Tietzes Syndrome

by Alex Davies
(Sault Ste. Marie, Ontario, Canada)

Tietzes Syndrome


I am a 21 year old male who has been an athlete and very active my whole life. For 2 years now I have been dealing with tense neck muscles and constant (and I mean they never go away, ever) headaches. It started with a dull ache at the back of my head where my spine reaches my head but has grown into a problem that is overwhelming me. Today I am so stiff it hurts to do stand, sit and do daily activities. The headaches are the same but now my ribs and chest ache and feel very tight. When I was 16 I had pain in the center of my chest (that I went to emerge about?) and they called it "chest wall pain" and gave me anti-inflammatory medication. I carried on and the chest pain was only really present when I sneezed sometimes or during certain stretches.

The severe pain in my ribs has only been present since seeing a chiropractor a couple months ago, and the pain I felt in my chest as a 16 year old is present all the time since then.

Tietze's syndrome, which I read about on your site describes my symptoms except the only thing that bothered me for the longest time was head and neck pain.

My physio therapist says I'm as stiff as anyone he's seen and believes a tight dura is the reason for my headaches but the stretches he gave me (standing rag doll, trying to touch my toes) have aggravated my ribs, chest, and back to the point where it hurts to breathe. No doctor has ever been able to help me and im feeling very helpless as my condition worsens.

Other symptoms I've experienced include a numb left arm where its obvious the circulation has been cut off to my arm in the sitting position with my arm elevated (mainly sitting at a desk or driving). I often have pressure in my ears which coincide with bad tension headaches.

I fear seeing a chiropractor again because I believe it made me worse, and no one else seems to have any answers.

Any advice would be greatly appreciated



Hello Alex,

It took me many years to work out that a heavy manipulation in the midback would aggravate this condition, so don't feel all alone.

It sounds like you have several different conditions that are overlapping. Just to be sure, I would suggest some blood tests to be sure that you don't have a medical condition such as Ankylosing spondylitis. Frankly, unlikely, but it does happen.

The numb feeling in your arm when you raise your arm is typical of a first rib fixation causing a "thoracic outlet syndrome". It also involves several muscles in the neck (the scalenes) which would explain the neck pain and headaches.

Tietze's is a nasty condition involving the whole rib, sometimes several, usually unilateral, but it can be both sides. Breastbone pain, and pain along the rib to the midback is the feature. Commonly aggravated by deep breathing.

The correct Chiropractic treatment is very specific, and carefully avoids any heavy midback manipulation. Oddly I had a new patient yesterday, a professional cyclist, with this exact problem.

Often there is associated indigestion and heartburn because the diaphragm is attached to the lower ribs.

I confess I too may have aggravated and even caused this problem until I worked out how to treat it. It's called Iatrogenic Illness, or doctor-caused disease!

If you had a good rapport with your present DC, despite the fact he aggravated this condition, then I would return to him, and carefully and very definitely point out that the treatment increased your pain. If he listens, and is prepared to think and adapt his treatment, well and good. If not, and you feel rushed brushed off, in and out, don't let him touch you, move on.

If he would like to Skype me, I'd be happy to outline the protocol I have developed. No charge.

Have you had X-rays taken? Neck and midback. Get those blood tests.

Shop around Alex. Before consulting another chiro, always first ask if he has heard of Tietze's. Heavy midback manipulation definitely aggravates and even causes the condition. It will only increase your problems even more.

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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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