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1st Apr

2014

Orthopedic Manual Physical Therapy for Rib Disorders

Our rib cage is mobile, with joints attaching to the thoracic spine in the back, and cartilages attaching to the sternum in the front, with ligaments supporting the joints, and muscles between the ribs that participate in the action of respiration. As such, we can also sustain rib injuries or experience rib pain, just as we can with other musculoskeletal tissues.

Common causes of rib pain include traumas such as falls, car accidents or from contact sports. Other causes are sudden strains, or overuse strains in sports or physical labor. Various forms of arthritis can affect the rib joints, and a painful condition caused costochondritis causes the cartilages by the chest bone to become inflamed or irritated. People with lax ligaments and who have loose joints, may be prone to rib joint strains and subluxations.

The pain may originate in the cartilages of the rib joints, the joint capsules and ligaments across the joints, the muscles between and crossing the ribs, and the bone in the case of a fracture. In some people who experience arm pain and tingling/numbness or a weakness feeling, the first rib may compress the major nerve bundles which travel down to the arm. Serious disorders which may cause rib cage pain must be ruled out, such as lung disorders or cancer.

Rib pain which stems from the joints in the back where the ribs join the thoracic vertebrae often shoots straight through to the chest bone in front. Many people go to the emergency room, thinking that they are suffering from a heart attack, when in fact they are dealing with a painful rib joint. Deep breathing or coughing often hurts when ribs are involved.

The skilled manual physical therapist will perform a comprehensive evaluation, to rule out serious disorders and to pinpoint the exact origin of the pain. This also requires a full evaluation of the thoracic spine (upper and mid back), since its function is closely related to the ribs, and there are often coexisting disorders in these areas.

Physical therapy for a rib joint which has become stiff or slightly displaced, may include techniques to mobilize the rib manually and with specific exercise, whereas a very inflamed or irritated rib joint or cartilage may need to be protected. Strained rib muscles can be gently worked with soft tissue mobilization techniques and retrained with specific physical therapy exercise to the rib cage and trunk. After a fracture to a rib or thoracic spine vertebra, the rib joints may become stiff (especially if the fracture was close to the rib joints in the back) and be the primary cause of the pain after the fracture has fully healed. The specialty trained manual physical therapist can then identify and mobilize these restricted joints, and restore normal and painfree rib/trunk movements.

Enjoy the spring, and stay healthy!

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