Expert: Dr. Victor Dolan, DC, DACBSP - 2/23/2009

Question
I injured one of my ribs a few years ago (the costal cartilage on the tip of my 10th rib in the front broke off, it is now a floating rib) and ever since then I have struggled with back pain on my right side (same side as rib injury). The pain feels like muscle tightness because when I wake up in the morning, the pain is completely gone. It's when I sit at the computer, the erector spinae muscle and the muscle right next to it (just below the 12th rib) immediately tightness up and causes a world of pain. If I lie down and relax it, it goes away. Doctors just tell me to take advil. I've been living this way for years now and want to try some releif. I did try a lumbar back support in my computer chair, which helped me tremendously! It was something about the pressure against the area that virtually took the pain right away. However, this releif only lasted a few months, and then it is like my body became immune to it and it no longer helps me like it used to. Do you have any suggestions? Should I try to stregthen my back muscles? Or should I do daily stretches? I have tried chiropractic but it was without success. Massage helps temporarily. I would appreciate your thoughts as to how I may be able to make this better. Thank you.

Answer
staten island back pain , back pain , rib pain , costal cartilage fracture / separation , staten island kinesio tape






Hello KC,

Sorry to hear of your years of pain.

"I injured one of my ribs a few years ago (the costal cartilage on the tip of my 10th rib in the front broke off, it is now a floating rib)"- This costal cartilage/ rib attachment point should have healed.

When you did this, did you go to the hospital?, did you seek care, did Xrays or MRI show this damage- permanent rib separation?  A permanent rib separation would be very unusual.  there is very little space in the body, very little distance between the costal cartilage and the rib.  Muscles coat the area and hold the ends (approximate the ends) together.  Permanent separation would be unusual.

IF the injury included a misalignment, a dislocation, the hospital, the doctor should have immediately re-placed, re-aligned the separate, dislocated, misaligned ends.  

Have you had any recent tests to show this non-union of costal cartilage and rib?  Again, non-union would be rare.

Regular Xrays would not work for this complaint/ condition.  MRI, perhaps ultrasound imaging would be needed to show a cartilage/ rib separation.  This would be a question for our radiologist colleagues at AllExperts.

The rib/ cartilage junction should have healed.  If it did not heal, the envelope, the covering of muscles should hold the ends in close approximation.  You need an imaging study to definitely rule in/ rule out separation and misalignment/ dislocation.

Support for the area should be helpful.  I highly recommend KinesioTaping techniques  http://www.kinesiotaping.com/  .

I have been using Kinesio taping techniques for years, an find it very helpful.  Why do I recommend it?- If you have a separation, misalignment; if you require support (and it sounds like you do); this technique allows support AND movement, and comfort.  The tape can stay in place, even with washing for  2,  3,  4, days.  Perhaps wearing the tape over a period of time would allow the area to heal properly.

My Staten Island Kinesiotape patients receive an information handout from me, this may be informative for you:





Olympic  Athletic  Performance     
                                                                                I have been using kinesio taping in my office for years.  Very different from regular white athletic strapping tape,  I was one of the early sports docs utilizing this approach.


Fun  to  see  the  articles  on  kinesio taping  at  the  Olympics,  here  is  one:  


                  .
Watching Olympian Kerri Walsh compete in beach volleyball last week, many viewers were wondering the same thing: what is that black thing on her shoulder?

A tattoo?
A bizarre fashion statement?
No.
Ms. Walsh was sporting a new type of athletic tape called Kinesio, touted by doctors as a better way to relieve pain and promote healing of injured muscles.

The appearance of Kinesio on the well-toned Ms. Walsh — she even wore it while meeting President Bush — has spurred international interest in the little-known brand. In black, pink, blue and beige, the tape has been spotted on a number of other Olympians, including the shoulder of U.S. water polo player Lauren Wenger and the elbows of Canadian Greco Roman wrestler Ari Taub. Members of Spain’s basketball team and Jamaica’s track team are wearing it.

Traditionally, white athletic tapes are wrapped around gauze to form a stiff bandage that immobilizes a joint or muscle. By comparison, the 100-percent cotton Kinesio tape is said to be modeled on the thickness and elasticity of real skin.

The flexible tape is applied to the skin in specific patterns, depending on the injury, a technique designed to create support and guide injured muscles and joints without limiting the athlete’s range of motion.

“This tape moves with the body, so the biomechanics are still there,'’ said John Jarvis, director of Kinesio USA.
Both the tape and the new wrapping technique have spread mostly by word-of-mouth among athletes, doctors and trainers who swear by it. Cycling great Lance Armstrong reportedly dedicates a page to the tape in his latest book. Recently soccer superstar David Beckham traded jerseys after a game and was spotted with pink Kinesio tape on his back.

