Expert: Dr. J. Shawn Leatherman - 3/21/2007

Question
ok dude, look when i was in middle school i dislocated one of the ribs on my left side from being a heavy weight on the wrestling team, and then last year when i was a varsity heavy weight i dislocated a/or rib(s) again on the left side and went to the doctors office for both times (obviously) and everything was fine until about six months after the injury occurred for the second time i was diagnosed with tendonitis and ever since I've been out of high school the symtyms of tendonitis come back every six months, the only that i can think of is the weather change (Because i live in Michigan and the weather changes quite freqently here) but is there anything that can be done for this to just stop for good or do i have to live with it for the rest of my life

your help would be greatly appreciated

Answer
Dear Jamie,

Dislocating ribs have the possibility of injuring the supporting tissue around the joint space...specifically the joint capsule that help to hold the joint together.  It is more likely that you have a condition called costochondritis than tendonitis.

Tendonitis is an an overuse injury that creates inflammation in the tendon and pain.  It is the same thing as tennis elbow, golfer's elbow, and minor shin splints.  The tendon is the end of the muscle where it attaches to the bone, thus is is susceptible to injury.  

Conversely, chostochondritits, is inflammation of the cartilage around the ribs, either in the Back where the join to the vertebra, or the front where they join to the sternum.  This can become chronic due to the build-up of scar tissue in the area, or the fact that it becomes irritated with daily movements.

What to do:  Both of these conditions require a period of rest so that the tissue can become less irritated.  Along with that you need to mobilize the area with either massage or stretching to allow for a greater range of motion while reducing the strain.  Elongated tissues always perform better and are less likely to be injured.

It is likely that this will be a condition that you will have problems with for the rest of your life, but it can be minimized and sometimes cured with aggressive myofascial release techniques.  (ART) Active release technique, and Graston technique are too very good ways to eliminate pain and increase function.  Check out the websites below to find a professional who can give you care in regards to this issue:

www.grastontechnique.com
www.activerelease.com

In the mean time, utilize ice not heat to help with the pain, and make sure that your diet is not promoting inflammation.  reduce the consumption of grains, sugars, colas, processed foods and snacks, and increase your intake of leafy green and brightly colored fruits and vegetables.  There is also a supplement in which  you can take to reduce inflammation naturally...omega III fatty acids, and glucosamine/chondroitin can help repiar injury...see below.

Omega-3 Fatty Acids:  act as anti-inflammatory agents, making them beneficial for patients with any inflammatory condition. There are three major types of omega 3 fatty acids that are ingested in foods and used by the body: alpha-linolenic acid (ALA)-18 carbons, eicosapentaenoic acid (EPA)-20 carbons, and docosahexaenoic acid (DHA)-22 carbons. Once eaten, the body converts ALA to EPA and DHA, the two types of omega-3 fatty acids more readily used by the body but this process is inadequate in humans therefore supplementation is better. Extensive research indicates that omega-3 fatty acids reduce inflammation and help prevent certain chronic diseases such as heart disease and arthritis.  Typical dosage after injury is 4000 to 6000 mg daily for 3 months.  Then reduce to a maintenance dose of 3000 to 4000 mg daily.  EPA and DHA combined must represent 50% composition of the total content of the product.  In addition the supplement should be molecularly distilled, pharmaceutical grade, and free of toxins.

Glucosamine/Chondroitin/MSM:  Glucosamine is thought to promote the formation and repair of cartilage and tendons.  Glucosamine hydrocloride is the form that is best absorbed by the body, but glucosamine sulfate is utilized more appropriately for repair. Chondroitin sulfate promotes water retention and elasticity in cartilage and inhibits enzymes that break down cartilage. MSM is also important in cartilaginous repair and helps to lubricate joint surfaces.  You need to consume a minimum of 1500 mg of Chondroitin and Glucosamine, as well as 750mg of MSM per day after injury.  A minimum dosage period would be for two months.

By the way, I am an OHIO STATE BUCKEYE, so I won't hold it against you that you live in Michigan.  Good luck Jamie!

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