Question
I am 26 year old female and have been having a helluva time with my chest injury.

Long story but about 7 years ago I fell off my bike and landed on the handle bars, the first 6 or 7 ribs on my left side of my chest were damaged. They were all out of place and as a result i developed severe costochondritis. It took about 2 years or so to settle down.I saw every doctor I could see and spent a tonne of time with a chiropractor.My ribs still sit out of place but have not caused alot of pain over the last 7 years. I've been an amateur boxer for a few years and no pain.

NOW.....I play hockey and suffered a pectoral tear about 3 months ago. They put me in a sling for two weeks, then i saw a physiotherapist. She did some ultrasound, deep massage...she discovered my weird rib outta place issue and sent me to the chiropractor. He thought it was the same costochondritis and feared it would take 2 years to settle again, so he aggressively started adjusting me. Every day for about a week and a half he adjusted my ribs etc. After about the 4th day or so, my peck muscle settled down ( i think from physio) but I felt I could not drop my left shoulder without a terrible sharp pain. I have been holding my shoulder up for about 3 months now. My physio tapes the shoulder so that it wont drop. If i do drop my shoulder the sharp pain is there so badly and it basically goes from the bottom of my shoulder blade around to the front 2nd, 3rd, 4th and 5th ribs. If i take a deep breath it hurts, to exhale is the worst. It is almost as if the shoulder blade is pushing on something. If I have my shoulder at rest and move the shoulder forward i get the sharp pain.It is almost as if the shoulder blade is pushing on something. Could this have anything to do with the Long thoracic nerve being pinched when my humerous drops?

Sleeping is terrible. I cannot find a comfortable spot without pain. I have been told this is a serrates anterior issue, but i am not sure. Could the chiropractor have adjusted something wrong? It seems like something is wildly out of place. I am worried they will have to do surgery to fix this. I have been on naproxen and celebrex forever. I am worried i will be in pain for the next 5 years before they actually discover the problem. No doctor I see has an answer. I am sure the old injury combined with the new injury and chiropractor adjustments all relate. I just cannot find anyone who has ever had this problem or a doctor who has ever seen this problem. Please help.

Sincerely,
Painful

Answer
Dear "Painful" Shantelle,

Thank you for your question.  I received a question several years ago that was remarkably similar.  Just like with that writer, in order to answer you properly, I抣l first need to give you some background on the chiropractic profession.  We will also talk a bit about anatomy and physiology.  

It is important for you to know that there are two branches or schools of thought in chiropractic.  Briefly, they are differentiated by whether they deal with the limited therapeutic approach for aches and pains (commonly termed "mixed" chiropractic because it represents a mixture of a chiropractor with a non-chiropractic matter) or a non-therapeutic approach to optimum body performance (termed "straight" chiropractic because there is no mixing of chiropractic with anything else).  My expertise is in non-therapeutic straight chiropractic.

Therapeutic "mixed" chiropractic is the older approach based on a split from the founding principles of chiropractic about a century ago.

Non-therapeutic "straight" chiropractic is the more modern of the two.  It deals with a particular, common situation called a vertebral subluxation. This is not specifically the same as what you mentioned in your question, but they may exist together.  The spine is made of many bone segments which house and protect the spinal cord and the smaller spinal nerve branches that come off the spinal cord and exit between the bones.  These nerve pathways carry information or messages between the brain and the cells of the body.  These messages are essential for the life of the cells.  Without vital brain messages, the cells immediately begin the process of dying; i.e., they can no longer function the way they should to maintain life.

Because the bones are moveable, they can misalign in such a way as to interfere with the messages and, ultimately, the ability of the person to function at their best or express their optimum potential.  People with vertebral subluxations are not able to get all they can out of life.

Vertebral subluxations can be caused by a wide variety of factors, what we'll generally call stresses.  These stresses can be physical (such as the birth process - whether giving birth or being born, certainly one of the most challenging things a person can experience - accidental trauma, sleeping posture and mattress condition, sneezing, falling down, etc.), mental / emotional (in its many forms, probably the most familiar use of the word stress), or chemical (such as pollution, drugs, food additives, etc.), which are, unfortunately, regular parts of daily living for all age groups.  In short, a vertebral subluxation can occur for a multitude of reasons.

Tragically, vertebral subluxations are rarely obvious to the individual they affect.  They usually have no symptoms.  The reason is that most of what goes on inside you happens without your awareness.  As an example, try to "feel" your liver.  What's it doing right now?  You can't know, so you can't know if it's functioning at its best or something less.  To complicate things, nerve pathways that carry messages of control (termed "motor" nerves) have no way of transmitting ache or pain messages, so your body function may be far from perfect and you'd not have any alerting signal whatsoever.  In addition, and quite relevant to whether any particular findings are related to vertebral subluxation ?including rib positioning - the branching of the nerve pathways is quite complex and extensive, making it exceedingly difficult to predict or determine exactly how the person will be affected.  This ignores the multitude of variables that determine the expression of function.  The question of how your individual body carries out the myriad of activities just to maintain life is enormous and would require your Creator抯 (or creator抯, for the agnostic) knowledge, or at least far more than our educated knowledge of the complexities of life.

