Question
Hi,

I was treated last year for a sports-related injury that resulted in some subluxed ribs from both my spine and my sternum (as well as some minor rib fractures - complicating things is that I have a separated shoulder so my muscle strengths get imbalanced easily without regular exercise). I have not been as good about continuing my physiotherapy exercises since completing the main care. About 3 weeks ago I landed hard on the ground (back playing the sport) and since then what had been general aches and pains in the centre of my back (between the upper shoulder blades mainly) has become considerably more pronounced. I am certain that poor posture is probably part of the problem. I do wonder if I may have jarred my spine and ribs enough to have shifted one of the subluxed ribs as the pain is similar. I am also considering an inversion table as a way to ease some of the pain but also as a way to more comfortably work on my core strength through inverted crunches etc. - does this sound like a reasonable plan and/or is there maybe a less expensive or safer option I should be examining first?

Answer
Dear Aubrey,

First of all, I do not advocate the use of inversion tables, however, if you are young (under 30) there is really no reason to tell you not to use it.  The problem arises with these table in an older population, or in a population with increased risk such as high blood pressure, heart disease, history of stroke in the family, or females who are currently using pharmaceutical birth control.  All of these things increase the risk of pressure in the brain while utilizing the inversion table.

Now, it is very possible that the trauma resulted in a subluxated rib, and this is actually a very common complaint....and a deconditioned posture can contribute to the problem due to imbalances in the musculature of the chest to the back (called - upper crossed syndrome).

I would suggest that you go to a good local chiropractic physician, preferably one who has additional training in sports injury, and have the rib and spine articulations addressed.  I would further suggest that you focus on strengthening the upper back musculature while stretching the muscles of the chest to allow for a better distribution of forces across the torso...I would hope that many of the previous physiotherapy exercises were addressing that issue.

Concerning core strength...crunches are not the best exercises to accomplish this because they focus on rectus abdominus strengthening...sit-ups are even worse because they really work the hip flexors and low back more than the ab muscles.  For good core strength you must address the intrinsic muscles of the spine, the extensors of the spine and the obliques as well as the traditional ab exercises.  You need to practice with side planks, bird dogs, pelvic tilts, pelvic bridges, and back extension exercises...no weight here...these are all to create stability and endurance around the core.   Ask the chiropractic physician how to perform all of these exercises correctly.

Good Luck Aubrey.

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