Slip, flop, pop right out.
It’s hard to imagine that our ribs have the ability to slip out of their normal alignment.
Before I explain a little more about this situation, let’s explore the anatomy surrounding our ribs. We have 12 ribs total on each side of our body. The first seven ribs from top to bottom on either side are called true ribs because they attach to both our vertebral bones in the back and to a piece of cartilage in the front of our chest that then attaches to our sternum. The next three ribs down from those on either side, called false ribs, attach to the vertebral bodies in the back and then come around the front to attach to a longer strip of cartilage without fully connecting to the sternum. And then ribs 11 and 12 on either side connect to the vertebral bones in the back but have no connection to any cartilage in the front, therefore, being completely unattached to the sternum. These last two ribs are called floating ribs.
We rely on our ribcage to be fully moveable for full inspiration and expiration of our lungs. The ribs rotate ourward with inspiration and then rotate back inward with expiration thanks to the muscles between the ribs (intercostal muscles) and the nerves that innervate them (intercostal nerves).
But there can be many forces working against us that prevent normal ribcage movement. The part of the spine (the thoracic spine) that the ribs attach to provides us with most of our ability to rotate our body (although it also provides elements of flexion, extension, side-bending). We can twist and turn thanks to this part of our spine–which also requires our ribs, attached to these rotating vertebrae, to accomodate and rotate at the joint where they attach to the vertebrae. Poor flexibility of our muscles, tendons, and ligaments that attach to these joints can prevent the ribs from completing their full range of motion, possibly even forcing them to slightly slip from the cartilage or bone to which they attach if the demand we place on them is too great for them to handle due to their lack of flexibility.
Patients usually report a pain in the front of their chest or in the back of their chest, most commonly felt with rotation of their trunk, caughing, sneezing, a hard laugh, pushing or pulling items or lifting a heavier object. Often, the pain of a slipped rib radiates from the back of the chest or front of the chest all the way around to the opposite side at the same level (pain along the intercostal nerve). Sometimes a clicking/popping/clunking noise is also associated with certain movements.
The best form of diagnosing a slipped rib is to get a proper case history and then to palpate the area around the painful region. Specific maneuvers requested to be performed during the exam may also indicate a slipped rib.
And then finally, what many people care about most, is the treatment of a slipped rib. The chiropractic adjustment to correct the slippage is extremely important. In conjunction with adjusting, it is important to loosen the tissue around the ribs with a stretching protocol and to monitor/adjust aggravating activities.
Should you want to learn more about slipped ribs or want to correct a slipped rip, please give me a call.
In correcting slipped ribs,
Dr. Phil Kotzan