Expert: Dr. J. Shawn Leatherman - 2/19/2009

Question
Hi,
I am 21 and cracked a rib 2 and half years ago which seemed to heal within 2 months. 7 months ago i injured my ribs again by being lifted up by a friend. Since then, it has been painful to breathe and particularly bad when out in the cold. It is also noticably swollen. I was diagnosed with costochondritis and given anti-inflammatries, which didnt ease the pain at all. After X-rays and blood tests coming back clear i have been referred to a physiotherapist, although there is still no suggestion of what is causing the pain. I have now lost my job and am unable to do every day things such as walking my dog. Do you have an idea of what this could be, and whether it could be a permanant problem?
Thank you

Answer
Dear Aimee,

There are two main areas of interest here in my opinion.  First is to address the joint spaces where the ribs meet the sternum...this is if the pain you are experiencing is in the front of the chest.  If the pain is felt laterally like under the arms on the side, then the cartilage and myofascial structures may be the predominant issue...in that case, you should seek out a chiropractor who has training in advanced soft tissue mobilization techniques such as Graston, Active Release Technique, or SASTM.

Since you have indicated that you were previously diagnosed with costochondritis, that would indicate pain more towards the front of the ribs rather than the side.  Therefore, this does sound like a rib subluxation (abnormal rib articulation with the sternum), and these types of articular dysfunctions can be quite painful (due to joint inflammation), and can become recurrent/chronic when not addressed.  

Chiropractic care to include manual adjustments to the rib/vertebral joint will normalize the the structure of the joint, but you will likely need multiple treatments because of the length of time this has been problematic.  The reason for this is the surrounding joint capsule...as the rib moves in relation to the vertebral surface it connects with, the capsule becomes stretched and can sustain minor/minimal stretching and tearing.  Over time these small trauma build up and create laxity of the joint capsule.  This is the reason that the problem tends to recur.  However, scar tissue should also be forming, and this will serve to complicate the issue as the abnormal bands of scarring will need to be broken up for the best resolution.

As the chiropractic physician adjusts this area, the body will have to heal the small dysfunctional joint capsule laxity over time.  To help this healing process, a joint support nutritional formula such as glucosamine/chondroitin and MSM will help.  Again, remember that this may take 6-8 visits, and the chiropractor may include electrical stimulation or ultrasound depending on how the joint space is functioning at the time of the examination.  You will likley need to use ice directly over the manipulated area after the adjustment as these rib/sternum issue can be exquisitely painful.

A functional evaluation is the only true way to find out what is going on...The longer you wait, the greater likelihood that this will remain a problem, get it scheduled.

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