Thoracic spine pain CaseFile

Keywords; thoracic spine pain casefile, rib pain treatment, biceps tendon strain, chiropractic help.



Just when should you xray when there is trauma involved? Always? Cover your butt? If your gut feeling demands it?

The reality is that every chiropractor would always like to have xrays after trauma, but the circumstances often gainsay it. The cost involved, availability of a radiologist over the weekend, and not withstanding that contact sportsmen have traumatic events every week leaving them bruised and battered.

You simply can't xray every time they take a knock.

S is the six-foot brawny captain of his high school rugby team. In the dying moments of the game two opponents tackled him simultaneously as he was making a dash at full speed for the line causing him to land on his right shoulder and he felt something crunch in the middle of his back. Half an hour later his mother phoned. We were just on our way out to dinner.


Thoracic spine pain Casefile

On examination

S was almost crying. It's not often you see a rough-tough six foot plus  young man blinking back the tears. Thoracic spine and rib pain can be severe. Plus he was supporting his right arm in a protective manner.


Lateral compression of the chest was not painful, but anterior-posterior compression caused sharp pain in the middle of his back, slightly more on the right.

Ranges of motion were reasonable in the circumstances, with right rotation and lateral flexion causing some discomfort. Deep inspiration was severe, again in the middle of the back, slightly to the right. There was no real dyspnea, and lung sounds were normal.

Percussion over the spine was normal, nor was it tender on palpation, but percussion of the rib head was painful. Deep pressure over the rib head elicited an immediate response. Ouch.

Pulsed ultrasound caused no pain.


Right shoulder pain

He admitted that he went into the match carrying a shoulder problem. The coach had it strapped, but the strapping came off in the first quarter. Passive ranges of motion of the shoulder were full and free, but resisted isometric flexion of the shoulder produced acute pain in the bicipital groove. Resisted external rotation with flexion was even worse: Biceps tendon strain. There was no sign of rupture.


Diagnosis @ Thoracic spine pain CaseFile

Sprung or cracked rib, that was the question? There was a distinct possibility that S had fractured a bone. Or was it a subluxated costo-vertebral joint? Should we xray? It would mean a 30 minute drive to the emergency room, and they still had an hour-and-a-half drive home.

I laid him down on the Chiropractic table and pressed hard over the rib. No pain. Percussion again. No pain. Pressure on the spine itself. No pain. Pressure over the rib head: severe pain.

Working diagnosis: 7th rib head (right) subluxation. DD: cracked rib?

Right shoulder: Biceps tendon strain.


Report of findings @ Thoracic spine pain CaseFile

Usually one would bring the patient back the next day for the ROF, an explanation of what Chiropractors do, and why, and the first treatment. That was obviously out of the question, and would have to wait for Monday.

I explained to S and his anxious parents the nature of the beast, and the dilemma. Should we wait for an X-ray? They agreed that I should go ahead, carefully, gently, not using what we call "brute force and ignorance" in chiropractic parlance.


First treatment @ Thoracic spine pain CaseFile

S tolerated deep Posterior-to-Anterior pressure over the rib-head prior to the adjustment. Good, that would not be likely in the event of a cracked rib. On the second 'take out the slack' with no thrust, the subluxated rib head repositioned itself of its own accord. Relief.

I did some soft-tissue work over and around the joint, mobilised the whole rib, and then did a gentle "anterior thoracic" manoeuvre with him sitting. No pain - almost certainly no cracked rib. The joint released.

I find that a combination of

  1. first a PA adjustment, and then
  2. an AP adjustment

is what works best for a rib-head subluxation.

After the proceedures, S could take in a deep breath without pain, and anterior-to-posterior compression was no longer painful. Excellent. More than that: perfect.

Active Release Therapy on the right biceps tendon proved painful but not excruciating. Despite some doubts concerning the efficacy of ultrasound treatment, I used some pulsed U/S. Two gentle exercises to be done hourly over the weekend.

After a few instructions on what to do over the weekend, we arranged for a consultation of Monday afternoon. His mother made an appointment at the same time for his kid brother: known hip dysplasia. Interesting.

Second treatment

Miracles we do at once. The impossible takes a little longer. A subluxated rib, a so-called "sprung rib" is a condition chiropractors love to treatment. It is excruciatingly painful and usually, after only one or two treatments, the pain is magically reduced. Both S's biceps tendon strain and the sprung rib were 80% less painful. There was no pain on deep breathing.

I explained to him the 50 percent less pain rule, gave him some new rehab exercises and repeated the treatment regimen of the first consultation.

Perhaps foolishly, he will be back in training this week. There's a big tournament on this weekend, and he's the captain of the first team. He'll probably be a mess next week. That's the joy of treating sportsmen.

They are tomato farmers. A magnificent box of tomatoes was offered in thanks.


Third consultation @ Thoracic spine pain CaseFile

His mother phoned in the morning. The pain in the rib is completely gone, shoulder a bit sore, and can she postpone to next week? They live more than an hour away in the hinterland.



A bit naughty, especially since S has a big rugby tournament this weekend, and we haven't started the rehab. I'm half expecting the worst next week. But that's the reality with health care; once the crisis is over, we forget the future, often to our ultimate detriment. Rehab for injuries is vital to prevent the problem from re occuring next week.


Developmental hip dysplasia

Whilst kid brother has no pain at all, there's no doubt about the hip dysplasia. The hip socket is much reduced in size, and the roof of the acetabulum slopes upwards alarmingly.

The range of motion of the hip is greatly increased, but only the test of Fabere was painful in the groin.

I spoke very directly to him, and his mother, about the need for a life-long regimen of exercises to strengthen the hip muscles. It is they, not the bony socket that keeps the hip in its place.

Follow the rules, and there's a reasonable chance this hip will behave. Break the rules and, like diabetes, it will be a nightmare. Hip arthritis and early hip replacement. Developmental hip dysplasia ...


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As they are leaving, Dad asks: can you do anything for knee pain? He is very overweight, and his right knee is swollen, and he's obviously having difficulty straightening the knee whilst walking. Symptoms of arthritis in knee ...


Prostate cancer 

Did you know that a man who eats a tomato-a-day has 50% less chance of getting prostate cancer? So the future of my prostate is hopefully assured! Tomato prostate ...

What's more phytosterols are the cure for an enlarged and inflammed prostate gland. What are phytosterols ...?


Useful links @ Thoracic spine pain CaseFile


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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?



Two common syndromes

  1. Frozen shoulder ...
  2. Rotator cuff syndrome ...

Frozen shoulder exercises

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.

Interesting questions from readers