Expert: Dr. J. Shawn Leatherman - 5/7/2009

Question
I started to experience pain at  the point of where my ribs meet my spine in the upper back. If I push on something it is very painful. also when I sneeze of cough there is a loud pop and enough pain to almost bring me to my knees. I have not been in an accident or suffered a sport related injury. I woke up one morning with the issue and don't understand why or how it happened let alone what to do about it.

Answer
Dear Matt,

I have seen this actual presentation many times a year in my clinic and the presentation is almost always the same. Primary complaint is back and rib pain that can be constant or intermittent and very intense, but with no radiation to the shoulder, neck, jaw or arms, back pain, may have pain upon deep breathing, coughing or sneezing...sound familiar?  Even though a disc issue may be present, this is much more likely to be a rib/vertebral articulation problem which is functional in nature.

You need to go to a chiropractic physician, this is a musculoskeletal problem of the rib cage where the ribs meet the vertebra articulation and results in dysfunction. Basically the joint capsule that surrounds the rib/vertebra is inflamed and is the cause of the pain... and yes it happens in the front as well because the rib attaches at both sites...both sites will need to be addressed as well.  Chiropractic physicians are well aware that this is basically a rib subluxation, and these types of articular dysfunctions can be quite painful (due to joint inflammation), and frequently become recurrent when not addressed.

The best thing you can do right now is put ice directly over the area for 20 minutes and repeat this every two hours.  This helps to reduce local inflammation and diminish pain.  Find a good local chiropractic physician to examine the skeletal system and adjust the rib articulations at the sternum and the back.  Note:  you may be very tender on the sternum where the rib dysfunction is found and you may actually be able to feel a small tender nodule..this is swelling and scar tissue at the site of involvement and can contain some minor muscle spasm as well.  

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 traumas build up and create laxity of the joint capsule.  This is the reason that the problem tends to recur.  

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. (Probably won't need this more than 3 months)  Again, remember that this may take 6-8 visits, and the chiropractor may include electrical stimulation or ultrasound depending on how the joint space if functioning at the time of the examination.  Moreover, a progressive chiropractic physician will incorporate soft tissue mobilization techniques and may possibly use a taping technique to stabilize the area and further reduce inflammation (Kinesiotaping or Leukotape).  A functional evaluation is the only true way to find out what is going on...get it scheduled.  These issues can usually be addressed very easily with a few visits.  Good luck Matt, hope this helps.

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