Question
Dear Dr. Gillman,
My 16 year old daughter runs distance in school. She ran a two mile event in late May 2008 and experienced sudden pain in the diaphram area and shortness of breath in the second mile. The team arrived late for the race and she did not adequately warm up or stretch. She has run distance for 3 years and had never had this problem before, but now experiences it every time she runs longer than one mile. We have been to our regular medical doctor and family chiropractor and have ruled out any problems with chest x-ray, echocardiogram, and lung function tests/exercise induced asthma. She does have low ferritin and takes multi-vitamins, vitamin c and iron supplements. Our chiropractor did some ultrasound treatments to the area and also gave us EC Mattrix to support cartiledge, thinking it could be an cartiledge injury in the chest or diaphram area which is the area of her pain. She recently finished her cross country season and seems to be improving slightly, however, it is always in the second mile that she struggles and develops pain. We are now 6 months from the initial problem. Do you have any other suggestions that we may consider? She loves to run and is disappointed that this happens, but has been patient in trying to heal. Should we consider other possibilities, additional ultrasound, or hope to expect the body to heal in time. Thank you so much for listening to our concern.
Christy

Answer
Christy,

First, I think it would be a good idea to completely rule out any internal organ condition.   The fastest/easiest way is simply to have a diagnositic ultraound of the upper abdomen (not just the heart).  The other thing that can be done is for your daughter to run until the pain begins, and then run right to the chiropractor's treatment room while symptomatic.  This way, it will be easier to see what may be provoking the pain.   The chiropractor can try some targeted soft tissue therapy to the abdominal muscles where they attach to the ribs.   If he/she is a Graston Technique provider, then it will be easier to work more deeply into the muscles with less discomfort, since the GT tools have different shapes.  High-velocity adjustments to the ribs (from front to back - and NOT with a drop piece, but with a towel roll on her chest...the DC can call me if he doesn't know what I mean) as well as the thoracic spine are also important considerations once it's been determined that there is no internal organ problem.  I'm curious if, when she has her pain, there is any sharp increase in pain when she takes a deep breath or if she coughs.   Does she have associated pain in her upper or middle back?  Does she have any scoliosis?  I doubt EC Mattrix is going to change anything.  If there is no internal organ issue, and she has no response to treatment with GT, then I would recommend a bone-scan to rule out stress fracture to the ribs.   Again, this is a simple and fast test that would show ANY increase in bone activity.  Keep in mind that a stress fracture, and it's precurser, a stress response, will not show up on an xray unless it's a big one.   I would lean towards bone scan if your daughter has spinal scoliosis.   If the scan comes back with a "hot spot" in the rib(s), then that's your answer.   It means she has to rest and allow it to completely heal.  

I hope this helps in finding an answer.   I am VERY interested to know how she does.   Please keep in touch with me on this: [email protected].

'Best regards,

Dr. G'