Classic Tietze's syndrome and heartburn.

by Dan
(Hinton AB )


I just stumbled across your page, searching for some type of relief. I'm a 29 year old male, fairly active and a father of two. I'll start by saying I've had chronic heartburn for as long as I can remember, probably started as an early teen. I've had left side upper rib and shoulder pain pretty solidly for a year now. It definitely slows me down with my kids, going to the gym or really any physical labour. I've completely stopped going to the gym out of some relief, and frankly I just feel my body has fallen apart so I have no mental game left either. There are two particular incidents I can attribute to this.

I rode a BMX as a child/teen and took an amazing amount of force trauma to most parts of my body. One particular 'wipe-out' I'm sure I cracked a rib. I, being a young kid tried to man up, never got it checked at the hospital. For a few months post wipe-out, every time I coughed, or sneezed it felt like it was re-breaking. Now, I know for sure it was on my left side and front. I'm unsure if it was upper or lower rib though. I assume this could be a link to my age old chronic hurt burn? Ether way this is the first of the two incidents I assume took part.

The second, happened about a year and a half ago. I was getting into lifting heavy at the gym. I was performing a classic bench press. I'm a smaller guy, and was pushing around 140 pounds. I pushed myself to go for another, without a spotter or in a cage, and failed. I ended up pinned under the barbell across my chest. I tried rolling the bar downward to get out, unsuccessfully. Eventually, I flopped the bar down across my left side to the ground. I knew instantly I did damage. It didn't really hurt at first. The pain took a couple of days to progress into the pain I know all too well now. So I went to my chiro.

After a quick visit I felt good as new. Then, it popped out again. Chiro visit 'fixed'. Pop out. Chiro 'fix'. Again and again for well over a year know. Never really getting that normal feeling again. Eventually I lost hope that my chiro would fix anything and tried physiotherapy. It helps slightly, when I get time to go. A tad hard as a new dad to my second child. Anyway, I feel as there is no hope. I've got the heart-burning, rib-poppin blues. Any info or help would be greatly appreciated. I am going to see my chiro tomorrow and will check if she knows of this syndrome. Thanks for the great write-up. Very interesting to me. Looking forward to hearing your thoughts!

Hello Dan,
Yours in an all too familiar tale; I wish I could get it through to folk that you're not training for the Mr Universe title and the gym is supposed to improve your health, not give you life long pain. Still the damage is done, and there aren't too many of us who have done a dumb thing or two, that we afterwards greatly regret! So, the injury is set in concrete, and let's see if we can move forwards.

Two things are not too clear.
1. Is the pain at the sternum, or in the midback? Or both?

2. After your visits to the chiro when you got relief but it again 'popped out' were you continuing at the gym, or generally in other ways playing silly buggers?

The heartburn may or may not be related. Start by not drinking anything with meals, or for an hour afterwards. Drink very little after dinner. Sleep in the early part of the night on your left side. Let me know if this makes any difference.

Are there tender spots where the ribs attach to the breastbone; is there a visible lump?

Do you have pain or discomfort when you take in a deep breath? Where? Or did you in the past, but not when you think you cracked a rib? Then inspiration was almost certainly painful.

Have you had an x-ray of your chest and thoracic spine, and a gastroscopy? All three would be advisable.

Give me a few answers and then I'll have a clearer picture of your problem.

Dr B

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Dec 31, 2016
by: Dan

Thanks for the quick reply Dr.B! I have pain mainly in the mid back, but I have pain near the sternum often as well. After going to my chiro, my rib will fall back out usually from sleeping.

On my left side 😑, which is unfortunate because that's pretty much the only night relief I get of heartburn. I have been trying to sleep on my back with a chiropractic pillow for about a year and it seems to help the amount of time between events.

When this rib issue first started I could barely breath it hurt so bad. Now it seems to be much more consistent. It doesn't hurt to breathe unless a rib comes out. Although, I have consistent pain regardless if a rib is out or not.

I have a large bump in the left front upper near my collar bone. And it's very very tender. Then I have one more very tender spot on the left between my nipples. I have not had an X-ray done. I will look into this. I have had a gastroscopy and a whole whack of other heartburn tests. These resulted in the doctor telling me my esophagus works at 30% strength and at 30% of the time (unconscious swallowing motion).

I told my chiro of the syndrome, and she had never heard of it. She has done some research and I tried laser therapy yesterday on the front tender spots. Seems the same so far. I'll see what happens. Thanks again Dr.B

Hello Dan,
My tentative diagnosis, speculative you understand is indeed classic Tietze's syndrome. It probably goes back to that injury years ago.

What's different in your case is that it seems to be affecting both sterno-clavicular and costo-sternal joints.

Gastric pain lying on your right side is fairly typical of a hiatus hernia; try to avoid the operation; it's very often a misery. Don't drink with or after meals, especially at night, and start a diary; what combinations of foods provoke the pain? Bread at night is often involved. Accept that for the first four to five hours of the night you have to sleep on the left side. If it's really painful, get up and walk around; most likely you'll burp up a bubble of gas.

Tell your chiropractor, for what it's worth, is that in my experience a heavy PA adjustment in the midback will aggravate the problem, but an "anterior thoracic" technique will bring far more relief.

Dan, sadly, no one is going to cure this. Work out what helps, what hinders and go for an occasional but regular chiropractic adjustment.

An ice massage every day in the shower directly over the swollen breastbone joints will help; and perhaps an ice pack in the midback too.

I wish I could bring better news, but in my experience that is the reality. Just like you would learn to live with diabetes with correcty diet and exercise, work out how to cope with Tietze's syndrome.

Remember that a heavy manipulation in the midback will increase the pain. And certain foods will provoke indigestion; smaller meals at night is part of the solution, and no coffee after dinner.

I hope this contributes; let me know in a month or two how you are getting on.

Dr B

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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.

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