Rib Injury

[sebastiano53]

Dr. Biggs, I fell a yr. ago running up stairs carrying something and injured ribs, back hurt where ribs attach on right side sometimes too.  Went to dr. and she said that I broke ribs, so I did nothing knowing it could take time to heal.  Turns out she misread report and when getting 2nd x-ray didn't break ribs at all.  I had been heating it for months(wrong thing, I know).  Have gone to a sports dr.(chiro training) for last few months.  He manipulates tissue but believes in continuing exercising and icing and taping.  I have had times where he makes me feel great, and pain greatly lessens but then when I exercise I reinjure it or when he manipulates it again it seems to make it worse.  Any recommendations?  I am very active(48), like to work out, hike, bike, run, tennis etc.  Running really seems to aggrivate it as does weights or crunches.  It has just turned a yr. now.

[DAry]

Dear Sherie,

Thank you for your question. I am so sorry about your fall and injury to your ribs. It is very frustrating for the patient, and the doctor, when a condition lingers for so long. A year is a long time.

Rib fractures are very hard to see and diagnose because the lungs and everything else in the chest cavity creates a lot of shadows and blurring of lines on the x-rays. Don't be too hard on your doctor that diagnosed you with fractures of the ribs. Often the only time that they are seen is when a second x-ray is taken a couple of weeks after the injury. By this time, there is scarring and repair that begins to take place, and it becomes a little easier to see. It is also possible that the second set of x-rays were not read accurately or that they simply do not show the fractures clearly.  Either way, whether there were broken ribs or not, the bones should have healed by now, so it is immaterial. Also, heating the rib cage injury did not cause you any additional problems in my mind.

The more devastating injury,(yet often the most overlooked) is the injury to ligaments, joints, and other soft tissues.  Ligaments are what hold bones/joint together. They are a specialized connective tissue, and as such, do not heal very well at all. As a runner, I am sure that you have heard of people who have torn cartilage or ligaments in their knees. These people often require surgery to repair the ligament or to remove the torn portion of the cartilage.  I am not saying that you need surgery to repair rib cartilage. What I am saying is that these tissues often don't heal very well, and any healing and repair that they are able to accomplish is going to take a long long time... months to years.

It sounds to me that you are getting some decent care with your doctor. You have to consider what options are available to you at this time:

1) Go to your medical doctor... who will likely give you pain medications and muscle relaxants.  To me, this is the least viable option because your condition is not being treated. Medications only treat your symptoms. When the drug wears off, the underlying condition is still there, and the pain returns. 2) Continue with your chiropractor/therapist. Binding, massage, exercise, stretching, electrical stimulation, ultrasound therapy, and spinal adjustments are all good options for your doctors. In such a setting, your health care team is attempting to assist your body in healing. Give it more time. Connective tissue is slow to heal. You might also ask them for suggestions of nutrients that you could use as supplements in order to assist with tissue healing.

3) Orthopedic Surgeon... if there is joint instability... this type of doctor might be able to re-attach rib heads to the spine or attach ribs to rib cartilage.  If you are very concerned, this would be the next place to go for a consultation and evaluation. If, on the other hand, the orthopedic surgeon does not find joint instability, it is unlikely that there is anything that she/he could do for you.

I think that it is great that you continue to be active with running and exercise. You should continue this as much as possible. At our age(I am also 48), however, it is not uncommon to have conditions that do not heal completely. If this is the case with your ribs and mid back, you need to find what treatment methods help you to manage your condition, not necessarily cure it. I see many patients that respond very well to my treatments, yet I know that they will not grow new discs or new ligaments. In these cases, I teach them exercises. I educate them on the permanency of their injuries, and we find ways of minimizing the ways that they are bothered by their conditions.

Sherie, I hope that these notes give you some ideas about your condition and options for you.

Keith Biggs, DChttp://www.eastmesachiropractor.comhttp://www.biggschiropractic.blogspot.com