Rib Pain Treatment

Treatment of rib pain is usually straightforward unless associated with trauma or costochondritis.

Care of the thorax in the chiropractic setting is adapted to the beautiful design of the chest. We are indeed fearfully and wonderfully made.

This page was last updated on 10th May, 2020.

It was designed to give protection to the vital organs, in particular, the heart and lungs. However, compromise was needed to enable us to breathe.

So these organs are surrounded by a cage of bone, interspaced with small gaps filled with muscles, and some other structures, nerves and an artery. They have to rise, increasing the space in the chest, drawing fresh air into the lungs, and then drop again as we exhale.




The ribs have a bucket handle configuration, with one joint in the front, with the breastbone, and three at the back, with the spine, allowing the them to rise and fall rhythmically with breathing.

Not generally well understood, and often poorly managed, breastbone pain can become a monster. Lying close to the breast, if on the left it's often confused with a heart condition, sometimes associated with gastro esophageal reflux disease and heartburn, and occasionally a very tender swollen lump may form over the costosternal joint. Tietze's syndrome, as it's known, can be extremely debilitating.

Tietze's syndrome responds well to specific chiropractic rib pain treatment but a heavy midback manipulation will worsen the condition.

Diagram illustrating the rib bucket handle.

Treatment of the ribs by chiropractors was designed around this beautiful structure. Like anything mechanical, the ribcage too needs maintenance. Both the joints the costo sternal joints in front, and those at the back, can be injured by freak movements.

An unexpected sneeze, a bout of bronchitis and trauma such as the injury from a seatbelt in an motor vehicle accidents, or a fall on the fist as in skating can and do injure the ribcage.

The rib cage

Rib subluxations can be exquisitely painful. Every breath may be a nightmare. However, the treatment, correctly done is not usually particularly painful.

Firstly your chiropractor will want to rule out conditions of the chest. For example, pleurisy also causes pain with breathing. So, too, a spinal infection. I've seen only one case in over thirty years, from an epidural, only 1 per 60,000 but it can happen. They key sign was inspiration pain, but bilateral; that was unusual.

For a fuller understanding of the anatomy of the ribcage you may want to read further.

Chiropractic treatment for rib pain

Your chiropractor will likely use one of a number of loosening up techniques prior to manipulation. This could be massage, or a vibrator, or stretching, or a mobilising technique.


"The Sprung Rib"

    Each rib has three small joints which articulate with the spine. A good sneeze, primarily, but any unexpected movement too, can subluxate one of these joints causing extreme sharp pain. It is characterised by pain whilst taking a deep breath.

    The chiropractic rib treatment is likely going to be a gentle thrust straight onto your back, whilst you are lying on your tum. Often the whole area, and your chiropractor will need feedback from you, making sure that s/he is on the correct rib.

The risks associated with rib pain treatment

OSTEOPOROSIS:

If you know you have brittle bones, it is important to warn your chiropractor. Most chiropractors will crack a rib occasionally on an osteoporotic patient. It is a risk, but greatly outweighed by the enormous relief millions get from chiropractic care from rib conditions, for every cracked rib. It is painful, and will remain so for a few weeks. You can expect a red faced doctor and a vase of flowers.

Fifty rib adjustments per week times 50 weeks equals 2500 adjustments per year.

One cracked rib every six years is my record. That's one in every fifteen thousand treatments. Seventy cracked ribs per million rib adjustments. That is very safe, much safer that taking pills for example, and a lot more effective for a subluxated rib, but indeed not perfectly safe. And if it was your rib, one cracked rib too many.

Thinking back, every one of those broken ribs should not have happened. After the fact, I could have, and should have done it differently. But it's a self limiting condition; really painful for a few days, then sore for a few weeks, with no long term sequelae.





None of them sued; all could have permanently put me out of business.

Doctors work under incredible pressure. Think twice before suing your doctor, remembering that there's a very fine line between a genuine mistake of judgement and neglect. You may feel vindicated, and receive your pound of flesh, but thousands of others will lose their doctor of choice. I know personally several doctors, medical and chiropractors, who have left the healing professions after being sued.

I treat at least ten patients in their eighties every week, yet continue to hear that medical doctors tell their patients that chiropractic treatment is far too dangerous for elderly bones. Bunkum, but we are careful, and gentle with the elderly. But, yes, iatrogenic illness does occur in chiropractic clinics too.

