Question
Dear Dr.
I would like to describe my situation and hope to get an advise from you. Being 32 weeks pregnant, I went to see the chiropractor (she is specialized in prenatal help) for my back pain. I felt it while laying down mostly, in the thoracic spine. On the third visit she used Impulse adjusting instrument in several places of this part of spine instead of usual manual adjustments, with following adjustments in pelvis region (i was "twisted"). Immediately after these manipulations, when I sat up I felt sharp pain on the left side of thoracic spine. She told me this must be muscle spasm and it will go away with some stretching exercise, which i did for a week.
I am 38 weeks now, and pain is still there, getting worse. It is sharp and annoying, on the level of middle shoulder blade, going down to the pelvis, getting worse if leaning back, deep breathing, doing stretching exercises. The chiropractor told me it could be rib-vertebral subluxation, she was not able to fix it. Tried cold, heat, massage - nothing take it away.
So, what can I do? what can be the cause of this pain? Would x-ray or other diagnostic imaging show anything?  
Thank You!

Answer
Ella,

I am very sorry to hear of your situation. Right now you are secreting a hormone called "Relaxin" which is perfectly normal and this hormone is present to help loosen the ligaments of your pelvic region for birthing. The problem is this hormone relaxes all your ligaments and therefore you are in a state of super mobility ( if I can say that so you get the idea).

I do agree that this is more than likely a rib subluxation. The ribs articulate with the Thoracic spine but are more of a ligamentous attachment than a bone on bone joint. Therefore the relaxin has more than likely caused this hyper mobility.More specifically it has to involve the spine, ribs and musculature. Ask to have your Rhomboid muscle checked for trigger points.

You absolutely have to get back to your chiropractor and discuss a plan as to how you two will deal with this situation. The impulse instrument is very safe and hopefully a stepped up visit frequency will be helpful. I would discontinue the stretching until you have less pain. Also I think that you should schedule 3-4 1 hour massage sessions within a day of each other with a massage therapist.

Also you may have to see another chiropractor who can perform what is called an A to P (anterior to posterior) Thoracic adjustment. The reason I say another chiropractor is that pulse practitioners usually don't perform manual adjusting. If you are comfortable with your DC then stay with her but you have to change your treatment program.This manual AP thoracic adjustment should be easy to do and does not have to be very ballistic.

I really don't think X Ray or any other diagnostic imaging would be the way to go for the following reasons: pregnancy and if the rib is not fractured then the exposure would not be worth it.HOWEVER IF THERE IS A FRACTURE IMAGING WOULD BE PERTINENT. Again you have to weigh the exposure to your baby as to the amount of information gleaned. In other words you could just treat it as if it is fractured follow a protocol for rib fracture w/o the x ray exposure. By the way the protocol used to be to wrap the ribs snugly or wear a pressure garment, which would be very uncomfortable even if you weren't pregnant. Most MDs are just not doing much for broken ribs as far as pressure garments or wrapping the area with an ace bandage. This risk of pneumonia outweighs the pain. That being said I opine that you in all probability do not have a fractured rib but w/o being able to do a physical exam I can only make educated guesses here.

If none of this works you might try a Naturopath who could do homeopathic trigger point injections to the musculature with a homeopathic preparation called Traumeel.

I sincerely hope this sheds some light on your health issues and good luck as you are in a tough spot. Please resubmit if I can be of further assistance.

Dr John Q Quackenbush
www.drqdc.com