Expert: Dr. Victor Dolan, DC, DACBSP - 11/3/2008

Question
I was in a car accident 5 years ago and the seatbelt going across my chest did some damage on my chest down the right side of my breast and for the longest time my chest bone in center would "crack" when i stretched and arched my back. I recently (this past yeat) has stopped cracking. For a week now i have had severe chest pain in the same spot when i look down only. Other times i can feel pressure there or when i press on it. My chiropractor told me that the cracking was normal it would not hurt me and would go away with time the less i crack it the sooner it would stop. It never hurt when i cracked it you could just hear it. The pain is specifically located right below my neck (maybe 2 inches) and just a hair or two to my left. Do you know what this could be. Also i have notices that laying on either side when i am compressing it gives me a  little discomfort.

Answer
Motor Vehicle Accident, Car Accident, car crash, auto accident, seat belt damage, seat belt fracture, contusion, chest pain, costochondritis, 'cracking',

Hello Katie,

Sorry to hear about your motor vehicle accident (MVA). Due to overdevelopment here in my home town, Staten Island Auto Accidents are commonplace,,,, and keep me busy as a Chiropractor and scared as a driver.

All kidding aside;  Pain, chest pain, any pain, any CHANGE in condition requires a new, thorough examination.  You USED to crack, with no pain, now you do not crack- WITH pain.  Katie, I assume you are a female and modesty is important even in the doctors office.  The area of complaint should be evaluated.  If you do not feel comfortable with your Doctor of Chiropractic (whether male or female), you should see your family MD, or GYN, or an Orthopedic MD.
Someone who will evaluate your sternum and rib attachments.  Visual inspection is important- even you can LOOK in the mirror and see if there is some asymetry- some imbalance one side compared to the other- any lumps, bumps, bruises, depressions, scars?   

The area should be palpated- and again, even you can do this; while looking in the mirror, palpate (touch) around the area of complaint- do you FEEL any lumps, bumps, bruises, elevations, depressions, any irregularities-- compare side to side.

The area should be Xrayed.  What is going one here that may affect an Xray- compare it to old Chest Xray Films from BEFORE the accident, compare to Xrays taken immediately after the accident.  Any changes?

"Cracking" is neither a good or bad sign.  Joints crack, joints make noise, the body makes noise.  CHANGES, especially changes WITH PAIN, should be evaluated.

Did you have Xrays of the area after the injury?  What did it show?

Did you have a 'seat belt bruise'-- actually it would be the shoulder belt going across your chest, between the breasts to help secure us in the car?- did you have a bruise at the time of accident?

Do you remember any difficulty breathing at the time of the accidetn or shortly thereafter?

It is not likely to fracture a sternum (breastbone, chestbone) but it is possible.  It is possible to fracture a rib or ribs (possible- but should have HURT and been Xrayed at the time).  It is possible to misalign the costochondral junction- where ribs/ cartilage/ sternum all meet in the front of the chest.  This area needs to be examined.

If your complaint is way up high in the chest, way down low in the neck; this could even be where your collarbone- the clavicle meets the sternum.

All of these things should have been Xrayed if they were a point of pain, an area of complaint 5 years ago after the car accident.  Now with changes, and increased pain, it is time to re-examine.

If you feel uncomfortable in one doctor's office for whatever reason, go to another doctor's office for this examination and Xray.  Xray, MRI, some kind of imaging should be done of the area.

You probably did not strike any part of your body in the auto accident.  Seat belts (lap and shoulder belts) save lives.  Sometimes Seat Belts save our life, but cause aches/ pains/ strains/ sprains/ contusions.  Wear your seat belt--- but this may be related to your seat belt,,,, even 5 years after the motor vehicle accident.

