Question
QUESTION: Dr. Gillman,
I am currently on my way to becoming a certified Yoga Instructor.  I have 3 months to finish.  I do have torn rib Cartilage due to performing an advanced inversion, with a spotter who did not spot me at all.  
I do see a chiropractor, my rib has been adjusted back into place.  However, I can not rest fully while in my teacher training course. I will feel fine for a few days, but simply raising my arm above my head causes pain while doing gentle yoga postures.  It has been three weeks since the injury.  Any suggestions and how much longer will it take to heal if I continue my yoga practice? (which I have to continue to complete my training).  Also, if I work through the pain, will I cause more damage?

Thank you,

ANSWER: Michele,

First of all, how are you sure you tore anything, and how do you know if it is cartilage that was damaged?    Did you have an MRI?   How do you know it is a rib?   I have seen over and over that that area of pain is assumed to be the location of tissue damage.    Doesn't someone with angina feel pain in their shoulder, for example?  It's not coming from the shoulder, but that's where they feel it.   I need more information.   How did you cause this pain to begin, e.g. what is an advanced inversion.    Also, based on what physical exam procedures or imaging procedures was it determined that you have a rib or rib-cartilage problem?     Once I know this information I will be better able to properly answer your question.  

Dr. G'

---------- FOLLOW-UP ----------

QUESTION: Dr. G,
Thank you for your prompt reply.  I had an x-ray, which nothing showed up.  My chiropractor who I have been seeing for 3 weeks since the injury occurred (3-4 days per week) advised me that the cartilage is probably torn, he did eventually adjust my rib into place and I have been getting electric stim when I go as well.  I had pulled muscles from both sides of my neck down to my right thigh for about a week.  The pain is behind my left shoulder blade, which I thought was a pulled muscle or pinched nerve.  I did not receive an MRI.  Just going on my chiropractors assesment.  

The yoga posture is called a scorpian pose.  You are upside down, balancing only on your forearms, head is off the ground, you slightly bend your knees into an upside down back bend.  My spotter never spotted me, so while I was upside down balancing on my forearms, I started to bend my knees, thinking she would be there spotting me as to not fall backwards (I usually do this against wall, with toes on wall for support).  The spotter never touched me, I thought she would be there as to balance out...but nothing. So I landed full steam ahead onto my back, my right leg was bent under me, my left arm was pinned behind my back on the mat.  Hence all the muscle pulls.  

I hope my reply helps.

Thank you,
Michele

Answer
Hi Michele,

Okay.  I saw the Scorpion pose and understand it.    I would ask your chiropractor to reexamine you and consider the following differential diagnosis':   "stinger" or nerve traction injury (funny it's called a stinger and you did a scorpion pose), and lower cervical disc herniation (which will cause pain along the inside border of the shoulder blade and in into the chest/ribs);    If the doctor is not careful in examining the patient, he/she will miss this and just assume that it's cartilage.      Also, electric stimulation will not fix anything or change anything.  It's a waste of time and money in my opinion.   Assuming you do have a crack or fray of cartilage, ask your DC to consider using a low level laser therapy (LLLT).   Unlike e-stim, the clinical literature shows that LLLT will create increased cellular ATP (energy) and affect better healing and outcome.    Also, if there is any soft tissue fascial damage, also likely and also with the potential to cause rib area pain leading everyone to think it's cartilage (which I doubt), then you need to consider using mechanically assisted soft tissue therapy as an avenue for changing the histology of that soft tissue.  Again, e-stim will not do this at all.   Look at:  www.FAKTR.com to see what I'm talking about.  There are some really excellent and really terrible chiropractors in NJ.    If you email me off list I will provide a few names.

'Hope this helps.

Dr. G'