Question
3 1/2 months ago, I had surgery on my lower ribs. I had "bilateral slipping rib syndrome": On my right side, my 10th rib tip was slipping up underneath my 9th rib, and my 11th rib tip was slipping up underneath my 10th rib. On my left side, my 11th rib tip was slipping up underneath my 10th rib. I was in pain for almost one year before the surgery. During surgery, the surgeon went through my abdomen on my right side and shaved off a few cetimeters of both of the slipping rib tips and removed some broken off cartilage. He then went through the left side and removed a few centimeters of the one slipping rib tip and took out the broken off cartilage.  I have two 3.5 inch cuts on both sides of my abdomen. It is very slowly getting better, but I experience back pain on my right side, along the right side of my spine. (Before my surgery, I was in the most pain on my right side. My left side didn't bother me nearly as much as my right.) I'm right handed, so I do more with my right side, which may contribute to the pain. But, whenever I increase my activity, like doing housework, laundry, cooking, etc, the muscles on my right side of my back really get sore and ache. And then when I sit for a bit to calm it down, it just throbs. Here is my question: Could it be that considering my operation, perhaps my ribs moved a little bit and have settled and my muscles are just getting used to that? I ask this because whenever I've gone to a chiropractor in the past, I would get adjusted and my muscles in my back would spasm for weeks! It's like my body just didn't agree with it or something. I realize that the ribs are connected to the spine, so is this why my back hurts? I am wondering what is going on inside my body to make it act this way, I would appreciate hearing your ideas. Also, 3 1/2 months seems like a long time to heal, sometimes I feel as though the pain will never go away. But, other people have assured me that ribs take a very long time to heal. Is this correct? Thank you! I look forward to hearing from you.

Answer
Dear Kristy,

First of all rib problems do take a longer time to heal than do other injuries.  It is quite probable that you will have lingering pain, problems, and dysfunction for another 3-6 months, but it should gradually continue to get better.  It is also common to have back pain after surgeries:  the trauma of a surgery as well as the changes in lifestyle for the initial healing process often result in back pain.   I have actually gotten quite a few patients referred to my office from a local general surgeon after abdominal surgeries he had performed. Due to the alteration in body mechanics, as well as decreased movement in the spine from bedrest etc...  the musculature can especially be affected.

Specifically concerning rib movement, it is unlikely that the ribs have actually moved, the surgeon would not have cut the musculature that adheres the ribs to each other except for at the tips for resection of the rib.  This is only a small bit, and will not affect the anatomical location of the ribs themselves.  Surgeons are careful only to alter the least amount of tissue so that function will remain, the shock to the body is less, and healing will be faster.  

The articulation of the spine and the ribs forms a close relationship, and can be affected by manipulation as well as muscle spasm, but remember that the movements of these joints is small (a few millimeters), and that most ribs have an additional connection to the sternum for stability and protection of the internal organs.  The ribs you mentioned are considered floating and do not have a true bony connection...some cartilage and soft tissue, therefore they will heal with the formation of granulation tissue (scar).  This tissue deposition, formation, maturation, and remodeling will continue for up to two years on a metabolic and physiological level.  You should be 70-75% healed in up to 40 weeks, but then the healing mechanism will slow down immensely and drag on.  It is important to keep the tissue mobile, but not overused to form the best scar possible and that is why soft tissue work such as chiropractic, massage, stretching, myofascial release etc... are important.

Now concerning the previous chiropractic care you had received, it is rare that patient have muscle spasms after adjustments that last longer than a day or so.  You most likely have underlying ng muscle dysfunction which is causing the problem that reacts to the adjustive procedure.  If the chiropractor you see does not perform functional examination, or perform rehabilitation in his office, you should have this evaluated by a healthcare professional who does...such as a physical therapist, or another chiropractor who has additional tanning in rehabilitation, sports injuries, or orthopedics.  In my office the rehabilitation is just as important as the adjustment, and both work together for proper spinal biomechanics and stability.  

A massage therapist who does deep myofascial work will also help...soft tissue work is another key factor in spinal rehabilitation.  We utilize massage often, and I additionally perform some active release protocols on patients when needed.  Chiropractors certified in ART (active release technique), NMT (Neuro-muscular techniques), or Graston soft tissue will give you a great benefit concerning overactivation of the musculature and resulting muscle spasms.  

Kristy, I hope I have hit all the points in your question and given you a better understanding of the injury/healing mechanism.  If you have any further comments or questions please feel free to write back.

Respectfully,
Dr. J. Shawn Leatherman