Question
Hi Dr. Dolan,
About 5 mos. ago I decided to take up the game of golf (again). I got very excited about it and soon began practicing or playing 5 to 6 days a week. Three weeks ago in the middle of a bucket of balls on the range, I felt kind of a burning pain between my lower left shoulder blade and spine. I thought I pulled a muscle and began heating it trying to loosen it up. After about a week it was worse and I went to a chiropractor. He said I dislocated a rib and that it shouldn't be too bad. He said he'd have me back on the course (he being a fellow golfer) in a couple of weeks.
  I of course learned I should be icing the heck out of it not heating it, so I began icing it about 5 to 6 times a day. I am very motivate to cure this ailment. Incidentally I'm 48 years old.
   Anyway, after 3 weeks I really don't feel I've made much progress. I've also came to the realization that this is a re-injury. I've discussed this with my chiropractor. About 6 yrs. ago I took a very bad fall, wasn't able to brace myself and took a pretty severe blow to my chest, left pectoral area. In retrospect I realized I had the same type of pain in the same area as I do now. I didn't realize it right away because this started out as a back injury.
  So my questions are; What do you think my problem is ? What should be the treatment ? (most importantly) How long before I can play golf again ? I know it sounds petty but the golf became very important to me. Lost 25 lbs. since I started playing and have been pretty depressed since I've got injured.
 I have confidence in my chiropractor, but he does seem a little perplexed why I really haven't felt any better.
 Thank you so much for your consideration.
Glenn

Answer
Hello Glenn

My name is Dr. Biggs. I found your question in the "question pool", which usually means that the doctor to whom you directed the question did not pick up your question and answer it within three days.  I know that I am different than what you requested, but with your permission, I would be happy to try and answer some of your questions and concerns.

First of all, the ribs attach to the mid back along the spine, spread around the chest and into the sternum, where via the costal cartilage, they attach.  As you stated, an injury to the front/chest could cause dysfunction in the back region, and the same goes the other way as well.

First, it is important to realize that other things can obviously cause rib pain. Some of these include lung or heart issues. I know that it has started up after hitting balls on the driving range, but this could be just coincidental. Make sure that you have a great MD and that you have had a good physical recently. If you are short of breath at all, dizzy, etc, you should certainly have an EKG to evaluate the heart.  

The rib head attaches to the mid back at the vertebral body and at the transverse process. When there is a torque or twist of the rib, it can irritate one or both of these articulations. There is a nerve that exits the spine near the rib head, and if the rib head joint is irritated, it can cause nerve pain/irritation. The result of the joint dysfunction and nerve irritation is muscle spasm and pain and soreness.

It is also very possible that more than a rib head injury, you might have strained muscles from the swinging of the club motion. Muscle strains mean that you actually tear the muscle tissues. Most strains such as these are mild, meaning that the muscles are still attached, they have simply suffered mild tearing within the body of the muscle.

I know that it has been three weeks since the injury, and that sounds like a long time to you, but the truth is that muscles require weeks to months to heal, and joints require several months to heal. If I were you, I would continue with your chiropractor and give it another few weeks. Ask the chiropractor if he/she has any other therapy modalities that they could use such as ultrasound or electrical stimulation therapy. These help to promote circulation and healing of the damaged tissues.

As for playing golf... since it is the motion that initially caused the injury, if you are not very careful, you could suffer a relapse. When you start to feel some better, go to the driving range and start with only chip shots around the green and putting. Then, work yourself gradually up to shorter clubs and half swings. Don't take full swings the first time on the range. I wouldn't even attempt a return to golf until I was about 80% symptom free.

I hope that this gives you some ideas Glenn. I know that it is frustrating when you are unable to do what you enjoy... by the way, I am 48 years old as well. Stay Active, don't give in!

Dr. Biggs
http://www.eastmesachiropractor.com
http://www.biggschiropractic.blogspot.com
http://www.therapeuticfoods.blogspot.com