Expert: Dr. J. Shawn Leatherman - 9/25/2008

Question
Hi,  my 16 year old son has been suffering with rib pain for 1 year.  It began as pain on his left side with a raised "lump" to to the left and below his sternum.  His symptoms were not consistent with costochronditis as there is no pain with coughing.  We have had negative x-rays, CT scan, Bone scan, blood tests.  We have seen his medical doc, orthepedic dr., chiropractor, and physical therapist.  He has had strain/counter strain therapy, 3 months of chiropractic treatment of 2x to 3x per week,trigger point therapy and a steriod injection---both of which made the pain worse.  It took 7 months to get the sprained rib diagosnis....so chiropractic and PT did not start until then.  Originally, only one rib was involved.  Now he has had as many as 12 out when we visit the chiropractor.  He is frustrated and wishes to discontinue chiropractic as he says the ribs only stay put for a matter of hours after going to the chiropractor. Our insurance maxed out on Chiropractic and PT a long time ago, and financially we are about tapped out. The situation seems to just be getting worse. Anti-inflamitories give him no relief whatsoever. Pain is dull and constant at rest.  With twisting motion it is sharp.  He estimates it as a 6 or 7 most days.  Rest does not improve it. Sometimes it interferes with his sleep, Usually activity makes it worse.

My son is (or was before the pain started to prevent some of his activities) atheletic.  Main activities are/were Cross Country, track, ultimate frisbee, volleyball, contra dancing.  He is 5'10 140 lbs.  We eat well, avoid fast foods, junk foods, soda, and packaged products.

We are at the end of our rope.  The chronic pain is turning our fun-loving happy son into a grumpy, frustrated old man.

Any advice, please!

Answer
Dear Gina,

It appears that your son has a chronic subluxation pattern of the rib cage which can either be primarily at the sternal or vertebral connection.  If you visit the chiropractor and he feels better after being adjusted and then it only lasts for a few hours until the articulation pops out again, then he likely has ligamentous laxity, and chronic inflammation in the joint space.  

This is not an easy issue to deal with because what he really needs is stability around the joints.  However, it is very difficult to stabilize this area due to breathing and the muscular attachments to the vertebra, ribs, and sternum.  I would normally say that you need to brace the area, but if you brace the ribs, you can actually reduce lung expansion and this can lead to pneumonia...so you can't really do that.

One thing that might work is something called prolotherapy.  This entails injecting a solution into and around the joint spaces, often a dextrose solution, which will actually kick start a new inflammatory reaction.  This actually helps to heal the joint area more properly which significantly reduces the chronic pain, and helps scar tissue to form.  Interestingly enough, prolotherapy is most specific for tissues that have cartilage tears, laxity, and chronic issues in pain, so it is very appropriate to research this technique concerning you son's ribs.

I suggest that you check out Prolotherapy online and learn as much as you can.  Then find a local physician who performs Prolotherapy and schedule a consultation to find out if it will be right for you.  Hope this helps Gina.

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