The ribs are an uncommon site for a stress fracture, however, through repetitive or increased loading, they can occur. Typically, rib stress fractures occur in the 1st rib anterolaterally (front/side), the 4th – 9th ribs laterally (side) and posterolaterally (back/side), and the posteromedial (front/middle) upper ribs. These fractures are particularly painful and early identification plays a huge role in the prognosis of the injury.
The fracture itself is quite different from your normal fracture where a single incident causes the bone to crack or break. Rib stress fractures appear as a weakened area in the bone due to the aforementioned repetitive loading through the ribs causing the formation of microscopic cracks.
What Causes Stress Fractures of the Ribs?
More often than not, rib stress fractures occur in the sporting population, particularly rowers and other sports involving highly repetitive forceful movements. Research (Rumball, Lebrun, Di Ciacca & Orlando, 2005) has identified two main factors that contribute to the development of rib stress fractures:
- The amount of rib loading (related to muscle, joint, technique, equipment and weight training), and
- Your body’s response to rib loading (sex, age, skeletal and training)
Muscular factors for the onset of rib stress fractures include:
- Muscle weakness resulting in the shock absorption capabilities of the muscle being decreased and consequently an increased level of stress at the selected focal point of the rib(s).
- Muscular pull across the bone exerting considerable repetitive forces
- A muscular imbalance between serratus anterior and external oblique muscles/abdominal muscles.
- Anterior Scalene muscle in the neck repeatedly pulling on the 1st rib
Training, sex, age or skeletal factors for the onset of rib stress fractures include:
- Poor sport-specific technique – incorrect structures being unnecessarily/excessively loaded
- Equipment problems – old or damaged equipment
- Lack of flexibility and or strength
- Non-graduated increase in training load
- Stiff joints between the ribs and the vertebrae decrease the ability to dissipate forces through-loading
- Female sex steroid hormones can be involved in the pathogenesis of rib stress fractures
- Decreased bone mineral density with age
Common Rib Stress Fracture Symptoms
Symptoms of rib stress fractures include:
- Gradual onset of chest or back pain with no single mechanism of injury – often eased with rest
- Pain is exacerbated by coughing, sneezing, rolling over in bed, doing a push-up or sit up and pushing open a door
- As time goes on, the vague chest or back pain can become more specific and often a very tender palpable bony formation results.
Rib Stress Fracture Investigations
A plain film x-ray will more often than not appear negative in its investigation for a rib stress fracture. The gold standard in imaging for rib stress fractures is a bone scan (black spots) or an MRI (white spots). However, this is only indicated if the pain has persisted for up to or greater than 3 weeks and the patient is not responding to conservative treatment.
Rib Stress Fracture Treatment
Phase 1: Early Injury Protection – pain reduction and anti-inflammatories
- A relative period of rest as determined by your physiotherapist – this will depend on the extent of your injury.
- Supported cough – this decreasing the pain associated with coughing, sneezing and laughing.
- Ice – to decrease pain and swelling
Phase 2: Range of Motion Restoration
- Soft tissue release work of the surrounding musculature.
- Joint mobilisations to stiff joints
- Pain-free exercises to prevent atrophy (muscle wasting)
Phase 3: Return to Sport
- Sport-specific technique addressed – modifying the technique to prevent regression in the improvement and decrease the likelihood of re-injuring.
- Graduated return to sport commenced – pain is the main mediator in the amount of exercise you can perform
- Must be able to complete the seven criteria pain-free before returning to modified training:
- Push up
- Sit up
- Deep Breath
- Rib Spring
- Night Pain
- Activities of Daily Living
For rowers experiencing rib stress fractures, please see the attached Australian Institute of Sport, National Rowing Centre of Excellence guidelines
- Scheuermann's Disease
- Spinal Stenosis
- Rib Stress Fracture
Nerve-related / Referred Pain
What is the PhysioWorks Difference?
You'll be impressed with the experienced physiotherapists, massage therapists, allied health team and reception staff who represent PhysioWorks.
To ensure that we remain highly qualified, PhysioWorks is committed to participating in continuing education to provide optimal care.
If you've been searching for health practitioners with a serious interest in your rehabilitation or injury prevention program, our staff have either participated or are still participating in competitive sports at a representative level.
We also currently provide physiotherapy and massage services for numerous sports clubs. Our experience helps us understand what you need to do to safely and quickly return to your sporting field, home duties, or employment.
How You'll Benefit from the PhysioWorks Difference?
At PhysioWorks physiotherapy and massage clinics, we strive to offer our clients quick, effective and long-lasting results by providing high-quality treatment.
We aim to get you better quicker in a friendly and caring environment conducive to successful healing.
With many years of clinical experience, our friendly service and quality treatment is a benchmark not only in Brisbane but Australia-wide.
What are Some of the BIG Differences?
Our therapists pride themselves on keeping up to date with the latest research and treatment skills to ensure that they provide you with the most advantageous treatment methods. They are continually updating their knowledge via seminars, conferences, workshops, scientific journals etc.
Not only will you receive a detailed consultation, but we offer long-term solutions, not just quick fixes that, in reality, only last for a short time.
We attempt to treat the cause, not just the symptoms.
PhysioWorks clinics are modern thinking. Not only in their appearance but in the equipment we use and in our therapists' knowledge.
Our staff care about you! We are always willing to go that 'extra mile' to guarantee that we cater to our client's unique needs.
All in all, we feel that your chances of the correct diagnosis, the most effective treatment and the best outcomes are all the better at PhysioWorks.