In discussing vertebral subluxation earlier in this message, I used the word misalignment.  I am not talking here about ribs or rib issues (including costochondritis), however, and these findings are not interchangeable with the term vertebral subluxation.  The misalignment that I address is that of a specific segment of the spine.  Technically speaking, we have to get even a bit more advanced in what is meant by misalignment to make this clear.  The question is, Misaligned with respect to what?  It is possible to describe the body geometrically, reasoning that we are bilaterally symmetrical and concluding that there is a measurable 搈idline?or that our hips and shoulders should be 揵alanced?on a perpendicular line to this proposed 搈idline?or that the body can be presumed to take on a certain geometry in other planes as well.  The problem with this thinking is that it assumes we are simply machines and ignores that we are alive, capable of movement, adaptation, growth, etc.  At any given moment, there is an optimum state for us to carry out life to our best abilities.  That optimum state will vary depending upon the circumstances, both within us and of our environment.  There are many examples to illustrate this.  If you carry something heavy with one hand, you must lean away from it, putting something of a curve into the spine, to keep yourself balanced.  Does that mean the body is failing because there is imbalance or a curve, or is it instead being quite successful in adapting you to the situation?  In another example, consider that those who argue for geometric balance or symmetry would be hard-pressed to explain why the carpenter who swings a 28-ounce hammer all day with his right arm only would have certain physical adaptations that favor his right side.  Should the carpenter have some of the tissue removed from his arm, hand and back so that it is equal to that on the left?  Or is he merely adapted to his circumstances?  The point I抦 getting at is that there is an individually determined, innately normal position for the body that cannot be described by geometry.

From the non-therapeutic standpoint, then, an adjustment is not a process with the goal of changing rib alignment.  As I said, rib position and vertebral subluxation are not interchangeable terms.  In order to know if someone has a vertebral subluxation, it is necessary to have that person抯 spine checked by a non-therapeutic straight chiropractor using a method of "analysis."  When a vertebral subluxation is detected this way, though, it is obviously important to correct it as soon as possible.  The term for this is 揳djustment,?and can be accomplished in a variety of ways, depending upon the unique vertebral subluxation and the individual person.  

Since vertebral subluxations are caused by so many different things, people choose to go to a non-therapeutic straight chiropractor on a regular basis to enjoy the most time free of the life-robbing effects of vertebral subluxation. There's a saying that non-therpaeutic straight chiropractic is not about your back, it's not about your pain, it's about your life.  Each person has a unique potential in life.  With vertebral subluxation, it's impossible to realize that potential.

A key question to ask, then, would be, Is someone with suspected rib issues better off with vertebral subluxation / nerve interference or free of subluxation / with the nerve channels open?  It is easy to see that having all the available nerve messages getting through is better than only some of them getting through, regardless of the person's situation otherwise.  So, having one抯 spine checked for vertebral subluxation is tremendously important, but it抯 not for the purpose of dealing with ribs or other pain complaints.  In other words, non-therapeutic straight chiropractic can be of benefit to any spine-owner, but perhaps in ways that you may not have considered.  It抯 not that someone should visit a non-therapeutic straight chiropractor FOR your complaints ?a person should visit one in an effort to be free of vertebral subluxations, even WITH such a history as yours.  Non-therapeutic straight chiropractic is not about diagnosing and/or treating rib problems, muscle issues or any other therapeutic-model or medical condition.  It is entirely separate in its goal.  

As I mentioned earlier, not all chiropractors adhere to this and it is important that you be able to distinguish which ones do if you're going to seek this type of service.  Please understand very clearly, though, that the practice objectives of therapeutic mixed chiropractic and non-therapeutic straight chiropractic are quite different, as described above.  What I can tell you must not be interpreted from the mixed viewpoint.  Realize that the goal in a non-therapeutic straight chiropractic model is not for the purpose of forcing a geometric alignment of ribs nor for the treatment of costochondritis.  This is not the type of objective that would be used in the proper delivery of non-therapeutic straight chiropractic.  This doesn抰 necessarily mean it is bad or good, it just means it is entirely different than what I would advise you on.  I am sorry, then, that I am unable offer you a specific opinion or make a conclusion about this.  

It seems that the office you have visited already is of the therapeutic mixed viewpoint because there is a focus on the rib issue.  If so, it would be reasonable that they should want to be aware of the seriousness or specific dangers inherent in changing its alignment, whether by manipulative therapies or anything else.  It is impossible for me to know if proper decisions were made thus far.  

In addition, and quite directly to the things you ask me, even though medical diagnosis is not a service that I would provide in my field, I would say to you that diagnosis under the best of circumstances is something of an art.  It would be irresponsible for anyone to give you a guess by e-mail or the web about your situation.  Diagnostic work and therapeutic advice is difficult enough when done properly.  It becomes a riskier proposition when done poorly.  

You would be best served getting opinions from someone with first-hand knowledge about you, not a limited acquaintance through correspondence.  There is apparently a lot of confusion and frustration regarding your findings and your descriptions reveal a certain lack of clarity in the information.  Anyone who is willing to speculate about your situation by e-mail is providing you little more than a guess and perhaps a dangerous one, at that!  Shantelle, I hope you understand the seriousness of this advice and seek appropriate information in person from a qualified provider.  

All that said, it would certainly be wise to have your spine checked for vertebral subluxations by a non-therapeutic straight chiropractor, even if you still elect to have therapeutic attention for your rib issues with another type of provider.  Remember, the two objectives are not the same.  If you are interested in finding out how to locate a non-therapeutic straight chiropractor in your area, please feel free to contact me again at [email protected].  

Shantelle, I wish you the best and hope you may have a clearer understanding of chiropractic.  It has been my pleasure to provide you with some information.


Sincerely,
James W. Healey, D.C.