Question
I am a paramedic and while lifting a heavy patient (290 lbs) from a bed to a floor, I twisted my upper back in an unusual manner.  It's been a month with little relief from chiro and PT.  I am now told I have a rib head out and with a few manipulations in can be replaced. My issue is, how can I prevent this from happening again?  My chiro said it just happens... and let it go at that.  I can't stand being in pain and out of work too.  please help thanks!

Answer
Sophia,

It is possible that you have a disc herniation.   Doc's and PT's are often fooled into believing it's a rib head "out" when in fact it is referred pain (and your body's reaction to the referred pain) caused by a deeper structure such as a disc.   A protruded lower cervical disc will cause pain into the medial scauplar zone all the way down to the middle thoracic level.   A thoracic dics protrusion will cause localized thoracic pain and also can cause pain into the ribs and chest.    First, ask your chiropractor to put on their diagnostician hat assess for disc protrusion.   This might also mean getting an MRI to see the discs.  If there's a disc lesion, you may end up in the office of a MD-Physiatrist for epidural steriod injection.  With or without a disc lesion, you also must be sure to keep the soft tissues clear of fibrous adhesion (www.grastontechnique.com), and you also must exercise to strengthen and condition your spine.  Lastly, lifting and bending ergonomics must be reviewed with you.  Authors such as Stuart McGill have written much on this topic.  

'Hope this helps.   Best of luck on getting this resolved.

Dr. G