5 Things to Do When a Rib “Goes Out”

Rib pain can be miserable. I cannot tell you how many patients have come in to see me after visiting the Emergency Department because they suspected a heart attack or something serious. Pain in the chest, shortness of breath, radiating pain down the arm, nausea, etc. Sounds like a heart attack but all of the tests are negative. So what do you when the emergency docs send you home and tell you it is nothing? Most likely you are dealing with a rib that is either stuck or not moving in the way it is supposed to. Here are five things to do, and not to do, to help.

  1. Heat and Ice. One of the biggest complaints, when a rib is out, is muscle spasming. Heat will help you endure a muscle spasm. There is a caveat, however. Heat brings blood to an area and if that blood is not flushed out, it will cause more inflammation. So, use heat for 20 minutes and then walk around for a while or ice it. Ice drives away inflammation. Ice for 20 minutes maximum. Always end with icing. For more information on heating and icing, go here.
  2. Massage, but be careful. As mentioned, muscles are often tight when a rib is not functioning properly. massage can really help to calm down the muscles. Here again, a word of warning. Often times, the person giving the massage will feel a good sized bump and mistake what is really the head of the rib for a muscle knot. Rubbing this bump will not only be painful but can increase symptoms. Working on the areas around it can be quite helpful. Massaging after the rib is moving again is great.
  3. TENS or Electric Stimulation. A great, non-drug option for killing a spasm and managing pain is to use e-stim, TENS or something similar. These are basically devices that send electrical pulses through wires and patches over muscles. There are several options of machines and can be purchased at various locations or from Amazon. Price and quality range drastically but I have found that the inexpensive units work pretty well.
  4. Get it adjusted! At the end of the day, until the rib starts moving properly it will cause problems. Not all chiropractors are great at adjusting ribs as they can be difficult. Likewise, you really need to have the specific rib adjusted and not just do a general spine adjustment. Even after you get it adjusted it may still feel out. Remember that the muscles have most likely tightened around it and formed a knot. Symptoms can take a while to settle down.
  5. Mind your posture and quit trying to stretch it. Typically, ribs go out because of a forward head and shoulder posture. So, why do we always try and stretch that same way to get it to feel better? Likewise, stretching spasming muscles does not really work. It drives me crazy when I adjust a rib and the first things my patient does is check to see if stretching forward still hurts. That is like separating a wound to see if it has healed yet. If you keep doing it, it will never heal. Instead, look straight ahead and pull your shoulder blades down and back. Here is the vintage YouTube video I created to demonstrate. If you do this exercise and it is still really painful, chances are the rib is out again.

Ribs can definitely be tricky. Sometimes they stay in after one adjustment and sometimes they take several adjustments. Usually, the longer it is out the more adjustments it will take. The rib joints at the front where it connects to the sternum can go out, too. These are also very painful and can be adjusted, although it is a different method. Please remember that although rib pain is brutal, it is not that damaging. Stressing about it will only complicate the healing process. If you have pain to one side of the spine by the shoulder blades, in the front next to the sternum, radiating along the ribs, or all of the above, just come in and we can either help you or, at least, point you in the proper directions.

Pillow Talk. (About Actual Pillows, Not the Other Kind)

Ah, the frustration of finding the perfect pillow! Have you found yours, yet? Once you do, your spouse or kid will probably steal it or your dog will chew it up. Or, do you have that pillow that has been perfect for longer than you are willing to admit and it is just moments away from disintegrating in the middle of the night as you blissfully rest? I know how it is. I wish I was writing this article with the perfect solution for everyone. Alas, there is no perfect solution but there are some general guidelines that can help.

First off, finding the right pillow can take time and you may need to invest a little in several different pillows. How much is up to your commitment to a perfect night’s sleep and how important it is for your neck to feel good in the morning.

The most important factor to consider is that you need to keep your head and neck is a neutral position relative to the shoulders. If your head is closer to one should over the other or flexed forward or extended back, you are no longer in a neutral position. This can put a strain on the joints of the neck and cause shortening of one side of the neck muscles and conversely lengthening of the other side. Because we spend so much of our lives sleeping, it is vital that you keep your neck and head in a position that puts little stress on all of the structures.

For side sleepers the biggest issue typically is finding  a pillow thick enough to take up the space between the shoulders and the head. This is especially hard if you have broad shoulders. A firmer pillow is usually your best bet because it will hold its shape all night. Down pillows tend to be fine for the first few hours then compress during the night. I, personally, sleep on a water based pillow that holds it shape really well but is soft enough to be comfortable. It has over a gallon of water in it so it weighs a ton which makes it hard to change the pillow case, but what do you do?

Back sleepers typically need a fairly thin pillow or no pillow at all depending on the curvature of the upper back. The shape of your neck will largely determine the style of pillow. If you have a good curvature (which is ideal), a pillow that helps maintain the arch can be great. If your neck is unfortunately straight or reversed, then that style of pillow might be very uncomfortable. Some say that using a pillow as a neck orthotic to restore the ideal curvature is a good idea. I could definitely make that argument but sacrificing sleep might not be worth it.

OK, I know the what you are thinking, “I switch from side to back all night.” Let me say it right now, unless you are just the right structure, there is not really a pillow that is dual purpose. Sorry! If you have a pillow thick enough to take up the space between the head and shoulders, it is going to be too thick to sleep on your back and vice versa.  Furthermore, if you are a stomach sleeper, there is no way to keep your head in neutral and still breath unless you have a slot for your mouth and nose.

There you have the basic guidelines. Happy hunting. FYI, just because pillows are expensive doesn’t mean they are going to be a good fit for you. Still, cheap is cheap. The pillows I sell in my office are around $50, if that is useful. Good luck and sweet dreams!

“It’s Never Just a Muscle!”

Back Pain

I hear it just about everyday. I don’t know how or why people think it. There is no known conspiracy about it. It may be because it is the only explanation people can think of. It drives me crazy and takes all of my energy to control my emotions when I hear, “I think it’s just a muscle.”

Let me explain why it is never just a muscle when you are talking about back and neck pain. The muscles in the back and neck are slow twitch muscle fibers. They are designed for endurance. They are not fast twitch, speed muscles. In addition, there are three layers of muscles with a ton of overlap amongst the muscles of each layer. For this reason, it is nearly impossible to tear or “pull” one of these muscle without doing damage to a much more susceptible structure first. 

The most common tissue to receive damage in the spine is the disc which can bulge, herniate, mishape, and swell when over worked or over loaded. Then there are the joints and ligaments of the spine which will sprain long before a postural muscle reaches tearing status. Finally, you have the nerve roots which if irritated even slightly will cause a muscle spasm which essentially protects the muscle. Herein lies the issue. 

When a muscle spasms it can be a lot more painful and noticeable than the underlying cause. Don’t be fooled. Muscles don’t just decide to spasm on their own. It is a protective measure. 

There can be occasions where a muscle due to overuse, usually because of postural strains, will form a knot (the technical term being a trigger point). When this happens it is commonly like asking, “which came first the chicken or the egg.” If there is a trigger point it will immediately affect the joints, discs, and nerves. There will also be a good argument that the trigger point only developed because of a lack of motion or subluxation of the joints. Either way, it is never just a muscle. 

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