(British Columbia Canada)
Dear Dr. Lewis
Is it possible to have this deep in the left sternum, not feeling it just chronically there like a knife in my chest at certain stretches over years. Only once difficulty breathing after another spinal adjustment. Was told to just lie down and breathe. Have been seeing chiros for 30 yrs. Is there an actual subluxation where the sternum and rib meet/attach? How would this be adjusted or cracked, moved?
Frankly, I don't quite understand your question. Like any other condition, it can be chronic, or recent and acute.
It's my own observation that I have in my early years in practice actually caused this problem through an over-robust mid thoracic adjustment.
And, like any other condition, be it a musculo skeletal condition like Tietze's syndrome, or diabetes, or ... it comes in severe forms, and mild forms.
Sometimes trauma (like an overly-robust thoracic adjustment) is the cause, other times a chronic midthoracic subluxation that has not been well cared for.
No, I don't think there is an actual subluxation. This joint is quite unique and unlike the synovial joints of the spine. I think of it more like a strain / sprain. Like sprained ankle ligaments or a pulled hamstring.
And just like a sprained ankle, where the ankle mortice or subtalar subluxation is not reduced, it can lead to a chronic pain syndrome.
Frustratingly, there is little research, medical or chiropractic about costo-chondral pain. In fact medicine has more on the subject, as the condition is so often confused with myocardial infarction, and because of the association with the diaphragm, Tietzes syndrome is often associated with indigestion and GERD.
Obviously, in severe trauma, the costo-chondral cartilage can be disrupted/ torn/ fractured. But in chiropractic practice the condition seems to be more of a "strain". And the treatment is not an adjustment in the normal chiropractic sense, but rather a mobilisation. Plus an adjustment of the costo-spinal joints.
Frankly, the patho-physiology seems to be poorly understood, and there is a dearth of information on the subject. But it does respond well to the protocol I have outlined.
And because of a host of tissues deep below the sternum per se, other "medical" conditions do need to be kept in mind. Medicine has established that occasionally an acute heart attack is associated with costo-sternal pain. Probably a distinct condition that existed prior to the MI but can be so early confused with a true MI.
I hope this answers your question.