Expert: J.R. Strecker, B.S., D.C. - 3/7/2008

Question
DR. Strecker,
My husband was in a 4-wheeler accident last Saturday, he broke 4 ribs and bruised his lung.  My question is when he coughs one of the ribs pops out of place. You can hear it pop back into place, should I take him to the doctor or is this something that is normal with broken ribs.
thanks for your time.
Cher Jones

Answer
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Hello C.,

Thanks for trusting me with your health.  Sorry to hear about the accident.  A major accident like that can not only be a huge bearing for the patient, but sometimes the entire family as well.  

That’s a pretty good question you ask.  Though I’m not sure, I’m thinking you’ve already taken your husband to the medical doctor because of your knowledge of there being 4 broken ribs and a bruised lung.  Because of the severity of the condition and how acute the condition is still, if you and your husband were to come see me, I personally would not adjust him yet.  Though it would be ideal to adjust him to help the tissues heal better, I wouldn’t want to risk doing more damage until the ribs have healed a little more.  During an adjustment, pressure is exerted throughout the entire rib cage, and it might be a little too stressful for the fractured ribs right now.  There are much gentler techniques, such as Activator, that will not likely harm your husband’s healing ribs.  There are some chiropractors that only use the “Activator Gun” and then there are some chiropractors that only use it on a select number of patients.  You can call around town to some of your local chiropractors and ask if any of them use the Activator and explain your situation.  But a manual adjustment with the hands probably shouldn’t be done right now.  However, no email can substitute for the advice for an opinion with a chiropractor in person who is able to evaluate and examine your husband him/herself.  Instead of an adjustment, though, a chiropractor may be able to help by administering some PT, such as therapeutic ultrasound (but not over the areas of the fractures!)  This will help the soft tissues heal faster.  Also, if the area of injury is still tender to touch, warm to touch, and/or reddened, keep the ice on your husband and stay away from the heat for now.  You may get a different opinion than what I’ve given you for ice, but so you know, you can do more damage with heat than you can with ice since ice should always be used before heat.  Just make sure to wrap the ice in a thin towel so his skin doesn’t get an “ice burn” and don’t ice for greater than 20 minutes at a time.  A good rule is 20 minutes on, 40 minutes off.  If the injury doesn’t match those characteristics (tender to touch, etc…), then you can start using the heat, such as hot baths/showers.  After the fractures have all healed up, which can take at least 4 weeks, then I would start to consider more aggressive adjustments for the ribs.  To help accelerate the healing, I would recommend a good multivitamin in addition to 1,000-2,000 mg of Vitamin C per day, as well as a Calcium/Vitamin D supplement.  If your husband is not used to taking Vitamin C, he may experience some transient diarrhea that should clear after a few days after onset.  Also, make sure he is well hydrated with water.  And again, it never hurts to follow up with the doctor to check his status and monitor the best time for him to receive his first adjustment after the accident.

I hope this helps a bit, and good luck with the healing!!

Dr. J.R. Strecker, D.C.