Chiropractic iatrogenic illness is not unimportant in that whilst the pain of a cracked rib, by a DC, can be severe, it is self limiting, and the patient recovers completely within a few weeks.

Causes of osteoporosis

Causes of osteoporosis is the most important page in my opinion at this chiropractic help site. Make sure you read it if you're a young woman. Prevention alas attracts little attention and the page doesn't get too many clicks. It's hard to focus on osteoporosis at thirty-five, I guess, but if you realised how important it is to prevent, and what suffering it causes, you might think again. Treatments after fracture is very limited.

Rib pain treatment which cracks a rib in the elderly is probably the most common iatrogenic, or doctor-caused, illness in chiropractic clinics. I confess myself to having cracked 9 ribs in 35 years; all recovered, though one was quite debilitating for a month.

When associated with chest pain in the front, and particularly at the costo-sternal joint, rib pain treatment needs to be gentle.

Teddy needs a rib adjustment.

It look like Pooh has come in from the Teddybears' picnic for an adjustment too. He gets the sneezles in the Spring sometimes, and it can spring a rib too.

Iatrogenic illness

Iatrogenic illness, or doctor-caused disease, occurs in the chiropractic clinic, though it's rarely serious. Heavy posterior to anterior  treatment in the midback can certainly crack ribs and worsen a costochondritis.

Nevertheless, because of the simply huge benefits from this treatment, the occasional mishap must be accepted. Every chiropractor strives to minimise them; each is very painful for a week or two.

FROM THE COAL FACE

The good wife has had a cold for a few days. Yesterday she sneezed while twisted and within an hour was in severe pain between the shoulder blades. Every breath brought her close to tears, a sharp, stabbing, knife like pain. It was so bad that she was unable to lower herself to the chair to eat lunch. She ate standing up.

Unable to get into the car, we walked with difficulty to the clinic, about ten minutes away. What a joy, it takes me literally two minutes on the bike normally.

Isolating the rib was not difficult, the seventh on the right; it was exquisitely tender on palpation. She had significant immediate relief from my chiropractic rib treatment, and we walked home quite normally, and she slept well last night. It will take a few days and a couple more days to get over it completely.

The rib adjustment, artfully done, isn't usually painfully despite the extreme pain of the condition.





I was given the task of making her favourite dish; an easy soup recipe at our broccoli facts page; see lower down. Did you know this brassica, as they are called, is the number one anti cancer vegetable, and has the double bonus of being very rich in magnesium, a deficiency of which causes chondro calcinosis, a leading cause of arthritis.

Every garden should have a few plants, and don't pull them when the head has been picked. The small florets that continue to come are even richer in those goodies; perfect for broccoli soup. Healthy eating is a vital part of chiropractic help. After all, if you don't look after your body, where are you going to live?

Now that we are retired in sunny South Africa, growing broccoli is high on the agenda; it is such an easy vegetable and goes on for months producing those small florets.

Breast cancer has a nasty habit of metastasizing to the ribs. If you have rib pain then it is very important to tell your doctor. He should ask of course, but these things slip through sometimes.

"Heart-attack rib"

Rib pain occurs sometimes at the junction of the rib and sternum (breastbone). Right over the heart so, if it's on the left, the pain may be confused with a heart attack. The key: tenderness over the breastbone, and its joints with the ribs. This condition is called the Tietzes Syndrome. If the subluxation is of the breastbone joint, then your Chiropractor will use a technique where the hands travel all along the rib, from back to front. His hands may lie close to the breast tissue, so if you feel uncomfortable bring a family member with you.

It is also known as costochondritis in its milder form.
Treatment for costochondritis
is not dissimilar to that of Tietze's syndrome, and heavy midback manipulation must be avoided. Chiropractic adjustments of the ribs are not usually particularly painful.

Your chiropractor may also use a treatment where s/he stands over you whilst you are lying down, (or behind you whilst you are sitting or standing), giving a sudden vigorous thrust on your back.


FROM THE COALFACE (II)

'Doctor, what did you do to me last week?'

'What do you means, Mrs Jones?'

'I've had such pain here in my side. Every breath hurts!'

