Expert: Dr. Victor Dolan, DC, DACBSP - 4/10/2008

Question
I am a 34 year old female and have seen a chiropractor every 3-4 months for the past 2 years to help align an "uneven pelvis".  I have a left sided hip hike which has caused pain in my right upper back from my compensatory posture.  My ribs are asymetric and my sternum is tilted at about a 30 degree angle (higher on the right).  This is not painful unless I sleep on my side for a long perior of time, then it feels like my sternum is going to fold in half.  It is very sore the next day.  I have a very thin frame and take calcium.  My mother was just diagnosed with osteoporisis at age 64.  I know this is not a condition that can be corrected surgically, but is there any type of chiropractic manipulation or stretches that may help this progressing problem?

Answer
"Sternal Asymmetry";  I am familiar with the sternal asymmetries of 'Pectus Excavatum' and/or 'Pectus Carinatum'.  I am not immediately familiar with a sternal asymmetry of 'sternal tilt',- unless that anterior skeletal peculiarity is secondary to a spinal scoliosis.

I use the word ‘peculiarity’, in part to put you at ease.   EVERYONE   has peculiarities.
I try not to use the word ‘deformity’ or ‘abnormality’- at least at first, because it must be understood that we all have some deformity, some abnormality somewhere in our body- whether physical or chemical.  Sometimes these deformities can be significant, sometimes they are not.  Some peculiarities require surgery to correct, some abnormalities we do not treat at all.  Some deformities require medication, some peculiarities do not.

You mention no trauma in your question.  Has there ever been a fracture anywhere along the sternum, ribs, or spine?  Has anyone ever used the words ‘congenital’, ‘developmental’, ‘idiopathic’ to you?  Have other doctors evaluated you?

A 'sternal tilt' of a 30 degree angle sounds severe.  I would ask; have spinal and chest x-rays been taken?  Comparisons made between prior Xray and recent Xray studies available (is condition progressing or static)?   Have CT or MRI scans been performed, again with prior studies compared to recent films.  In these studies are there any indications of cardio-pulmonary compromise?   If there is cardio-pulmonary compromise, I am sure your Doctor of Chiropractic would refer you to a pulmonary specialist, a cardiologist, or even a thoracic surgeon for their evaluation and opinion.  If severe or urgent condition does not exist, then mechanical manipulative physiotherapeutic approaches may slow progression or halt progression.  Reversal of boney abnormality may not be easily attainable, if available at all, even through consistent treatment.

A sternal deformity is of course, a chest wall deformity.  The chest wall is sort of like a barrel, the barrel consisting of the sternum, ribs and spinal vertebrae from anterior to posterior, making a container.  The container holds primarily the heart and lungs.  Enough angle, enough depression, enough curve and compression of the organs, the heart and/or lungs can take place.  Make sure that adequate diagnostic testing has been done to evaluate for this heart/ lung (cardio-pulmonary) compromise.

You mention pain from certain positions.  In addition to pain – are you ever short of breath? Do you have any heart or lung symptoms?  I assume you do not, because in addition to chiropractic evaluation, if you had heart or lung symptomatology, cardiac or pulmonary evaluation should be mentioned in your question.

Again, the sternum and the ribs actually ‘hang’ from the spine.  You speak of  sternal asymmetry, sternal tilt, and a ‘hip hike’.  This leads me to a conclusion that you may have a scoliosis which causes the rib and sternal ‘tilt’ problems.  However, I am making assumptions throughout this answer, and we know what happens when we assume……

Given that you have no boney deformity of the sternum, ribs or spine (proven through Xray, CT and/or MRI), given that you have no cardio-pulmonary compromise,  given these assumptions; chiropractic could be helpful.   If your boney ‘asymmetry’ is due to joint misalignment, then chiropractic can halt or slow the progression, and could- I emphasize could- over time reduce that ‘tilt’.  Seeing a chiropractor once every 3- 4 months, and hoping for a change in a ‘severe’ condition is not likely, it is not a regimen of frequent enough visits for the manipulative physiotherapeutic effects of the mechanical correction to take place.   Ultimately, my assumption is a scoliotic cause to your complaint.  Chiropractic can help you there (given no boney deformities).  

An exercise I utilize in my patients is to have them ‘hang’ around the house.  Install a chin-up bar, and instead of doing ‘pull-ups’ or ‘chin-ups’, just grab the bar, get off your feet, and hang.  Let your spine straighten and lengthen and relax.  Try to hang for two minutes in the morning and two minutes in the afternoon.  You will not be able to hang for two minutes straight.  If you can, Great!.  But if you cannot, try to hang for two minutes in as short a time as possible….. it may take you four minutes near the chin-up bar to get a total of two minutes hang time.  Hanging is a great stretching,  straightening, relaxing, lengthening exercise.

You mention taking calcium.  I guess you have concerns regarding the density/ strength of your bones.  Calcium is a good start, but other considerations are magnesium, boron, vitamin D, even vitamin C, phosphorous,  exercise and protein intake.  Get your calcium from dark green leafy vegetables, do weight bearing exercise.

The advice given here is general in nature, it is not meant to be prescriptive or specific to your case.  I have not seen Xrays , nor any testing, nor any physical evaluation at all.  I do hope this helps, good luck.  Certainly go through all of the steps I have descrbed here, testing, comparisons, evaluations.  Thanks, and I do wish you- Good Health Naturally!