I hope this helps.  If you have further information for me, or further question, do not hesitate to contact me here at AllExperts.com .   ( http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm )

A couple of information handouts I utilize in my Staten Island Chiropractic office may be helpful:

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PAIN     Pain  is a  ‘red light on the dashboard’.  Pain is your body telling you that something is wrong.  That RED LIGHT on the dashboard of your car- -- do you ignore it until the car breaks down, or do you get it checked and correct the problem?  Pain, pain in your body- -- do you ignore it until your body breaks down, or do you get it checked and correct the problem?   Pain,  do you cover up the pain by taking a painkiller?  Take a painkiller, mask the pain, and allow a problem to progress in your body?  

NOTICE  ON  PAIN  RELIEVERS:  

Label changes ORDERED by FDA;  

the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;   

The  American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07).

Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.

Vertebral  Subluxation           (  ‘VSC’ ,    ‘subluxation’   )

Vertebral Subluxation  is  actually  a  quite  common  condition.   Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).   


Only a Doctor of Chiropractic will evaluate and treat for VSC.   


The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.

         Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.

Subluxation  is  a  serious  condition  identified  by  its  five  parts:

    Spinal Kinesiopathology:        This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.

    Neuropathophysiology:         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.

    Myopathology:           Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.

    Histopathology:       A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.

    Pathophysiology:     The VSC contributes to OsteoArthritic degeneration.  Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.

The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.   
         Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.

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P.R.I.C.E. =    P  protection.   R rest.   I  ice.   C  compression.   E  elevation.
Hurt  yourself ??  injury/ trauma/  bruise/ not even sure - - a broken bone ??
You should certainly get to the Doctor or trained health professional to be examined  if you think it  is  bad  enough.     BUT  in  the  meantime,  some  simple  steps  may  help.   PRICE.
The  PRICE  protocol will usually help just about any musculoskeletal injury.
P = Protection;  protect the area from further injury- stop what you are doing, can you
     pad  or bandage the area ? Tape the area? Do something to protect the area !
R = Rest;  rest the area as much as possible, if a part is damaged, give the body time to
       repair the area
I = Ice;  ice is a potent anti-inflammatory; it will slow swelling, help with pain control
     (ice is analgesic), place ice over cloth over the injured area for 5, 10 minutes, off the
     injured area for 30 minutes; then back on again
C = Compression;  to help prevent swelling compression may be helpful- for example
      if it is an ankle, wrap the ankle with an ace bandage and ice the area.  Many body
      parts may not be applicable to compression.
E = Elevation; again to fight swelling and pain, raising the injured body part above the
      heart may be helpful- ie raise an ankle or knee, you lay down, raise the injured part
PRICE  may  help :    Sprains,  Strains,  musculo-skeletal injury,  bruise,  contusion
Sometimes  a slip, trip, fall, heavy lift, athletic injury, or a motor vehicle accident can cause a bump or bruise, sprain or strain.  Sometimes also involved with the injury is a vertebral subluxation (or other joint subluxation) (subluxation is a mechanical problem- of any joint- and requires a mechanical correction).  In the spine, a sprain/strain  is a misalignment,  a ‘kink’ in the joint, a stretch of the muscles, tendons and/ or ligaments:- more properly termed a Vertebral Subluxation.   Sometimes symptoms can come immediately, sometimes days, weeks or even months later!- Well after the actual trauma !!!
         Spinal = Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)  ;   ( subluxation COULD be any joint )
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A  subluxation  interferes with the proper functioning of the nervous system  (the master system  which controls and coordinates all function within the body)  and may cause various other conditions, symptoms and problems.
This is a serious condition identified by its five parts:
    Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
    Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
    Myopathology:
          Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
    Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
    Pathophysiology:
         Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
         Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
          Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.  For good health- Treat the   Cause,  not just the Symptoms.  Sprain/ strain/ bump/ bruise?= may result in subluxation of the nearby joint.  CORRECT the subluxation !!!!

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine

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Thank you for your question.  Do not hesitate to re-contact if necessary.  Good luck.  Wishing you Good Health Naturally !

Dr. Victor Dolan, DC
http://drvictordolan.chiroweb.com       (email newsletter)