'Oh dear, I may have cracked a rib, Mrs Jones. Let me examine it ... yes, I'm sorry to say, I have done you a mischief.'

'Cracked a rib! How long will it be sore?'

'About three weeks. I'm sorry. I must have been a little too vigorous!'

'Will it remain weak?'

'Absolutely not. Within 3-6 weeks, the time it takes for bone to heal, the pain will be completely gone. It will be as strong as ever.'

'Should I sue you?' said Mrs Jones, with a laugh.

'You could, but then you will lose your chiropractor! Remember how many times over the years you have crawled into this office on hands and knees!'

'But it's so sore.'

'I'm afraid so. You are third person in twenty-seven years in practice. I'm sorry it had to be you. It will get better with no sequelae.'

'Now don't go using the long words again ...'

A bouquet of flowers arrived the following day at Mrs Jones's address! It happens with ribs therapy. Three times in the 27 years. "Helaas", as we say in Dutch.

Sketch of woman playing ring o ring o roses on bicycle and injuring a rib.

A traumatic fall not only damages the bicycle but can also bend the cyclist's chassis. Whilst bruised and even cracked and broken ribs will heal, usually without great dramas, the simultaneous injury to the rib-spine and rib-breastbone joints can continue for months and years. Read more... Chiropractic RIB PAIN TREATMENT CaseFile ...

First rib syndrome aka Thoracic Outlet Syndrome

First rib syndrome can affect both the artery and the nerves that supply the arm; it's medical name is thoracic outlet syndrome.

Rib pain treatment is the most commonly effective care of this condition that produces tingling in the arms and hands.

Structures affected in the interscalene triangle sometimes complicated by the first rib.

The artery to the arm, and the nerves pass through a narrow space in the neck known as the Inter Scalene Triangle - a triangle made up of two Scalene muscles and the first rib.

Whilst very occasionally something really serious (like a lung tumour) can invade this space, the usual cause of irritation of the artery and nerves is either a first rib subluxation, or Scalene muscle spasm. Often they occur together.

It is the underlying cause of many of the arm pain conditions faced at the Chiropractic Coalface. Frozen shoulder, Carpal tunnel syndrome and the like.

Cervical ribs

Cervical ribs arise occasionally in the neck. Chiropractic rib treatment is the first port of call, though it won't "cure" the condition.

It's a grizzly operation to remove offending rib, and not without dangers to both the artery and nerves that supply the arm.

The neck vertebrae are not supposed to have ribs, but 1/500 (Wikipedia, 2019) people may have a cervical rib. Usually they are small and of little consequence, but very occasionally a monster occurs. Read more here at this cervical rib case file.

The result as the rib invades the "thoracic outlet" is pain and tingling in arms and hands ...

The interscalene triangle may be invaded by the first rib.

Residual lung volume

Since for normal breathing we use mainly the intercostal muscles and not the diaphragm, about one third of the lung volume is not often used; this residual space is wasted and not exercised. I often wonder if this does not contribute to a hiatus hernia.

It is important to use this part of the lung on a regular basis. If you work out, that is fine; you will be using it. If not, try this exercise.

Breathe out as far as you possibly can. Then using the diaphragm force yet more little puffs of air out of the lungs until everything is depleted. Then inhale normally. Do this numerous times a day, especially if you have a condition like asthma.

Open heart surgery

Open heart surgery requires splitting of the sternum in order to reach the great vessels; usually the bone heals normally, but currently I'm treating a patient who acquired a nosocomial, hospital acquired chest infection.

Owing to the coughing that continued for several months, the breastbone never healed. Eventually the sternum had to be plated; for the next three years he experienced midback, rib and sternal pain. 

Adaptation of the usual chiropractic techniques has been challenging, but happily he is responding well.

Shingles

I would suggest that there isn't a chiropractor alive who has been in practice for more than two years who hasn't been caught out whilst delivering what he thought was rib treatment.

Instead, when a few days later the lesions appear, he realises there has been a misdiagnosis; instead they are involved in a case of shingles.

It's pure anecdote, but I've never had such a patient who went on to the misery of post shingles neuropathic pain; it seems that in some way the treatment ameliorates the disease.

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INTERESTING LINKS

References

Cervical rib at Wikipedia.


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