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4536 Views 9 Replies Latest reply: Aug 22, 2011 11:17 AM by JamesJohnsonLMT
MaryPrusa Amateur 15 posts since
Sep 9, 2010
Currently Being Moderated

Aug 10, 2011 4:05 PM

Ribs out of place

Has anyone dealt with slipped ribs or "ribs out of place"?  I got an adjustment today from the chiropractor but wondered what your ordeal was like and how soon you were running pain free.



  • rkblackwell Amateur 36 posts since
    May 19, 2010
    Currently Being Moderated
    1. Aug 10, 2011 5:15 PM (in response to MaryPrusa)
    Re: Ribs out of place

    I occassionally get a rib out... not a big deal, never interferes with running.  It's always in my mid to upper back.  My wife's a chiropractor, so I just have her pop it back and I'm good to go.

  • JamesJohnsonLMT Legend 1,282 posts since
    Aug 23, 2009
    Currently Being Moderated
    3. Aug 13, 2011 8:57 PM (in response to MaryPrusa)
    Re: Ribs out of place

    I'm glad the solution is easy so far, but the popped ribs shouldn't be  considered normal. Frequent irritation of these joints may not be a  necessary part of athletic activity, but it does help explain why  athletes have a much higher incidence of costochondritis than the general population. To spare some potential chest pain in the   future, I'd look into preventing the tension on these ribs in the  first  place. Possibly some problems in the Serratus, Intercostals,  Obliques, or other muscles connected to the ribs, is pulling them out of  place by resisting normal movement?

  • JamesJohnsonLMT Legend 1,282 posts since
    Aug 23, 2009
    Currently Being Moderated
    5. Aug 15, 2011 12:46 PM (in response to MaryPrusa)
    Re: Ribs out of place

    While I have not personally used kettleballs,  I have handled them and appreciate the concept. I think the allure for  their use among endurance athletes has to be preservation of upper-body  mass. I am very much impressed by the evidence that vigorous exercise,  including weight-training, has tonic effects beyond the cosmetic,  extending to better recovery from exercise, and the retarding of the  aging process by affecting telemere shortening. Besides, it feels good. I guess if you are an endurance  athlete, you might start out at a disadvantage when throwing any weight  around, so there you probably have it. Hit the nail on the head.


    What  I find so fascinating about exercise physiology is that the things that  are the best for us can often be the worst by a very small degree. It's  a jeckyl and hyde thing, I suppose. Gotta watch that stuff! Going forward, what to do, since it appears to be a  persistent problem. If you are familiar with some of my other posts, I  often mention "trigger points" as a cause for recurring pains that don't  seem to respond to rest, stretching, exercise, etc. You may have seen  those plastic instruments displayed in the link I included in my earlier  comment, on the case of the female volleyball player with recurrent  chest pain, later diagnosed as costochondritis induced by years of athletic activity that involves,  as I'm sure you've seen, a lot of reaching and straining to exert  maximum force with ribs extended to their maximum reach. Most people go  through their entire lives without using these muscles to that extent.  Arguably, they aren't really designed well for repetitive use at maximum  output, such as might be experienced by a volleyball player, or even a  competitive swimmer. The unusual extent of use of these muscles more or  less explains the confinement of symptoms to folks in these athletic  categories, but an injury once sustained can come back to haunt over and  over again, even when the former activities are abandoned. This is  where the instruments, and trigger points, come into play.


    While the case-history article discussed what was apparently "graston technique," to break down poorly remodeled recovered tissue, and kinesio taping as a lymphatic aid, I read more into the approach than what was  covered there. What is in common with my approach is the presence of  dysfunctional muscularature and a manual therapy to address it. The  really good news is that a lot of muscular dysfunction merely involves  stored tension in the muscles in question (trigger points, if you will),  and the availability of techniques for disarming those dysfunctions, instruments not required (in most cases). Lots of cases of intercostal lock-ups can be solved by simply working the ends of your thumbs into  the spaces between ribs that these muscles occupy, and releasing those  knots. The muscles are very sensitive and do not require much pressure  at all, just the introduction of this new stimulus. A varying amount of  subsequent treatments often results in complete remission from these  symptoms, when the normal flexion/extension of these tiny muscles is  restored. What is probably happening right now, is that the intercostals (and/or many other muscles acting on the ribs) are immobilized after  some minor injury that has long since healed, but persist in a holding  pattern of limited movement. With respect to the authors of the article,  I will allow that substantial scarring can produce the same results,  but I doubt that you would experience that after cross-training with a kettleball. Trigger points, however, are quite likely.

