Over the years I have seen many injuries. I have only worked in orthopedic outpatient settings since graduating, and yet I have treated things like Post-mononucleosis Fatigue Syndrome, CAD, and Pudendal Nerve Entrapment. But now and then we see the “little things” like Boxer’s Fractures. This mini series of posts is dedicated to three injuries and conditions that seem little in size but have huge consequences; the first of which we will dive into today.
Broken Rib – I’ve never broken a rib and I do not want to ever break a rib. The current population that I work with fall more often than I was ever accustomed to when in school or after, and they also have slightly weaker bones, and this makes for a mess in the chest. On a scale of 1 to 10, I hear that broken rib(s) hurt a hell-of-a-lot! Typically they rank right below pregnancy and kidney stones as the most painful things people have experienced. But broken ribs are more than just painful, they are downright destructive!
Hopefully by now most of us know how important proper breathing patterns are for good trunk stability, CNS functioning, and good movement patterns. And because broken ribs can’t be braced or casted, these loose ends of serrated bone are just free to stab our nerve rich intercostals, or rub against each other, making even the thought of a deep breath unbearable. Without proper chest expansion, the diaphragm cannot descend properly (allowing for good trunk stability or breathing) and before you know it, the person who came in with tennis elbow who happened to break their rib on the slip-and-slide, is now being treated for low back pain 6 weeks later. But I digress.
Without proper chest expansion we also lose thoracic spine extension. If you think about the sternum as a pump handle from one of those old-school water pumps, as the handle comes up, our thoracic spines have to extend; creating a mini joint mobilization EVERY. SINGLE. TIME! Once thoracic spine mobility decreases you can say hello to neck pain, shoulder pain,or even more back pain. I kid you not guys, these broken rib things are no joke.
So Mike, what the hell do we do?
- Let pain be your guide. I hate saying that, but pain can make any movement pattern end up looking like Bambi’s first time walking, so why try to get back to discus practice when there are ragged boney ends rubbing each other. Typical bone breaks heal in 6-8 weeks in healthy adult populations, and broken ribs are no different. The pain subsides before this, but it is not a hall pass to return to sports. Check in with your doc first to get clearance. Up to that point, work on pain reduction, reducing the accessory muscle breathing patterns that will likely show up and the associated muscle tone in the upper chest/back/neck.
- If a fall is what caused the client’s break, examine their balance. You may be surprised at what you find. If not too painful, progress through a wide-to-narrow, double-to-single leg, high kneel – to – half knee to – standing, stable – to – unstable balance progression. Basically make balancing harder as they get better.
- Re-pattern faulty breathing once pain has subsided. The sooner this can be done the better.
- Re-establish proper trunk stabilization.
If you’ve ever treated someone who has broken a rib, or have broken a rib yourself, you know that it can derail everything else in your training or rehab. It may only be a broken rib, but the cascade of secondary issues that may arise make this one of the most underestimated injuries out there. Stay tuned for the other two injuries, and if you have any suggestions of your own, please feel free to leave a comment!
Be sure to read this Related Post that answers some of the common questions I have been getting about this post.