Some limited data suggest it may be effective. In July, the Journal of Orthopaedic & Sports Therapy published a study of 42 people with shoulder injuries. Half of them were treated with Kinesio tape applied in a pattern designed to support the injured muscle. The other half were given a “sham” treatment in which two strips of tape were simply pressed across the arm. The study was conducted by physical therapists at Winn Army Community Hospital in Fort Stewart, Ga., who didn’t receive funding from the tape company (important:  OBJECTIVE study,,, rather than drug research PAID for by drug companies…..).   Notably, the study participants who received the real therapeutic tape treatment reported an  immediate   improvement   in   pain.


Last year, Research in Sports Medicine published a study from San Jose State University showing that in 30 healthy test subjects, use of the tape along the lower trunk area appeared to increase the range of motion.

Kinesio claims that in addition to supporting injured muscles and joints, the new taping method helps relieve pain by lifting the skin, allowing blood to flow more freely to the injured area. The tape is also widely used in pediatric physical therapy for muscle disorders like cerebral palsy.

Given Kinesio’s high profile at the Olympics, it seems likely that we will be seeing more and more of it.


What Does Kinesio Taping Do?

Kinesio Taping gives support and stability to your joints and muscles without affecting circulation and range of motion. It is also used for Preventive Maintenance, Edema, and Pain Management

              Kinesio Taping was invented by a Doctor of Chiropractic, and is utilized- especially by SPORTS Chiropractors throughout the world.  Kinesio Taping helps the body heal naturally, can be used preventatively, as treatment, in rehab, during competition, or as a ‘take home’ treatment applied by the Chiropractor   (medical doctors give drugs, chiropractic doctors give tape) .

              Kinesio Taping is a technique based on the body's own natural healing process. This Kinesio Taping exhibits its efficacy through the activation of neurological and circulatory systems. This method basically stems from the science of Kinesiology, hence the name "Kinesio". Muscles are not only attributed to the movements of the body but also control the circulation of venous and lymph flows, body temperature, etc. Therefore, the failure of the muscles to function properly induces various kinds of symptoms.

               Consequently, so much attention was given to the importance of muscle function that the idea of treating the muscles in order to activate the body's own healing process came about. Using an elastic tape, it was discovered that muscles and other tissues could be helped by outside assistance. Employment of Kinesio Taping creates a totally new approach to treating nerves, muscles, and organs. The first application of Kinesio Taping was for a patient with articular disorders.

               For the first 10 years, chiropractors, acupuncturists and other medical practitioners were the main users of Kinesio Taping. Soon thereafter, Kinesio Taping was used by the Japanese Olympic volleyball players and word quickly spread to other athletes. Today, Kinesio Taping is accepted by medical practitioners and athletes in Japan, United States, Europe, South America and other Asian countries.

               The Kinesio Taping Method is applied over muscles to reduce pain and inflammation, relax overused tired muscles, and to support muscles in movement on a 24hr/day basis. It is non-restrictive type of taping which allows for full range of motion.

               In contrast, traditional sports' taping is wrapped around a joint strictly for stabilization and support during a sporting event obstructing the flow of bodily fluids... an UNDESIRABLE side-effect.

              Kinesio Tape is used for anything from headaches to foot problems and everything in between. Examples include: muscular facilitation or inhibition in pediatric patients, carpal tunnel syndrome, lower back strain/pain (subluxations, herniated disc), knee conditions, shoulder conditions, hamstring, groin injury, rotator cuff injury, whiplash, tennis elbow, plantar fasciitis, patella tracking, pre and post surgical edema, ankle sprains, athletic preventative injury method, and as a support method.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians;  Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine

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"......And then it is like my body became immune to it and it no longer helps me like it used to......", when it comes to the musculo-skeletal system, the body will not 'become immune to it', the way it can with chemical medicines.  This change shows that things are changing in your body.

I recommend imaging studies of the area of complaint(s).
I recommend a Doctor of Chiropractic (perhaps with a sports credential- DACBSP, CCSP) that does kinesio taping for support.

I hope this helps.

I wish you luck, and good health naturally!,

Dr. Victor Dolan DC DACBSP
http://drvictordolan.chiroweb.com           (email newsletter)




info on the costal cartilage:

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Rib_injuries?open

http://umed.med.utah.edu/MS1/anatomy/study/thorax.htm

http://www.medilexicon.com/medicaldictionary.php?t=80992