Have you ever had sharp back pain just off to the left or right side of your spine? Many people will describe it as if someone stabbed them with a fork and point to the area over the ribs? Well, I got to experience that wonderful pain this weekend. Although it has been some time since my last episode, this reminder served as my inspiration for this blog. We will discuss the anatomy of the ribs, the possible causes of the pain, and the solutions if you suffer from this pain.
The anatomy of the posterior thorax surprises many of my patients. The reason is there is a lot of confusion around the relationship between the spine and the ribs. Below is a picture taken from wikipedia (http://en.wikipedia.org/wiki/Human_back) As you can see, the ribs articulate into the thoracic vertebrae with the shoulder blades (scapulae) lying over top of them.
If we take a closer look at one rib you can see the articulations better. However, not pictured are the many muscles, ligaments, and other supporting tissues between the rib and the vertebrae. In a rib subluxation (malposition), the surrounding articular cartilage becomes irritated and increases the local inflammation around the nerves. In turn, the nerves will irritate the muscles and cause spasms and sharp pain. At times, it will be difficult to take a deep breath, cough, sneeze, or laugh.
So what are the causes of this type of benign rib pain? It can be a result of a hard cough or sneeze, improper lifting (especially when the arms are extended fully), trauma (sports injury or fall), as well as a quick reaching motion. More serious causes of rib pain include fracture/braking a rib, osteoporosis causing fracture, pleurisy, or cancer. In the aforementioned list, it is necessary to contact your medical provider for care. However, if the rib pain is from a benign source, a doctor should perform several different tests to verify your safety before treatment begins. The first assessment will deal with your range of motion, followed by determining whether there has been a fracture (x-ray). Finally, the muscles and ligaments will be tested to ensure that they are maintaining their integrity.
Over the weekend, I was fortunate enough to see a chiropractor who performed a extra-spinal adjustment. I was then treated by a massage therapist working to calm the accessory muscles of the back and neck. Finally, I used acupuncture to further reduce the pain and inflammation. All of the above treatments are amazing for quickly and effectively reducing pain and inflammation. You may also consider, rest, ice, and an NSAID if nothing else is available. For more information, please call or write us at www.drcharleshecht.com.
Dr. Charles Hecht is a sports chiropractor in Chapel Hill, NC. He is the only Certified Chiropractic Sports Physician in Chapel Hill and maintains over 20 hours of sports chiropractic education each year. He enjoys working out, playing tennis, paddle ball, and scuba diving. You can also follow him on Twitter @DrCharlesHecht or on Facebook or LinkedIn.