Rib dysfunction

A patient came in a few weeks prior with crippling lower back pain which began 4 months prior and progressed to the point of antalgia. The muscles in the left thoracolumbar junction were very tight in a spasm and the pain was intense. I took the patient's vitals and did a heart and lung exam to rule out other causes of this pain. The patient had markedly reduced range of motion in all directions but primarily right lateral flexion.

I had the patient lie face down so that I could palpate the ribs, thorax and lumbar spine. The most tender spot was right at the thoracolumbar junction on the left and it seemed to be the paraspinal muscles that were fired up. The ribs in that area were restricted in movement and breathing hurt the patient. The thoracic and lumbar spine had segmental restrictions as well. Kemp's test was positive bilaterally and all neurological tests suggested no deficits. The history was free of red flags.

We transferred rooms and begin treatment. I decided to put some heat on the patient's back for 10 mins to loosen up the tissues that were in spasm. This helped. The muscles became a little more pliable and less spastic. I then had the patient lie face up and I set up a rib adjustment a little higher that needed work and one a little lower, then I went to the lowest restricted rib and it was not going to move! Dr. Roberts tried to adjust it as well and it stayed spastic and "stuck". I then adjusted the thoracolumbar region in hopes that the costovertebral joints would move, but the pain persisted. It was then I decided the problem was just too acute to fully resolve that day, so I stripped the muscles in the area, applied some KinesioTape and sent the patient out the door with instructions on how to use ice for inflammation.

The patient came in two days later. There was quite a lot of improvement in pain and the range of motion was much better. The ribs in that area were still quite restricted. I decided to do a Farfan-type maneuver (patient lies face down, doctor grabs the side of the pelvis and pulls up to the ceiling while pushing into the rib cage down to the floor) first thing to see if that torquing action would free up those costovertebral joints. I had the patient take a breath in and blow it all out while I added pressure to the lower rib cage. My hope was to get the lower trunk moving a little bit more each time the patient took a breath. After about 5 passes through, there was a little audible "pop" around rib 8 or 9. The patient sat up and said the symptoms had improved to almost normal!!

I finished by adjusting the upper thoracic spine and cervical spine because there was some movement restrictions in a few segments and I adjusted the thoracolumbar junction. The TL junction was a bit painful for the patient but I eased into each side slowly and as it loosened up, I gave it a little bump. A few audible pops occurred with those adjustments as well.

The patient stood up, flexed to the floor, extended back, bent side to side and rotated each direction and no movement caused any pain. We resolved the issue that day and told the patient it would be wise to get adjusted once every 4 to 6 weeks to prevent this problem from occurring since this occurs every 4 months.

This case is a great example of conservative treatment for lower rib and thoracic joint dysfunction. It is a common problem patients present with in the chiropractic clinic.

All for now