  • NancyLFreeman Legend 243 posts since
    Feb 17, 2010
    Currently Being Moderated
    6. Aug 15, 2011 1:21 PM (in response to JamesJohnsonLMT)
    Re: Ribs out of place



    I haven't much to add to James' in-depth analysis, but I did have a rib out of place once a few years ago, which manifested itself as a nasty stitch in my side.  Fortunately my GP is also an osteo, so when I finally went in he popped it back into place and told me no weightlifting for a week, and I haven't had a probem since.  I wasdoing BodyPump wasn't lifting very heavy weights, and I think the problem was actually caused in BodyCombat, a combination of all the twisting and not having very strong abs yet.



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  • JamesJohnsonLMT Legend 1,282 posts since
    Aug 23, 2009
    Currently Being Moderated
    9. Aug 22, 2011 11:17 AM (in response to MaryPrusa)
    Re: Ribs out of place

    I think we are not there yet. Since there are 17 muscles attached to  the shoulder blade, many of which are attached to the ribs, you may have  to survive a good amount of whack-a-mole therapy before that shoulder  and ribs move freely. Groups of muscles like this work synergistically  and can lock up as a group, in support of a single member that may seem  to have little to do with where you experience the problem. The symptoms  you report when attempting the overhead motion confirm that it is  likely to involve more than the muscles on the ribs themselves. In fact,  they could be far down the line of dominoes from the source. I once  worked with a chiropractor using ART, and had a chance to observe the  technique close-hand, and see it implimented on several athletes. He was  kind enough to explain the technique to me, even working on my own IT  band, which was causing problems at the time.


    One thing  I noted about ART is the importance of movement during therapy. It is  directed toward breaking adhesions between tissues that have improperly  healed due to past trauma, which is something that affects many  athletes. When excess collagen has been deposited at a particular site  after inflammation has run its course, there is no guarantee the tissues  involved will remain separated during this healing process. What was  probably explained to you is that the same thing happens in deeper  tissues that happens with scarring on the outside of the body. If two  burned fingers are taped together during the healing process, they might  actually be fused together as a result, requiring surgery to separate  them. In ART the offending tissues are pinned by the practitioner during  movement in order to force the fused tissues to separate by tearing the  collagen bond between them. This of course requires movement during  this process, but as any physical therapist can tell you, continued  movement of the healing tissues is necessary to model the repair and  prevent these adhesions from taking hold in the first place. ART,  Graston, ASTYM, and other potentially painful techniques are used to  remedy improper healing when the modeling failed or was not done. In  many cases the injured athlete is unaware that an injury has healed in  this way, and the therapies are used after the fact. This is possibly  your case.


    What I am concerned about is another  potential problem that may have us barking up the wrong tree. If there  is fixation of the joint(s) due to one or more of the muscles that  interact with your shoulder, your ribs are simply recipients of this  lack of flexibility. The problem may not be in the rib muscles at all,  but simply affects them. If the Intercostals are actually moving freely  (their range is very short), too much aggressive manipulation can  actually tighten them. The massive Serratus (Anterior) muscle that runs  from the back of the shoulder blade to 9 of your ribs can be responsible  for the problem you have, since this muscle is sensitive to the  twisting movements of swimming, crosstraining with a kettle ball, deep  inhalation/exhalation, emotional stress, and coughing, all of which you  may have encountered within a short span of time. The Teres muscles, S/I  spinatus and Subscapularis also come into play. When I do shoulder work  I usually have to address several of these synergists to get the group  to relax enough for free movement to take place. I've had to do this on  myself as well, since my profession is very shoulder-intensive.


    While there is a certain amount of movement between  tissues that can be isolated with a technique such as ART, some of these  muscles move very little in any place that can be reached by such a  technique. In addition, adhesions are only one problem an athlete can  have in muscle or tendonous tissue. Muscles can remain in a state of  contraction that prevents free movement even when there are no  adhesions, and this problem is much more common. Not only is it common,  but it is very easy to make worse with aggressive treatment, including  pin-and-stretch techniques. In fact, muscles often remain in a  contracted state to prevent painful movement, and until the muscles  themselves are released (not the tissues between them), there may be no  meaningful increase in function or range of motion. To complicate things  further, a muscle may remain in a contracted state because another  muscle in the group has a problem, so you can work on it all day without  changing anything. When I talk about whack-a-mole, I imply that more  diagnostic sleuthing may need to be done. This requires that each muscle  in the group be isolated by an individual test for function, by  somebody very familiar with the rotator cuff, which is something  physical therapists (and some orthos and MDs) specialize in. When we  find out what is not moving properly and transferring all movement to  the ribs, we will know where to productively direct our efforts toward a  permanent fix. Meanwhile, your chiro may be able to refer you to a good  neuromuscular therapist for the time-consuming exploration of those  other dozen or so muscles, possibly releasing them in the process. There is more than one way to rule out each of those 17 synergists.

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