Rib pain treatment casefile

Rib pain treatment casefile arrives whether it is a fall, a sneeze or whatever. Chest pain is perhaps less common after a fall from a bicycle but this was happened to this lady.

This page was last updated on 8th November, 2018.

Please note that anecdotes like this do not constitute scientifically proven evidence.

For that we need to do randomised, controlled trials. A group of people with a particular condition are divided into two, the one getting the real McCoy treatment, and the other a sham.

Nevertheless they create interest and often are the stimulus for new research.

Six months ago Mrs T fell on her back and ribcage. Her bicycle skidded in the snow, and she found herself lying deep in a drift. She had immediate pain in her midback and ribs on the right. The pain radiated towards the midaxillary line, under her armpit.

She went to her doctor who diagnosed bruised ribs, and felt no x-rays were needed. He prescribed anti-inflammatory drugs; within 5 days she had severe diarrhoea, so she stopped the medicine. But six months later she still has the runs daily. I only wish that that I knew then about the importance of a probiotic such as kefir that we now drink daily.

Initially the rib pain was mild, but several days later, and for the following three weeks, she had severe back and chest pain.

Her blood pressure rose alarmingly, and she developed a rapid heartbeat. She went through the wringer; the Dutch have the quaintest sayings, meaning that she underwent a thorough cardiovascular checkup during which time nothing was found by the cardiologist. The symptoms were ascribed to a bad reaction to the antiinflammatory medicine. The heart related condition gradually lessened as predicted by the specialist.

• Other rib pain causes ...
• Anti inflammatory drugs ...

But the pain in her mid back and the diarrhoea remained. She also remarked that, since the fall, sharp stabs in the right groin seems to have started.

At the first consult she described how the back and ribs felt thick, so she said, and hindered her movement; like there was a thick pancake on her back, to use her words. Nothing relieved the pain.

She's a particularly with it lady, very much in contact with her body; she's a former star athlete, and still has a standing Netherlands record set at the Olympics many decades ago. She just missed the bronze. Mrs T claimed that her posture had deteriorated seriously since the fall; she was very fit prior to the injury.

Indeed, she had seriously bent her chassis.

Rib pain treatment case file

Rib pain treatment case file suggests consulting a chiropractor if you have discomfort in your chest, but no fever; especially if it hurts when taking a deep breath.

Chest pain

A rib pain treatment casefile will often involve chest pain; it could be in the midback, under the armpit, over the heart, under a breast or at the sternum.

Examination

A skew pelvis was immediately evident, low on the left, due to a short left leg, and nothing to do with the injury (a so-called incidental, but important, finding). A mild C-shaped scoliosis is evident, convex left, but she has no significant low back pain of note. A few creaks and groans periodically. Range of motion of the lumbar spine was full and free.

On motion palpation a severe fixation in the right sacro-iliac joint was evident. Thus it came as no surprise that flexion, internal rotation and adduction of the right hip were also reduced, with a hard end feel; another incidental finding.

Side bending to the left provoked pain in the 9th,10th and 11th ribs on the right. Percussion with a reflex hammer over the spine and ribs elicited no discomfort. Six months ago that may well have been different.

Compression of the ribcage, both from front to back and side to side provoked no pain. There was no tenderness over the costosternal, or breastbone joints, but there was restricted movement of all the lower rib breastbone joints on the right on deep breathing.

Motion palpation of the costovertebral joints T10 and T11 on the right revealed profound fixations and tenderness in the midback. The bron of the problem as we say in Dutch; the source.

Treatment

CONSULT 1 : HISTORY and EXAMINATION

Subjective: Right mid-back and chest pain since a fall six months ago.

Objective: Side-bending to the left > pain in the ribcage on the right.

Assessment: Costo-vertebral sprain.

Plan: Chiropractic Manipulation of the rib. No treatment at the first consultation.

Second complaint: Eartly right hip arthritis. Is there anything to be done? Yes! Chiropractic mobilisation of hip.

