Question
QUESTION: I am 53, basically healthy and active female that has been seeing the same
chiropractor for approximately 15 years. I have have minor back ailments
ongoing,lower back, neck etc., and usually after adjustments feel better.
I have had MRI's & X-rays with some findings of spinal degeneration and bulging
disc that that at times I have had to visit my health care provider and
chiropractor 3x's per week. Since earlier this year, I have started to have rib
cage/back pain during my sleeping hours only to go away about an hour after
getting up in the morning. The pain is so intense that I have to get up. I have
rule out my sleep number bed since I have tried everything from 15 to 100 and
also tried sleeping on other beds couch, recliner, etc. Since February of this
year my chiropractor whom is up on all the latest spinal info out there
purchased a new adjustment table, the type with drop sections that can move and
tilt to accommodate the mirror image effect. Well I started noticing about a
month or so after using this table for adjustments I started having this pain. I
have expressed this problem to him but to no avail. I am clueless to what this
is. Hope you can shed some light on this.



ANSWER: Sandra,

I need a little more information to try to help you:

1. Is your chiropractor using a technique called Chiropractic Biophysics?


2. Is the rib pain you're having in the back near the spine or the front of the chest?

Thanks -

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

QUESTION: #1. I am under the understanding that all chiropractors would use a form of biophysics. The machanics of how the stucture works or should work is relevent.
#2.Both. The pain starts about 3 hours into sleep. I sleep only on my sides. The pain wraps around from the back to the front of my rib cage on both sides. Then it hurts in both my back, sides to front.I rotate throughout the night and do tend to fall back asleep after a while. Then upon getting up the pain diminishes within a hour. But I do notice my knees, legs and ankles also seem stiff during sleeping hours.

ANSWER: Sandra,

Thanks for your question, and for providing some more information regarding your problem.

To address your first comment in the follow-up, I think it would be more accurate to say that evidence-based chiropractors are concerned with optimum outcomes based on measurable improvements in symptoms and function; they use techniques and treatment approaches which are patient-centered.

Proprietary techniques tend to be more doctor-centered; that is, they emphasize more of a "cook-book" approach to patient treatment. Please see the following link for a critical analysis of one such technique which emphasizes a "mirror image" approach to spinal manipulation:

http://tinyurl.com/29szmvn

I inquired whether your chiropractor was using a particular proprietary technique, since in your initial question, you mention that your symptoms began about a month after your chiropractor began using new equipment to manipulate your spine in a "mirror image" fashion.

It is unclear to me if this change in equipment and technique is the root cause of the onset of your symptoms, but there seems to be a causal relationship between the two.

Secondly, and probably more importantly with regard to your initial question, I can't offer you a definitive diagnosis of your condition over the Internet, but I can provide this information for you regarding the pain which radiates from your back to the front of the rib cage on both sides:

Myofascial trigger points (tender nodules located in taught bands of muscle which produce inflammation and characteristic pain referral patterns) may refer pain from the back to the front of the body. In particular, the serratus anterior muscle may produce rib pain, flank pain, and pain under and around the shoulder blade.

"Slipping rib syndrome", or a displacement of the articulation of the rib head to the joint which attaches the rib to the thoracic (mid-back) vertebra, is usually present one one side, and may produce pain which radiates to the front of the chest.

The differential diagnosis of slipping rib syndrome includes a variety of conditions, such as cholecystitis (gall bladder inflammation), esophagitis (inflammation or swelling of the esophagus), gastric ulcer or acid reflux disease, liver or spleen abnormalities, stress fracture, inflammation of the rib cartilage, and pleuritic chest pain. Typically, the pain in slipping rib syndrome is worse with deep breathing.

Rib hypermobility (too much movement of a joint) caused by weakness of the rib-sternum (sternocostal), rib-cartilage (costochondral), and/or rib-vertebral (costovertebral/costotransverse) ligaments, allowing rib hypermobility, is thought to be the primary cause of slipping rib syndrome (http://tinyurl.com/2evrthd).

Tietze's syndrome is a less common situation in which pain is usually felt in the upper ribs (typically on one side) and the midline of the chest. Tietze's syndrome often follows a course of prolonged coughing, and deep breathing and laying face down tends to exacerbate the pain. A diagnosis of Tietze's syndrome is made on clinical grounds after ruling out other problems such as inflammatory arthritis or other lesions which can cause pain and pressure in the chest wall (such as tumors) (http://tinyurl.com/2cn9qo5).

Another fairly uncommon cause of pain in the mid-back is thoracic disc herniations. The pain patterns may be quite varied (http://tinyurl.com/2e4785t).

At this point, I would recommend seeing your primary care physician to discuss your symptoms. You may need to have an x-ray of your spine and/or chest, and possibly an MRI or CT scan.

You may also consider seeing a massage therapist to determine if trigger points or other muscular problems may be causing or contributing to your symptoms, and until the problem is appropriately diagnosed, you may want to consider discontinuing your chiropractic treatment, especially since it seems that your symptoms began a few weeks after beginning treatment with this new technique.

I hope that this helps to answer your question.




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

QUESTION: Thank you for your answers given. I just have one more question...is it typical for any of these situations that my pain goes away when I get up in the morning. That is the thing that confuses me. I could see if the pain lingered throughout the day, but it is only during the night. I feel good during the day, I watch 2 grandkids and 3 other children and we are pretty active.  

Answer
It's difficult to identify why you feel pain worse when laying down at night, since I'm not quite sure of the cause of your pain. It may be that, as in some kinds of arthritis (especially osteoarthritis, or degenerative joint disease), movement is preferable and pain is lessened as opposed to maintaining a static position in rest.

I definitely think that follow-up with your medical provider is indicated at this point.

I hope this helps.