Question
I am very into weightlifting. About eight months ago I woke up with strained shoulders and pectorals. After a week my shoulders were fine but there was pain in my inner pec whenever I moved my arm upward. I saw numerous othropedics and physical therapists about the injury and they all informed me it was a musecle strain and that it would heal over time. I had an MRI performed that showed nothing. After eight months with no results, i saw a chiropractor and he informed me that the injury was a rib cartillage injury. He has been performing accupuncture for a couple of weeks now but nothing seems to be getting better. THe only thing thats different is i'm suddenly able to crack my ribs by leaning backwards which relieves pain. Still, the tender spot remains and my chiro told me not to crack my ribs too much. I should also mention that my day job requires me to do things such as hammering, filing, and opening and closing lopper tools. ALthough it's not THAT strenuous on my ribs, it definetely irritates them! I am so lost and confused and don't know where to turn! I havent lifted weights now in eight months! ANy advice would be helpful! Thank you.

Chandler

Answer
Dear Chandler,

This is a very difficult question to answer. I found your question in the "question pool", which usually means that somebody else didn't want to answer the question.  Even though your inquiry was not directed at me, I will make an attempt to answer.

First of all, if the injury is indeed rib cartilage, you are not going to like the answer.  Cartilage is a tissue that is "avascular", meaning that there is little or no blood supply to it. As a result, it is a very slow tissue to heal.  (in contrast, skin is highly vascular, and it heals quite quickly and nicely).  I am concerned in your case that perhaps you have an instability due to damage at the junction between the the rib and the sternum, in the rib cartilage. Sometimes cartilage injury never really does heal. For example, if cartilage is torn in the knee, it is often surgically shaved off or removed.

Another possibility is that this is still a muscular strain that hasn't resolved.  At times, muscular strains at the bone insertions can be quite painful and resistant to healing. An example of such a condition is Tennis Elbow.

My primary concern is that there is no underlying disease process. I take some comfort in the fact that you have had an MRI.  Although I doubt that there is any underlying disease process going on, you need to rule out any lung and heart conditions. Gall bladder pain can also cause chest pains at times. You also must consider the tissues known as the pericardium around the heart and the pleura that surrounds the lungs. I found this site that talks of a variety of chest pain conditions common to athletes. Take a look! http://www.sportsinjurybulletin.com/archive/chest-wall-injuries.htm

If this is truly muscular or cartilage, some treatments that might help are:
1) Ultrasound therapy on the injury. This is an older therapy that has fallen off in utilization the past several years, but it is a very affective therapy. It helps to promote circulation through the area, promoting healing.
2) Avoidance of all activity that is going to strain the area. It sounds like you are trying to do this, but that your work causes stress to the injured area.
3) The ribs attach both to the spine and to the sternum. If there is a torque or twist to the rib as a result of spinal joint dysfunction, adjustments of the mid back segments might help.
4) There is a nerve that travels from the spine along the rib. If the nerve is irritated, it theoretically could refer pain into the chest region.
5) If this is pectoral muscle and cartilage injury, it is an annoyance, but not life threatening. Perhaps you have already tried this, but have you considered returning to weight lifting, but starting out with EXTREMELY LIGHT WEIGHTS?  If you try this, do not get impatient. You should stay with very light weights for several months, working with more repetitions.  (I know that this won't work if you are a serious body builder who is looking to bulk up, but if you are simply lifting weights to stay fit and healthy, this is an option.)

Chandler, as you have stated, you have had multiple orthopedic doctors and physical therapists evaluate your injury. You have also had at least one chiropractor evaluate you.  Please remember that I am just one more chiropractor, and I am at a great disadvantage over the others because I haven't even seen you!  If I were you, I would not give up. I would try and find an orthopedist that specializes in sports injuries. I might even talk to a cardiac surgeon. (cardiac surgeons cut through the sternum as they perform open heart surgeries. They could give you some idea, possibly, regarding how long it takes for costal cartilage to heal).

Don't give up. Keep asking questions. I know that it is frustrating because you want to get back into weight lifting.  Keep an open mind with everyone that you talk to.

Keith Biggs, DC
http://www.eastmesachiropractor.com
http://www.biggschiropractic.blogspot.com
http://www.therapeuticfoods.blogspot.com