CONSULT 2 : Report of Findings

At the second consultation, we routinely go through

1. the history with the patient to check that no important details had been omitted.
2. We then explain in some detail to the patient what the orthopaedic, neurological and chiropractic findings (and radiological, if X-rays have been taken. None in this instance)
3. A short presentation on chiropractic philosophy, how chronic, unattended subluxations deprive the joint cartilage of nutrition causing Immobilisation Arthritis, and how toxic waste products in the joint, if not washed away, may lead to irritation of the nerve roots affecting general health.
4. An explanation of the treatment. What the treatment will consist of, the scheduling, and what course of action will be followed if the patient does not respond as expected.
5. Give the first chiropractic treatment.

Light prone drops T10-11 costo-transverse joint (right)Sitting mobilisation of the ribcage.No adjustment today.

• IMMOBILISATION ARTHRITIS ...
• VERTEBRAL SUBLUXATION COMPLEX ...
  

CONSULT 3 : RIB PAIN TREATMENT CaseFile

S: Definitely feeling a little better.

O: Costotransverse joint still fixated and tender.

A: No after-pain from the treatment.

P: First chiropractic adjustment today.

• T11 (straight bilateral transverse pisiform technique), no release.
•  Anterior thoracic techniques T11 (fist extension)
• Sitting mobilisation of thorax.
  

CONSULT 4 : RIB PAIN TREATMENT CaseFile

S: 50% less pain. Less of a wobbly, oscillating feeling when walking. Some slight lower back pain.

O: Lateral flexion still restricted.

A: Progress better than expected.

P: Continued treatment of the ribs.

• First treatment of the pelvis today. Sacrum left / sacroiliac right prone drops. (No sideposture adjustment yet)
• Start treatment of the hip joint next consult.
  

CONSULT 5 : RIB PAIN TREATMENT CaseFile

S: Some rib pain after more forcible adjustment.

O: Percussion negative, bruised rib.

A: Avoid hard PA treatment.

P: Continue with treatment of the ribcage and pelvis.

• Begin chiropractic mobilisation of the right hip. No PA rib-head treatment.

CONSULT 6 : RIB PAIN TREATMENT CaseFile

S: Still feeling it in the ribcage (anterior). Mid back pain improving.

O: No inspiration pain, tender on palpation.

A: Iatrogenic illness ...doctor-caused disease. An overly robust chiropractic treatment has caused a temporary setback.

P: Continue with mobilising treatment of ribcage, no PA adjustment. Sitting fist-extension treatment of the T11 ribhead. Prone drops on the pelvis.

• Next consult: Do proprioceptive test with a colleague to determine efficacy of a heel lift on the skew pelvis.
• IATROGENIC ILLNESS ... includes bruised ribs from overly robust chiropractic treatment. 

CONSULT 7 : RIB PAIN TREATMENT CaseFile

S: Still improving. Anterior rib much less tender. Amazing, the diarrhoea has abruptly stopped. No real change in the arthritic hip joint.

O: Lateral flexion of the thorax is no longer painful. Proprioception testing indicates a 3mm lift in the left shoe would be most beneficial to level the pelvis, and reduce the scoliosis.

A: Considering the set back with the bruised rib, progress is most satisfactory. She is happy. No improvement in the arthritic hip which is to be expected after after only two treatments.

P: Chiropractic treatment as used previously.

• 3mm heel lift.
  
  At the next consult:
  
• Begin instruction on a home rehab programme.
  
• Discuss nutritional management of aging hyaline cartilage.

CONSULT 8 : RIB PAIN TREATMENT CaseFile

S: A very happy lady. She says her back is better than before the fall! No diarrhoea unless she eats out. Chinese did her in for 1 day. Hip also much looser.

O: Complete free range of motion of the thoracic spine. No further pijn from the bruised rib, neither is it tender.

A: Treatment phase nearly over. Now more rehab. Shot put exercise. Chiropractic mobilisation of hip.

