Question
I am on vacation and experiencing a recurring problem that my chiropractor can fix when I get home--I'm just frustrated and looking for prevention for the future.

It's the painful thing where the rib below the shoulder blade in back isn't where it should be (luckily, it's not the cripplingly painful version that turns me into Quasimodo, which I've had). One or two adjustments will generally fix this, and it's probably been 9 months since the last time.

What causes this and how can I prevent it? I didn't have any sudden movement or trigger event--I just woke up with this.

I do yoga regularly (Ashtanga, at a reasonably advanced level, 2-3 times per week right now) and thus both strengthen and stretch my back muscles.

And is this related to another problem I've had over the years? It was diagnosed as chostochondritis in an ER trip years ago. It's a sharp, painful spasm as if I have a charlie horse on top of my rib cage in front, on the same side as the one where my rib goes out in back. I can feel the hard contracted muscle sticking out, and have to stand and stretch to ease it. This is often triggered by yoga postures that put me in an extreme forward fold/tucked-in position utilizing my core muscles for exertion with my legs tucked up, such as Crow, so it limits my practice because I hesitate to try postures that I know may trigger it.


Answer
Barb,

Anyone, including myself, that comes up with a very smart and slick answer to your question is most likely to be completely wrong.  I'll give it a try anyway.  Here's what we know: if there is an anatomic barrier that becomes impinged, you will have pain.  So if you have a previous injury to the rib area rendering you with some bone spurring or other boney growth around the injury site, or if the injury site has residual scar tissue or calcification in the soft tissues around the rib joints, then any time that anatomy gets pinched or compromised you will have pain.  The type, intensity, duration and reaction to the pain is truly an individual experience.  If your body is very sensitive, a minor compromise, pinch, or tug on that anatomy can cause pain and a reactive spasming (the Quasimodo thing).   Since the joint manipulation to the region of the rib provides relief, it points to a mechanical cause of your pain as opposed to an internal organ problem, causing your pain.  What you are describing is common.  I've seen it a lot.  And just like you, my patients come in and get the immediate relief with a visit or two.   In your case, however, you can trigger the pain/spasm event!  That can be very helpul.  Ask your DC to test you when you are not symptomatic, by you bringing your trunk position (e.g. Crow) to the point where your rib pain is about to begin, and then at that point start to look for the anatomic switch that provokes or alleviates the symptom.  This style of evaluation and treatment is employed by such methods as Graston Technique (www.grastontechnique.com).  I don't think your previous costochondritis is a factor for your current problem...maybe your current problem caused the costochondritis...  

'Hope this was helpful.

Dr. G