Question
I'm a 25 y/o female, 5'3 and 108 lbs. I've been experiencing right side pain for the last 4 months now. I actually first noticed it about 9 months ago while jumping up and down on a mini trampoline during an aerobics class. I've practiced the same aerobics routine for 2 years, so I'm unsure as to why the pain all of a sudden occurred during this particular session. I wasn't doing anything strenuous or anything like that, but anyway. I'm fairly athletic and exercise 4-5 days per week, or used to... I haven't been able to since I've had this side pain... During the last 15 minutes of my aerobics class, I started noticing a sharp pain below my right ribcage. Since I only had 15 minutes left, I decided to keep going. As I kept moving, I felt moderate discomfort. After the class was over, the pain throbbed for about a day but went away. A few days later, I did an aerobics class and was fine. A few days after that, I performed the same aerobics routine and noticed the pain again. I worked through it and after the class was over, the pain throbbed for about a day or two but again, went away. I noticed it again about a week later while out dancing with friends. But, the pain subsided after the dancing was done. A few days later, I performed my normal aerobics routine, and again felt the pain, but continued with the class. This time, I was forced to take it really easy because of increased pain, but after the class was finished, the pain throbbed and ached, and it never went away! This pain has stayed with me every single day for the last 4 months. It gets worse when I sit down. It's no longer a sharp stabbing pain like when I felt when I was doing aerobics, it's more of a severe ache. It feels like a warm/burning/pressure/almost tingly sensation on my right side. The pain is generated from my abdomen/right flank, just under my rib cage, but above my hip and it radiates over to the right side of my back, all the way up the right side of my spine near my shoulder blade. It's almost like my whole right torso is affected. I feel a lot of pressure and a pulling sensation underneath my right rib cage. I have a very hard time sitting at my desk at work, leaning back in my chair, and leaning forward to write. When I wake up in the morning, the pain is pretty much gone! But of course within the first 5-10 minutes I start walking around a little bit and sitting down to eat my breakfast, it starts. It progresses throughout the day. I cannot do aerobic activity anymore. All I can do is walk at a slow pace, and even that irritates it. What I eat doesn't bother it. Nobody can figure out what I have, but it seems to be getting worse. I've had many different types of blood tests, I've had a CT scan of my right side, an MRI of my T spine, a bone scan, an X RAY of my ribs, an ultrasound of my right side, an ultrasound of my heart (echo) and everything has shown up normal. I've been checked for kidney stones, gallstones, kidney problems, liver problems, gallbladder problems, but so far, everything is normal! I also went to an OB and he checked my ovaries and uterus and said everything feels normal. He also did a quick rectal exam and he said things feel normal. The doctors are stumped. One doctor suggested, 搒lipping rib syndrome? Are you familiar with this and does this sound like the symptoms? I've researched it on the internet and the symptoms I've read on it and the symptoms that I am experiencing seem to be right on! What do you think? As a chiropractor, have you dealt with this before and have your patients reported feeling better afterwards?

Answer
Kristy,

Thank you for the thorough description it gives me a great picture of what is going on with you!  It is unfortunate that you have dealt with this for nine months.

I have to say that a subluxated rib is one of the first differentials that come to mind considering your description.  This is simply a rib, or ribs, that has moved out of normal postion and now causes pain due to the rib tip curling upward impinging on the superior rib or the intercostal nerve.  The intercostal nerves run between each rib and as a rib becomes malpositioned it cause nerve irritation.  This will often cause pain that radiates to the flank or even may feel like angina as it radiates pain to the front.  This pain is generally worse with deep breathing which may explain why it hurts with exertion.

Often times rib subluxations occur with sneezing, coughing or deep breathing when lifting.  As you inhale you expand the articulations and create a situation that makes it easy for the ribs to be pulled out of place.

Slipped syndrome is basically the same thing as a rib subluxation only due to lax articulations it happens more often.

Adjusting a rib often bring immediate relief.  With your longer standing case you may need a few more treatments to ensure that they will remain in the proper position.  With slipped rib syndrome it may be neccessary to add additional taping to the treatment plan.  One other thing that you should discuss with your chiropractor is proper breathing to minimize chest expansion and create proper core stability.  

I have treated a number of rib subluxations and have had great responses with this care.

Wishing you the best of health

Dr. Wiggins