs are never going to be right, so my back is always going to try to stabilize everything continuously. What can I do to make this right? The only thing I can think of is major strengthening of my back muscles and ab/core muscles. Right now, I just don't do ANYTHING because I'm afraid of causing pain. But, my massage therapist is right when she says, "If you don't do anything, you'll get weaker and weaker and it will cause more LACK of muscle and flexibility and therefore contribute to the pain." And my back muscles are virtually non-existent right now. Since the injury, my back muscles have completely gone away. Seriously, it’s pretty much skin and bones. I'm nervous to work those back muscles since they are tight to begin with. How do I strengthen when they are tight to begin with?! Do you think my idea makes sense, and do you think stregthening will help? Thank you!


Answer
Your massage therapist is right:  you have to get up and moving.  take things slowly; don't just jump into Pilates to strengthen yourself!!!  Your muscles will get more sore with inactivity.  Having the back muscles atrophy, it is allowing the anterior (abdominal) muscles pull you forward, and aggravating the rib ends and causing "poking".