By Emma Maaranen

Ribs – not the barbequed ones, yours!  At Focus Bodywork we have seen many rib injuries lately, and I have my own handlebar-induced one as well.  Rib injuries come in many flavors: bruised, separated, cracked, broken, and even collapsed.  These injuries are common in athletes participating in sports where contact or crashing occurs.  You may have heard a friend talking about one of these (hopefully you have not had one of these injuries yourself), but few people actually know what these terms mean and what a rib injury really is.  Let’s clarify.

Your ribs surround your torso, protecting vital organs.  With the assistance of several muscles, ribs help our lungs expand and contract so we can breathe; two very important jobs!  Each of your twelve thorasic vertebrae (the part of your spine between your neck and low back) has a pair of ribs attached to it that wrap around your torso, and all but the bottom two attach to your sternum (also called your breast-bone) on the front of your body.  When your ribs experience a serious blow, they can be injured.  They are designed to displace or crack to absorb a serious force so your organs below are not damaged.  They are not invincible, and sometimes lungs can be punctured,  or other organs experience trauma despite the ribs’ aid.  Here are the common rib injuries:

Bruised Ribs – The muscles and connective tissue around the rib were injured, but the rib bone is ok.  The area will be sensitive to touch, and moving the torso (looking over your shoulder, bending forward) will be painful.  Discomfort from sneezing and laughing are common.  Rest, avoiding jostling activities, and icing the painful area should resolve bruised ribs in a few weeks.

Separated Ribs – The rib has sprung free from its attachment on the sternum.  The site of impact will feel deeply bruised, any torso movement will be uncomfortable and it will be very touch sensitive at the sternum where the rib attaches.  A separation is a joint injury where the ligaments that hold the rib in place are injured, similar to a sprain.  This will take about six weeks of rest to heal.  Many athletes get frustrated with the healing time of this injury and return to play too soon. Separated ribs can progress to a chronic inflammatory condition that is very painful and will require ongoing medical care, do it’s best to see the rest period through.

Cracked Ribs – This is where the rib is cracked, but does not actually break.  It will be extremely sensitive to touch, and any torso movement (including breathing) is very painful.  Rest and minimal activity for 6-8 weeks is the typical protocol for healing a cracked rib.  Athletes that return to play too early risk the cracked rib progressing to a displaced fracture (where the bone breaks into two or more pieces).

Broken Ribs – This is a displaced fracture, the jagged edges of the broken rib may shred the muscles around it and can puncture the lung.  This is an extremely painful injury where moving or even breathe is excruciating.  It will be extremely sensitive to touch, may be visibly deformed and will likely bruise severely.  Six to eight weeks of rest are needed to heal, but athletes with broken ribs are typically in so much pain they won’t return to play too early!

Flail Chest – This is where several ribs are broken, and the rib cage is no longer able to assist the lungs to breathe.  This is a medical emergency.

Pneumothorax – This is where a broken rib punctures the lung.  This is a medical emergency! Fortunately there are two lungs, so breathing is sort of possible before a medical team can intervene.  Again, six to eight weeks of well-deserved rest are the norm.

Rib injuries are frustrating.  Your arms and legs work just fine, but you can’t bend, twist, lift, breath hard, laugh, sneeze and I hope you don’t get a cold with cough!  There is little you can do to speed  the healing ; it just takes rest.  Ice and anti-inflammatory drugs can help with the pain. Increasing your protein intake will ensure you have the building blocks needed for tissue repair and taking a calcium/magnesium/phosphorus supplement will aid in bone repair.  An acupuncturist can help with the pain and stimulate your body to put a lot of effort into healing the injury.  In the past, rib injuries were taped or supported with an ace bandage.  This is no longer recommended because the limited rib motion from the brace can lead to pneumonia.  The last thing you want is to have more problems breathing with a rib injury, and coughing may make you more miserable and lengthen healing time.  When the rib injury has healed to where it is not very touch sensitive and any broken bones have knit back together, massage therapy can help to restore normal rib motion.  When rib injuries heal, it is common for the intercostal muscles (the ones between ribs that pull two ribs together) to develop scar tissue and adhesions.  These muscle restrictions can limit  torso motion and the ability to breathe deeply.  Often the diaphragm (the muscle at the bottom of your lungs that helps the lungs expand and contract) has developed adhesions as well.  Using neuromuscular therapy and myofascial release, your massage therapist can resolve these tension sites, which helps you return to pain-free activity quickly.

I sincerely hope you do not have a rib injury this summer; but if you do at least it’s BBQ season.  While gnawing on some baby back’s and resting in a lounge chair, you can share some rib injury trivia with your friends.