Question
QUESTION: Hello! I am dying for help with my rib injury. I was warming up in the gym doing push ups when I felt a 'pop' in my chest. I figured I pulled a muscle, so I quit and went home. Later I noticed my back hurting, I had worked back the previous day, so again I figured it was nothing and I was just sore. After a few weeks off, I started slowly lifting again. First 3 chest workouts went fine, I added weight and bam...injury is back! Went to the doctor and she said I messed up some cartilage most likely and sent me to the physical therapist. She agreed and said I must have tore/sprained the cartilage where my rib connects to my sternum. As usually, they gave me Motrin and said come back in three weeks!

It's almost been 3 months since the injury and I'm still suffering. I don't have problems breathing, I just can't lift weights without my chest hurting. If I do something too hard, I get a pain in my back where the same rib (3rd rib by the way) connects to the spin. Motrin doesn't help anything.

I am very active, love to lift weights and play sports...but I haven't been able for the last three months. My own research looks like I'll always have a problem...tell me I'm wrong!! Any help to what might have actually happened and what I can do will GREATLY be appreciated. I am in the Marine Corps and I'm sorry to say, but aside from Motrin and light duty...they don't help with anything. Please help! I'm dying to get back into the gym and back onto the playing fields!

ANSWER: Dear Jason,

Unfortunately, these types of injuries are difficult and do take a long time to heal, many will be come chronic. It is also likely that you may have damaged the joint capsule that surrounds the articulation of the rib head, and this means that you have some ligament damage as well.  Again ligaments are also notoriously slow to heal.

I would suggest that you get to the chiropractor and have the rib articulation and the cartilage assessed.  These cartilage traumas are often accompanied by the displacement of the rib head either at the sternum or the vertebra, and in some case both areas.  Even though these displacements are small, if it is not reduced the problem will definitely become chronic.

Additionally, you will need to start taking a joint support supplement that contains glucosamine sulfate and methylsulfonylmethane (MSM) to help the joint space repair.  I would also recommend that you try to find a supplement that also contains anti-inflammatory enzymes...many chiropractors actually carry this in their offices as I do.

Hope this helps Jason.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net

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

QUESTION: Dr. Leatherman,

Thank you for the help. I wish I could go to a chiropractor, but the military doesn't like to pay for those and 'dislikes' when we seek treatment outside of the clinic, but I'll definitely ask my physical therapist about all of these things.

I noticed you have or you are trying to get your CSCS. I'm currently studying for the NSCA-CPT, but I'm not too good on anatomy just yet, however I was wondering if you had suggestions on what exercises I could possibly still do to keep some upper body strength. My legs are getting tired of being the only thing being worked on.

Also, since my spine does hurt if I injure the rib again, would you recommend against running? Being in the military it is very important to them that I keep running, so unless I specifically get a no running chit, I'm out there 3-5 days a week. My PT says I should be fine, but to take it easy...but even taking it easy is aggravating sometimes. I just want to make sure I'm not continuing to mess up my spine.

Thanks again.

Answer
Dear Jason,

First of all, as an active duty soldier, you qualify for chiropractic care on base.  If you cannot get into the chiropractor on your base, or if your base does not have one, you can request to be seen off base.  We see a lot of active duty in our clinic even though the base here does have a chiropractor on site (Eglin).  We offer them discounts to ease the money issue. Not to mention a few spinal adjustments or anterior rib adjustments could easily solve the problem.

In addition, the physician therapist is prohibited by law and their license from giving a spinal or extremity adjustment. They can perform mobilization and manipulation techniques, but your sternum problem will likely not be helped with mobilization or manipulation only.

By the way, you did not mention if you ever had an x-ray.  If you are in continual pain for 3 months...the standard of care dictates that further investigation be utilized.  I would suggest that you ask for an x-ray to be taken.  It is obvious that Motrin and a wait and see approach is not working.  By the way...if you get to the chiropractor make sure they take an x-ray!!

Isometric exercises would be a good choice to continue working the upper body for the chest and shoulders and back...it will stress the muscle without creating movement.  You will need to vary position.  When the pain begins to decrease, Isotonic exercise are appropriate with a move to Isokinetics.  Do not use free weights until isokinetic activities are pain free with normal weight., The you can move toward free-weights and plyometric training.

Concerning the tri's and bi's, you should be able to work these areas without increasing stress on the cartilage, but your form needs to be perfect and nothing should be performed over head.

I understand that running is important for your conditioning.  As long as you are not significantly jarring the body hard, running is okay, but elliptical machines, recumbent bikes would be better considering the present problem. I would tell you that you could wrap or tape the ribcage for stabilization, but this often limits chest expansion for breathing and can set you up for a lung infection...so it is ill advised.

By the way...did you get a good joint support yet, you should definitely do this, and stay on it for a minimum of 6 months.  In the past I have utilized three separate formulations in my office, but the one I recommend and use most for my patients is from Ideal Health.  You can actually purchase it online with an access/referral code at www.idealhealth.com.  Feel free to use my access code if you wish 5582806.  It usually takes 2-4 weeks to notice a change.

Good luck Jason, I hope this clears up for you.  Keep studying the anatomy and good luck with the NSCA-CPT exam.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net