Question
Thanks so much for your expertise and recommendations. I sincerely appreciate your time, and if i could, i'll take up just a bit more. I'm wondering if you think it would be wise to return to work bartending, where alot of bending and twisting will certainly send my ribs slipping and sliding all about.  i need the money, but i don't want to interfere too much with the healing process. Any thoughts?
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Followup To

Question -
A week ago, blunt trauma cracked 3 of my ribs. The ER doc who saw the x-rays didn't suggest wrapping and didn't mention the possibility of dislocation. I'm concerned now, to say the least. There is so much slipping and moving that i can't figure how anything could heal at all. I've taken it easy and did started wrapping the ribs a few days ago to prevent slippage. There's still movement though. Is this a natural course of healing. Will things tighten up? I'm just wondering when i should expect some relief? I am an avid runner and cyclist and am scared to death at what i may have done.

Answer -
Dear Glenn,

Unfortunately, you can't do much about broken ribs except control the pain until the fracture heals.  Yes you can wrap the area to prevent the excessive movement of the ribs, but the reason your E.R. physician did not advise you to do so is because compression wraps can keep you from taking deep breaths, which can increase the risk of lung infections. The last thing you want to do is have to fight off a lung infection while you are trying to heal a fracture.  If you are using compression wraps, do not excessively tighten them, and use them intermitently throughout the day.  I would not advise using them at night, and the continued movement you have is a consequence of the normal breathing and healing mechanism.  Ribs are not considered to be primary weight bearing bones, so some movement in the healing process will be okay.

Now, broken ribs usually heal completely in about two months, but you can help the healing process along with nutritional concerns.  Specifically there are nutrients that have been proven as well as have been correlated with increased bone formation and healing tissue.  You had also mentioned concern with dislocation.  This should have been ruled out in the E.R.

A well-balanced and healthy diet obtains vitamins and minerals from natural sources. You should always use food first and supplements second. However, in times of physiologic stress, such as your chest/rib injury,  it can be hard to meet the body's increased needs through diet alone. It is also important to stress that nutritional supplements do not work immediately and must be taken consistently, even if effects are not immediately and directly noticed.  The underlying repair mechanisms of the body only work when they have the correct substrates and cofactors. Following are some notes on nutrients for bone and wound healing.

Glucosamine/Chondroitin/MSM
Glucosamine is thought to promote the formation and repair of cartilage.  Glucosamine hydrocloride is the form that is best absorbed by the body, but glucosamine sulfate is utilized more appropriately for repair. Chondroitin sulfate promotes water retention and elasticity in cartilage and inhibits enzymes that break down cartilage. MSM is also important in cartilaginous repair.  You need to consume a minimum of 1500mg/day of glucosamine, 1500mg/day of chondroitin and 750mg/day MSM.

Bone-Healing
Bone healing rates may be enhanced by following some of the recommendations for preventing and reversing age-associated bone loss, such as supplementing with the nutrients calcium, magnesium, boron, and vitamin K. It should also be noted that you must have sufficient vitamin D (D3) to facilitate the absorption of calcium and magnesium.  The preferred forms of calcium and magnesium are the citrate forms. Do not use calcium carbonate. You can obtain enough vitamin D from 20-30 minutes of sun exposure daily.

Copper
Copper supplementation is important in fracture healing and in the early formation of collagen in a wound. Eight milligrams of copper daily provides adequate supplementation and should be taken for six weeks for a fracture of a non-weight-bearing bone. It should be taken for 2-3 months for a major weight-bearing bone. Because copper is also a pro-oxidant, supplementation should be stopped after this period of time.  In addition you will need to have an increased intake of antioxidants such as vitamins a, c ,e, selenium, bioflavanoids, quercetin, pycnogenol, co-enzyme q-10, and ginko biloba  to combat the excess oxidant actions of copper.

Zinc
Zinc has been recommended at a dose of 90 mg daily (as recommended for early healing of wounds). Zinc's enhancement of fracture healing may be related to its effects on increasing IGF-1 and TGF-beta.

Vitamin-C
Vitamin C and additional anti-oxidants have also been shown to speed the healing process.  Whole food complexes of vitamin c are preferred over synthetic forms.  Ascorbic acid is a poor form. Vitamin C is a major constituent concerning collagen repair.

Omega-III-Fatty-Acids
The omega-3 fatty acids act as anti-inflammatory agents, making them beneficial for patients with any inflammatory condition. There are three major types of omega 3 fatty acids that are ingested in foods and used by the body: alpha-linolenic acid (ALA)-18 carbons, eicosapentaenoic acid (EPA)-20 carbons, and docosahexaenoic acid (DHA)-22 carbons. Once eaten, the body converts ALA to EPA and DHA, the two types of omega-3 fatty acids more readily used by the body. Extensive research indicates that omega-3 fatty acids reduce inflammation and help prevent certain chronic diseases such as heart disease and arthritis.  Typical dosage after injury is 4000 to 6000 mg daily for 3 months.  Then reduce to a maintenance dose of 3000 to 4000 mg daily.  In addition the supplement should be molecularly distilled, pharmaceutical grade, and free of toxins.

Flaxseed-Oil
One or two tablespoons of flaxseed oil daily is considered optimal for a healthy individual. Capsule doses are 3,000 mg per day for disease prevention and 6,000 mg per day for treatment to reduce inflammation.  Flaxseed is not utilized as well by the body as omega III fatty acids, but it is still important in eicosanoid management (pain management).

Linolenic-Acid
A diet that gets 1-2 percent of its calories from Alpha-linolenic acid has been shown to give maximum tissue levels of DHA, avoiding any apparent deficiency symptoms.  ALA does have to be converted in the body through an enzymatic process using delta-5-desturase, before it can enter the cell membrane.

Precautions
The ratio of omega-3 fatty acids to other essential fatty acids is important, but some caution is warranted. Take omega-3 oils cautiously if you bruise easily, have a bleeding disorder, or take blood-thinning medication. Excessive amounts of omega-3 fatty acids may increase the amount of time that it takes for the blood to clot following a cut or other injury.

In addition Glenn, you must reduce your activity levels and eliminate and activity that will jar the body.  I know you are anxious to be active, but heavy breathing will exagerate your pain, and may increase healing time.  I would recommend no running for the next 2 months, and very lite work on the bike.  In addition try to limit pain meds such as ibuprofen, and acetominophen.  These meds actually reduce the healing capacity of your body tissue when metabolically active.

Respectfully,
Dr. J. Shawn Leatherman

Answer
Dear Glenn,

I think it would be fine for you to return to work, but you must do your best to eliminate excessive movements.  If you can pick up slower shifts, even though the money is not as good, it would be better for your healing time. I don't think late night Friday and Saturday shifts would be the best thing for your recovery at this point. Ultimately if you re-injure the area, or prolong the normal healing time, it will only keep you out of work longer.

If you return to work I would recommend that you lightly wrap the ribs in question for stability, but remember to wrap only when absolutely necessary.  Also, keep your immune system function at top notch levels.  Reduce bad foods, reduce alcohol consumption, reduce caffiene intake, absolutely no smoking, increase your intake of antioxidants (fruits and vegetables), and make sure that you get a minimum of 8 hours of sleep at night to allow the repair to occur.  More would be better...your body does the majority of its repair and rejuvination at night.

Keep your head up Glenn.  Stay positive, you will heal, and it will happen faster than you think!

Respectfully,
Dr. J. Shawn Leatherman