Expert: Scott F. Gillman, DC, DACBSP - 7/24/2009

Question
Dr. Gillman,

I recently started doing some Zumba classes which is a lot of upper body rotating along with salsa steps. I am a woman of 52 post menopausal.  I have not done this kind of moving in years have been pretty sedentary except for the occasional walk or treadmill or bike at the gym. After doing these classes I was a little sore and stiff and thought a trip to my chiropractor was warranted.  Much to my and his surprise, I felt a pop in the front of my chest left side, with a little discomfort at first.  He did not know what to do. As the day went on the pain increased and mobility became less. I called my masseuse she referred me to a chiropractor that specializes in ribs.  He was able to put the rib back (painfully i may add)  but recovery was great. I then shifted the rib cage and moved the ribs on my right side (NOT dislocated) again my new chiropractor adjusted them back.  All was moving forward recovery was great almost no pain after 1 week. Now the fun begins.......feeling good not being aware of my ribs at all, I leaned out the open window of my husbands hummer to get a friends attention in the car behind, leaning on my left side rib cage.  I heard a crunch and felt my weight collapse slightly at the ribs. Again, not so much pain at first but of course progressing as the night went on.  The pain is in the very front, lowest point of my left side I'm assuming where the floating rib attaches to the cartilage.  This was a Saturday so my chiropractor was not open.  I saw him on monday we tried 2 times to set the ribs, then he decided the rib was not out and that it is soft tissue damage.  He is still adjusting my back leaving the rib cage alone. Sorry for the long description but I thought the history was necessary for your response.  It will be 2 weeks tomorrow since the last damage. It is still so very tender when I touch the ribs. Recovery is so very slight. I can now bend straight over in the front, however it slightly rotated it hurts. If sitting its pretty pain free. Stretching the left side does not feel good. Sleeping is ok but moving on my back in the bed is very uncomfortable. Depending on how I slept will determine my pain the next day.  What can I do myself to help recover and what should I not do?  What exactly does "rest" mean? I'm not one to just sit around.  I do all my daily chores, but at a calculated pace and movement. How long can I expect to be in pain and when out of pain how long should I take it easy?  It does hurt the rib cage when taking deep breaths, which was advised by my chiropractor to keep movement in the rib cage.  I have taken an anti-inflammatory drug only twice. I feel taking these only mask and could lengthen the recovery time. I have a pt job at Crate and Barrel that requires lifting and making boxes and wrapping items.  Does rest mean I shouldn't do these tasks as it requires all upper body repetitive movements?

Answer
Lauren,

Either the rib was fractured or the junction where the bony portion of the rib meets the cartilage of the chest was sprained.   This is not an uncommon phenomenon.  It can happen to any patient that is older and stiff in the ribs and spine.   It will happen when you're face down and the DC presses on the back to make an adjustment.   I speculate that the DC's hands were not close enough to the spine, making the ribs more susceptible to sprain or fracture.  Either way, it is going to take between 3-6 weeks to feel back to normal.  There's no popping it in place...  The manipulation is is mechanically stimulating to the area and it temporarily feels good.   These heal over time, so be patient.   I've never heard of a chiropractor that specializes in ribs.   'Thought that was pretty funny.   Does he have a post graduate specialty degree as a rib master? (Just kidding...it's Friday night, you know!#.  You might accelerate recovery with low level laser to the tender area.   It's okay to get skillful manipulation to the corresponding spine region so long as it is comfortable.   Was it really necessary to change chiropractors?   'Kind of curious about this...    In the future, if you are osteopenic or are simply susceptible to rib strain, there are ways for your chiropractor to adjust your upper or middle back with less strain.  If you get adjusted from front to back, with your arms hugging a thickly rolled up towel #or 2 towels#, and you hold your breath #making for a solid air cylinder to push through#, then it makes this easier and less likely you'll sprain or fracture #you can see this on my web site video's, adjusting a child, at www.drgillman.com).   

'Hope this was helpful.

Dr. G

www.drgillman.com