Expert: Dr. J. Shawn Leatherman - 2/8/2008

Question
I just read your reply to Kevin and have a similar injury.  I am a 65-year old male.  On New Years Day I took a hard fall while skiing.  I fell on my left side with my elbow tucked under my left rib cage.  The blow to my ribs was severe.  I had the ribs xrayed but no fractures were noted.  I suspected the injury was to the soft tissue around the ribs and to the cartilage connecting the ribs to the sternum.  The pain lessened somewhat in the weeks after the accident but seemed to settle in at a level I would describe as moderate and annoying.  The intensity increases if I lie flat on my back.  (I work out daily.) Yesterday I was lifting a heavy box and felt a sharp pain and snap in my chest and now the pain is back to the level it was with the original incident.  Is this symptomatic of cartilage damage?  Do you recommend I see a doctor, or is this to be expected with this type injury?  I suspect full recovery will take sometime.

Answer
Dear Jerry,

Everything you have described is indicative of cartilage injury, however, the joint space where the ribs meet the vertebra is another common area to have dysfunction after a direct trauma.  I am not sure what answer you read previously(Kevin), as I have answered hundreds, so I will explain this a bit further.

The cartilage when damaged is very slow to heal and often results in ongoing pain and dysfunction.  Moreover, the joint capsule responds in a similar manner for the same reason...both anatomical structures have a poor blood supply.  Therefore, the healing times will be greater, and often these problems will become chronic.

Now, yes, I would suggest that you have it checked out by a doctor.  I would advise you to have a chiropractic physician check it out.  If you have already ruled out a fracture, then a chiropractor is one of the few physicians who will actually work with the joint space to further diagnose the are and to make sure the injury is correctly identified.  Medical physicians are not trained in biomechanics of the spine and rib interfaces...its not what they do, they prescribe medicine.  If the joint is the problem, the chiropractor can adjust the articulation and this should significantly reduce discomfort, but it will need to be addressed frequently in a two to three week period for the best overall resolution.

If the injury is truly to the cartilage, then there is really little you can do.  The best option is to rest the area, and support it as much as possible.  You can wrap it, but realize that a wrap must not be tight.  You can restrict lung expansion and this can lead to infection...so be careful.  

In either case, cartilage or joint injury, I would additionally recommend that you start taking glucosamine sulfate for a minimum of 6 months...(Do not take the glucosamine HCl form it is poorly utilized.)  3000mg per day for two weeks, then reduce your intake down to 1500mg per day.  You should also take MSM (methylsulfonylmethane), 1500mgs per day for two weeks, then reduce down to 750mgs per day.  This will give the tissue what it needs to repair and lubricate the surfaces of the joint.  Anti-inflammatory enzymes are also something you should consider to reduce the inflammation in the area.  

I utilize a product with my patients from a company called Ideal Health, and it is top notch called "FLEX CAPS", I take it myself as well due to old ankle injuries.  It contains everything I mentioned above in one product to reduce costs.  You can find it at www.idealhealth.com.  You may be prompted for a referral name or code, and you can just type in my name, or use my clinic code 5582806 if you wish.  I have had great results with patients on this product...I have a few patients who swear by it.

Lastly, if nothing helps your pain, and the doctors you see still can't quite seem to figure out the problem, I would recommend that you do some research on Prolotherapy.  This utilizes injections into the cartilaginous tissue to help jumpstart a new inflammatory process and thereby break the old chronic inflammatory process.  It is a new technique showing promise, but most doctors are not certified to perform it yet.  You will need to research physicians in your area to see if they are qualified and actually utilize the technique.

Good Luck Jerry.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net