Back to Back Issues Page
CHIROPRACTIC HELP #15: Breastbone-pain
June 15, 2010


  • There are few things more disconcerting than pain in the chest, particularly if it's on the left side. "Am I having a heart attack?" Well, that needs to be ruled out, particularly if your cholesterol is raised, your blood pressure is high, and you're a smoker. The weed will knock ten precious years off your life, you know. It will, you are unlikely to be the exception that proves the rule. And the end will be shit, put in plain language.

    But back to breastbone pain. Gently, use your right hand to run your fingers away from your breastbone on the left, between the ribs towards your left shoulder. Are certain ribs tender? Swollen perhaps? Repeat on the other side with your left hand.

    Do you also have discomfort in the middle of the back, between the shoulder blades? Did it all start, perhaps years ago, after an attack of sharp stabs of pain in the middle of the back, worsened by deap breathing? Every breath would have been like someone was sticking a rusty knife into your back!

    Chances are you're not having a heart attack, but an attack of Tietzes syndrome.

    Research at one university ER revealed that about a third of patients presenting for a suspected heart related condition were in fact suffering from a musculo-skeletal rib-related condition (once a heart condition had been ruled out).


    The ends of bones are covered with a very hard super-smooth lining called hyaline cartilage. Unlike most other living tissues, hyaline cartilage has no blood supply of its own, so it's utterly dependent on the normal flow of the fluid within the joint for its nutrition.

    In the ribcage, the rib cartilages are rather different. The cartilage joins bone-to-bone (rib to breastbone) giving the chest the elasticity essential to enable breathing. It's still living tissue, with all the need for nutrients and oxygen, and the dispersal of waste products, yet lacking a direct blood supply (like bone has), so movement and exercise is vital for young and old alike. Otherwise your cartilage will lose its elasticity, breathing will become restricted further adding to the already inadequate tissue oxygenation. COSTO STERNAL CHEST PAIN ...


  • Trauma to the ribcage is one of the common causes of Tietzes syndrome. That could come from a heavy tackle in rugby or American football, for example, or simply a shower of sneezes, or an acute attack of bronchitis.

    Another, fortunately uncommon, cause of damage to the costal cartilages is an overly robust manipulation of the midback. How do I know? Because I myself have caused Tietzes syndrome in several patients over the years. It's known as Iatrogenic Illness, or Doctor-caused disease. In the USA alone over 200 000 people per year DIE from Iatrogenic Illness, largely because Americans swallow about 50% of the world's medications. Anti inflammatories alone contribute to about 14 000 deaths per year by causing a bleeding ulcer. Chiropractors are committed to health-without-drugs, whilst recognising that certain medicines are absolutely essential.

    Fortunately chiropractic-caused deaths are EXTREMELY RARE, hence our low liability insurance premiums, but lesser injuries, for example the rib cartilage mentioned above, is not that uncommon. Mostly iatrogenic illness in the chiropractic context is very temporary with no lasting effect. IATROGENIC ILLNESS ...

  • So how will your Chiropractor fix your Tietzes syndrome if a chiropractic manipulation can be one of the causes of the condition in the first place?

    The management of rib pain is highly specific and absolutely avoids heavy manipulation, posterior-to-anterior, of your midback. Rather s/he will use other highly specific rib mobilising and spinal adjustive techniques. RIB PAIN TREATMENT ...

  • Whilst case files are not scientific evidence (we call them "anecdotal evidence") they often give interesting insights into clinical conditions. TIETZES SYNDROME CaseFile ...

  • SCHEUERMANNS DISEASE ... Does your teenager have a slumped back?

    Scheuermanns disease is a condition of the spine that, in its mild form is really quite common. One or more vertebrae or slightly misformed, and it's no big deal.

    True Scheuermanns disease involves at least four vertebrae, the vertebrae are wedge-shaped, there is a distinct kyphosis in the midback, and it's usually associated with a deep ache in the midback.

    The endplates of the vertebrae are brittle, and the disc may herniate through the endplate into the vertebral body causing a Schmorl's node.

    Less commonly Scheurermanns affects the upper lumbar spine, and then it can be very serious especially if it's associated with a leg length inequality (short leg) causing a scoliosis.

  • Obviously because of the potential seriousness - fatal seriousness - don't mess about with your chiropractor if you have sudden onset of chest pain. So what are the signs of heart attack? CHEST PAIN ... What are the differentials? >>

  • An usual topic you might say, when thinking about a musculo-skeletal condition. However, interestingly the diaphragm muscle which separates the chest cavity from the abdoman is attached to the lower six ribs. It's a weakness in the diaphragm that is the cause of a poorly functioning stomach valve that should keep the contents of the stomach (highly acidic) from squirting up into the oesophagus. The oesophagus is not protected, as is the stomach, against the highly toxic acid in the stomach needed for good protein digestion.

    Recently a young man was referred by a cardiologist for chest pain that the specialist deemed was Tietzes syndrome, not a heart condition. (After very expensive, extensive tests I might say). It certainly was a Tietzes, but in addition the young man told me about terrible bouts of his dinner that would suddenly appearing back in his mouth. Last week he reported that, after eight chiropractic treatments, not only has the pain in his chest all but gone, but the regurgitation of food has also stopped and, along with it the heartburn that he suffered constantly from.

    Admittedly, we also discussed at some length, the do's and don'ts of how to manage a hiatus hernia including easy soup recipes (no this isn't a misprint!)... INDIGESTION HEARTBURN ...

    Yes, there are some important rights and wrongs with soup that anyone suffering from heartburn should consider. It's much more sensible than the dangerous heartburn tablets.

    "Sometimes we have the dream but we are not ourselves ready for the dream. We have to grow to meet it."

    Louis L'Amour


  • I have had a dream of doing research on some of the many conditions which I KNOW chiropractic has an important contribution to make, yet there is no scientific evidence confirming it. However, it's been important for time to pass, that researchers should know the right questions to ask, and I have had to grow as a clinician. I am considering whether it's Failed Hip replacement surgery or Tietzes syndrome will be my first topic. RESEARCH PROPOSAL TOPICS ...


    This month we feature the broccoli plant, one of the most powerful anti-cancer vegetables available, and so easy to grow if you have an empty sunny corner of the garden. The mistake many people make is to pull the plant once the main head has been reaped. However it will continue to produce, and it's these young florets especially that are rich in a substance called Glucoraphanin.

    There is much research now, powerful convincing research that broccoli eaten on a regular basis has an amazing preventative role in cancer. Prostate, stomach, skin... read more about

    Until next month then. Promise not to fill your Inbox with information overload.

    Should you have found this email helpful, feel free to forward to family and friends. Your doctor?! Our readership is rising in leaps and bounds, 97 000 page impressions at CHIROPRACTIC HELP last month, but for the considerable work put in, I would love this letter to go 10 000 people!

    Yours in Better Health. Plant half a dozen broccoli plants, and some parsley this spring. They are particularly rich in the anti-oxidants that protect the cells of your body.

    Till next month then.

    Bernard Preston, DC.

    Back to Back Issues Page