Question
Hi Dr Gillman,

I have read a few of your past answers to manubriosternal related questions but they weren't specific to my problem.

I am a 16 year old gymnast, training around 12-14 hours a week in 3hr sessions. We do a large amount of conditioning (upper body intensive), such as cross and other rings strength. About a month ago all of a sudden while training rings I felt a pop in my upper sternum. I was quite suprised and took it easy for the rest of the session, although it still popped a few more times. After training there was a slight ache deep in the sternum around where it popped. I have tried to take it easy in training, no rings strength stuff etc, rubbing anti-flam into it fairly regularly and being careful, but it has not gotten better.

Just tonight I went online and did some research, and the pop is occurring at the intersection of the sternum and the second rib, (the manubriosternal junction as I found out). I think I might have pulled the cartilage at the junction slightly off the bone or something, but am not sure how to fix it.

I have nationals coming up in a month, and really would like some advice on fixing this! Thanks,

Scott

Answer
Scott,

This is a very difficult condition to treat, and short of resting it, there is no fast cure.   Sorry.  Not being able to see, feel, and examine you makes my recommendations a little cumbersome.  If there is frank dislocation at the joint, whether it is at the sterno-clavicular or costo-sternal articulation, then there is the chance that it is mildly unstable from ligament damage.  If not, and the area is just sore and irritated from strain, then maybe you can find some relief.  If it is the rib, and if there is no dislocation, and you only subluxed the rib joint, then you must consider having a chiropractor attempt to adjust the rib.  This would be determined if there was prominence and loss of rib motion, and the adjustment would be to free it up.  If it is the clavical head attachment at the manubrium of the sternum that is prominent, this is not a structure that simply pops back in place (I know. I dislocated mine.)  Whether rib or sternoclavicular, you may find relieve with the combination of these methods:   1) low level laser therapy (LLLT), 2) Graston Technique, 3) proprioceptive tape, kinesiotape, or strapping tape.   I'll go through each.   LLLT has clearly been shown to speed up healing of damaged tissues.  Laser in wavelengths of 635 nanometer through 940nm will promote ATP production, and this is akin to energizing the cells and kicking up the healing process.  Some argue that the longer wavelengths (870 - 940) are not as good, but there's not sufficient data to support this notion.  I like my 635/808nm unit.   There's no down side to LLLT.  All it can do is help.   2) GRaston Technique (GT):  go to www.grastontechnique.com.   While I perform a variety of soft tissue procedures, none are as good as GT.  If you can find a GT provider that is rehab/sports oriented, they may be able to put you in pain-provocative postures while performing GT and literally find ways to reduce the pain right there on the spot.  For example, after adjusting your rib, I would put you on your back on a bench/treatment table and have you do a chest fly with tubing (or light dumbbell) into and out of a painful range while at the same time mobilizing your soft tissues (e.g. ligaments and fascia).   3) Tape:  Tape can do many things.  It can cinch together parts (to a certain degree) that are torn.   Strapping tape can be used to pull together or apart the tissues around the sternum.   Stretchy kinesiotape, like you saw on Olympic athletes, can be used to create increased circulation under the skin and to also reduce pain.   After your treatment is over, your skin would be prep'd and then tape would be applied.  The tape should provide an immediate feeling of pain reduction or immediate feeling of support/stability.  Otherwise it should be removed or re-applied.   As part of your exam and treatment, I would test the strength of your pectoralis major (both clavic and sternal divisions), pec' minor, serratus anterior, and coracobrachialis to see if isometrically challenging these muscles provokes pain.   If so, then I'd re-test them post treatment and note the results.  Lastly, the chiropractor will look along the kinetic chain, the joints associated up and down the line from the injured joints, and improve their surrounding soft tissues and function.  This is the current and emerging paradigm for treating sports injuries, employing functional and kinetic approaches with pain provocation, movement, and applied soft tissue treatment. There is even a course called FAKTR-PM that teaches this.   This is the best I can do for you, Scott, short of treating you personally.   I don't know where your event is, but the head chiropractic physician for USA Gymnastics hopefully will be in attendence.   He is Dr. Tim Smykal.  If he is there, seek him out!!   You can even print this information and give it to him.  Dr. Larry Nassar is the medical director and a real good guy.  He can assist you as well if he is there.   

Good Luck!!   Email me if you have any other questions ([email protected])

Dr. G