Question
3 years ago I was rear ended and suffered terrible muscle spasms in my upper back/shoulders for 2 years.  Found a chiro in my area who pretty much completely resolved problem except for occassional bouts.  Now 3 years post accident I am having terrible rib pain on both left and right sides.  My chiro adjusted ribs and felt better for awhile, now my ribs are constantly hurting, can't sleep on my side because of the pressure on my ribs, hurts to lean against a chairback, etc.  Now I practically have to see her once a week to adjust the ribs and I'm getting very worried about this.  Saw a spine specialist in Newton who recommended I have prolotherapy injections to strengthen the rib ligaments.  However, no one has ordered an MRI or other test to see if it is the ligaments or what is going on with my ribs.  She is going by my current chiro's impression I am now suffering from slibbing rib syndrome.  The frequency of it happening is now what is really worrying me and it's very painful.  Any advice on helping with my ribs and or knowledge about prolotherapy. A local accupuncturist felt she could help me with the ligaments issues through accupuncture vs. having prolotherapy.  I am in so much discomfort I no longer know who to turn to for help.  My present chiro has been great but my ribs seems to be getting worse not better with her treatment. I'm 46 and a mom of 2 and this is really restricting my activities and strength.  

Answer
Hi Rose,

'Sorry you're having such difficulty.  Is your chiropractor doing any targeted soft tissue work, such as transverse friction therapy, active myofascial release, or Graston Technique?    I would recommend the MRI first, before any more invasive procedures, and especially since your pain is not resolving with time and treatment.  MRI would rule out any disc lesions.  It is not common to get a disc protrusion or tear in the thoracic spine (unlike the cervical or lumbar spine), but it is possible and it would cause rib pain.  MRI would also help rule out the unlikely possibility of internal organ disease that could cause rib area discomfort.   If it is negative for disc protrusion or other obvious spinal problem, and your diagnosis is thus considered a rib problem(where the rib meets the spine/vertebrae), then your doctors must address the soft tissues around that rib/spine joint system.  If you haven't had any soft tissue therapy by your chiropractor, then seek that first. Prolotherapy is gaining interest by doctors, but remains quite new and experimental.  However, as far as I've read it is pretty safe and can't hurt to try if other more established and less expensive soft tissue treatments fail.    If skilled soft tissue therapy doesn't work, I would recommend you consult with an "interventional pain management" specialist.  [Rose, you mention "Newton" and I'm assuming you mean Newton, Massachusetts.  Consider a consultation with Aneesh Singla, MD, of the Spine & Pain Institute of New England:(781)326-8888.]  Acupuncture will not toughen ligaments, but may help control pain. It also is very safe.  Also, are you exercising?  If isometric or other exercises reduce pain, then you should do them.  The chiropractor or other "spine specialist" should be able to test you on exercises such as the "Bird Dog" (on all 4's, opposite arm and leg straight out) or "Sky Diver" (on belly; chest and thighs up off floor) exercises to see if paraspinal muscle engagement in these exercise postures provokes or alleviates your pain.  

Rose, if the MRI is okay, then obtain good soft tissue examination.  That's the best place to start.  If that fails, call Dr. Singla.

I hope this was helpful.  I wish you the best of luck in getting your condition resolved.

Dr. G'
www.drgillman.com