Question
Hi there. I am a 21 year old rugby player. I have had a long term injury that was originally diagnosed just as impingement of the rotator-cuff. I had an extensive physio rehab course; stabilizing my shoulder blade and correcting my pattern of shoulder movement. this appeared to help, but as soon as I started contact rugby again I got the same pain. I went to a specialist, who straight away manipulated a couple of subluxed ribs back into place. he also gave me a couple of sessions of deep massage to break up "scar tissue" below my clavicle on my pec. this all helped with the impingement pain. however every time I play rugby, front row prop, numerous ribs sublux. I get them manipulated back, but it happens again. My first question is; what is the long term implications of this repeated process? Second question is how can subluxation be prevented? Thanks a lot

Answer
Hi Andrew,

Regarding Q. 1: Repeated strain to a joint system, e.g. spine/ribs can lead to a syndrome of chronic sprain, where there is constant sensitivity to the joint;  this is similar to "cumulative strain syndrome" or "repetitive strain syndrome."   Same animal, so to speak.     Re: question 2) As for "subluxation," the problem is that we do not really understand what it is.    It really is not a bone out of place   It may feel like that, but all the research we have points to it being something else.  We hypothesize that it is a joint that is stuck or fixated.   Even this remains a hypothesis.    We assume that scar tissue or adhesions exist because that's what it feels like to the practitioner, and because we have some understanding about how scar tissue can form, e.g. from healing of torn or strained tissues, as well as from tissues being kept idle and not moving (e.g. in a cast).    My suggestion is to see if there are any areas of muscle weakness.  This means that the doctor has to strength-test you, and not all have good skills in this department.    Also, if you are going to get joint manipulation and soft tissue mobilization, get it from the providers who have the most training and skills in this department:  sports chiropractors.     Lastly, check out www.faktr.com as this is a great avenue for athletes with your condition.    It is hard to know what is causing your condition and many providers will make stuff up and it will sound pretty good, but the truth is that we don't completely know.   The bottom line is that whatever methods used cause you to not have your problem, then that's the method you want to stick with.   

'Hope this was helpful.  

Dr. G"