P: Begin a diet rich in fatty fish such as salmon, 1000mg omega-3 or codliver oil capsules. Chicken bones extract and flax seed. Start slowly in case it starts diarrhoea again.

• LEG LENGTH INEQUALITY ... 
• HYALINE CARTILAGE ...

COMMENT @ RIB PAIN TREATMENT CaseFile

1. It is interesting that, whilst radiological research proves there is a higher incidence of hip and knee arthritis in persons with a short leg, that arthritis could be either on the short or the long leg. In Mrs T's case, the arthritic hip is on the side of the long leg.
   
2. Frank cracked ribs do not happen often in the chiropractic practice (I admit to five in thirty years), but a bruised rib as happened in this case occurs periodically. The patient feels some rib discomfort for a week or two. Whilst Iatrogenic Illness (doctor-caused disease) does happen in the Chiropractic arena, it's a pale grey compared with that of medicine (over 200 000 deaths per year in the the USA alone).
3. I wasn't prive to the examination of Mrs T six months ago, but I think the decision by her doctor not to X-ray was probably justified. There's no indication of a spinal fracture. Whilst I could find fault with his management once the 4-6 week period for a cracked rib were over, the fault is probably with us chiropractors for not properly informing our medical colleagues what chiropractic can mean for their patients.
   
4. Certainly it was not his fault that she got diarrhoea for six months for his medication, it's simply one other instance of iatrogenic disease, and I'm in no position to point a finger!
5. I'm expecting her arthritic hip to respond well to chiropractic management. It's not advanced, her weight is perfect, her attitude to fitness is very positive and, provided she takes the nutritional support needed seriously, I'm expecting a good result in the hip. X-rays may be necessary to define how advanced the arthritis is.
   
6. Whilst there were fixations of the rib-breastbone joints, fortunately she never developed a concomitant Tietze's Syndrome. That causes severe breastbone pain... TIETZES SYNDROME CaseFile ...
   
7. It's difficult to explain how and why a six months diarrhoea, caused by drugs or possibly even by the subluxated rib(s) themselves, ceased after a few chiropractic treatments. Perhaps we underestimate the devastating effects that medicines and subluxations can have on general health.
   

Chest pain

Your chiropractor will examine you very carefully if you are suffering from chest pain; whilst many musculo skeletal conditions can cause rib, midback and breastbone pain, obviously every chiropractor is also thinking heart, lungs, stomach, liver, pancreas. Every rib pain treatment case is potentially complex and serious.

Cancer, particularly metatases from the breast, often target the ribs. Prevention is the key; we all should on a daily basis be enjoying dark green leafy vegetables, particularly for a phytochemical called sulforaphane; there are over fifty research articles documenting this substance's ability to detoxify cancer-causing agents. It's the reason why broccoli is known as the Queen of the Vegetables, but also to be found in other greens such as kale and arugula. These are both hardy and easy to grow in your own garden.

• Nutrition of arugula, also known as rocket.
  
• Health benefits of kale

Google appears to frown on too many links, so phrases in bold, like that above, need to be copied and pasted into the Site Search function in the navigation bar on your left if you want more information.

Nutritional support

Hyaline cartilage requires the correct environment to heal. Research done in the Netherlands on knee joint distraction clearly shows that unloading of joints and increasing cartilage perfusion lessens joint pain and disability and initiates joint cartilage healing.

Furthermore many orthopaedists are now using Omega-3 oil as an anti-inflammatory, and its important affect on hyaline cartilage.

Other research done at Harvard Medical School has shown the important effect of a chicken bones extract on arthritic joints.

• KNEE JOINT DISTRACTION ...
  
• CHICKEN BONES EXTRACT ...
  
• SMOKED SALMON DIP RECIPE ... omega-3, vitamin D, calcium metabolism, anti-inflammatory effect. 
• chest pain
• Rib pain treatment home page
  

Use the Site Search function in the navigation bar on your left to find the links to those topics highlighted in bold.

• Tietze's syndrome, or costosternal pain.

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