Common Sources of Spinal Pain & Injury
- Neck Pain - Cervical Spine
- Upper Back Pain - Thoracic Spine
- Lower Back Pain - Lumbar Spine
- Sacroiliac Pain - SIJ
- Scheuermann’s Disease
- Spinal Stenosis
- Rib Stress Fracture
Nerve-related / Referred Pain
Youth Spinal Pain
Teenager Neck & Back PainTeenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control. The competitive athlete and most individuals who exercise regularly or maintain a level of fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Your physiotherapist can assist the resolution of any deficits in this area. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions. Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these type of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
PelvisCommon Youth & Teenager Sports Injuries Common Youth Leg Injuries Common Youth Arm Injuries
Article by P.XuAs we slowly start getting into the cooler seasons, many people will begin to notice sore joints waking up in the morning, or that movement has become stiff, or even headaches increasing in frequency or severity. Why is this? It turns out that cold weather can have a significant impact on your body’s tissues. Notably, the connective tissue gives our muscles and joints the ability to move as they do, called elastin. As the name suggests, elastin is one of the critical components that provide our joints and muscles with the ability to bend, stretch, and move as they need to get you through the day.
What is Physiotherapy Treatment?
Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice. Physiotherapists maintain physical health, allow patients to manage pain and prevent disease for people of all ages. Physiotherapists help encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing daily living activities while assisting them to remain functionally independent.
There is a multitude of different physiotherapy treatment approaches.
Acute & Sub-Acute Injury Management
Hands-On Physiotherapy Techniques
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Soft Tissue Techniques
Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, to name a few.
Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.
Alternatively, your physiotherapist may recommend a supportive brace.
Acupuncture and Dry Needling
Many physiotherapists have acquired additional training in acupuncture and dry needling to assist pain relief and muscle function.
Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you, depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.
Aquatic water exercises are an effective method to provide low bodyweight exercises.
Sports physio requires an extra level of knowledge and physiotherapy to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.
Women's Health Physiotherapy is a particular interest group of therapies.
Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.
Plus Much More
Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your problem, please contact your PhysioWorks team.
How is Kinesiology Tape Different from Conventional Strapping Tape?Rigid strapping firmly wraps around your injured structures. Most standard strapping tapes are non-elastic. They aim to provide rigid support and restrict movement. These rigid strapping tapes can only be worn for short periods, after which you must remove them to restore your circulation. and mobility. Alternatively, kinesiology tape has some unique elastic properties that allow it to provide active support, protect muscles or joints, and allow a safe and functional range of motion. Rather than being entirely wrapped around injured joints or muscle groups, kinesiology tape is applied directly over or around the periphery of troublesome areas. This non-restrictive characteristic of kinesiology taping allows most applications to continue for several days. This period reinforces therapeutic benefits to accumulate 24-hours a day for the entire time they’re worn. You can wear kinesiology tape during intense exercise, showering or swimming. It quickly dries after a quick pat with a towel. More info: Strapping & Supportive Taping
Back & Neck Pain Prevention TipsHere's some beneficial advice to help you prevent back pain and enjoy life to the maximum.
PostureI'm afraid that your mother was right. If you slouch, you'll end up with problems. Just one of those problems is back pain. You'll find other problems elsewhere on this website. Think "Grow Tall". Imagine that you have a string screwed onto the back of your head, just above your hairline. Then think that someone is dragging you up off the chair you are sitting on. Hold this "grow tall" position for 10 seconds and repeat every half hour. As well as greatly reducing your chances of back pain you'll note that your chest has lifted, shoulders are relaxed, the chin is tucked in, the head is level and stomach muscles have contracted. Not bad for such a simple exercise. This posture can be repeated in sitting, standing, sleeping, walking or running. Try it, and the physio will work for you too!
LiftingThe best method to avoid back pain from lifting is delegation. If this isn't an option for you, try the following:
- Use back support to lift loads over 15 to 20kg.
- Bend at the hips and knees with your feet shoulder-width apart.
- Firmly grip the load and hold it close to your body.
- Think "grow tall" to tighten your stomach muscles and look upwards to straighten your back.
- Stand using your strong thigh and buttock muscles to lift.
- Once upright, turn by using your feet. Avoid twisting your back.
SittingUse the "grow tall" principle each 15 to 30 minutes while sitting. A supportive chair or lower back cushion is essential if you must sit. If possible, don't stay seated for too long. Regularly stand up, stretch your back and walk short distances for a variety of posture. After all, we were designed for hunting and foraging - not sit in front of a computer!
ExerciseFitness has many benefits. Stronger, more flexible muscles and less weight to stress the bones and discs. PhysioWorks specialises in the provision of exercise programs to keep your back flexible, strong and pain-free. Exercise can involve aspects of flexibility, strengthening and postural control. Consider Real-Time Ultrasound Retraining to ensure you are doing it right!
SleepingA quality pillow and mattress are necessary for a healthy spine. You do spend somewhere between one-quarter (1/4) and one-third (1/3) of your life sleeping. Do it in comfort! You'll need to consider a new mattress if you wake up through the night or in the morning with back pain. Please ask your PhysioWorks therapist for advice at your next visit.
DrivingUse the "grow tall" principle each 15 to 30 minutes while driving. The combination of sitting and bumpy roads is a recipe for back pain. A lower back cushion is essential if you must drive any distance. If possible, don't stay seated for too long. Regularly break your travels to have a walk and perform simple stretching exercises for a variety of posture and a healthy spine. After all, we were designed for hunting and foraging - not sit in front of a computer!
What are the Symptoms of a Heart Attack?Some heart attacks are sudden and intense — the "movie heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening: Shortness of breath. May occur with or without chest discomfort. Chest discomfort. Most heart attacks involve discomfort or heaviness in the chest's centre that lasts more than a few minutes or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one (commonly left) or both arms, the back, neck, jaw or stomach. Other signs include breaking out in nausea or vomiting, cold sweat, or dizziness/lightheadedness. If you think you or someone with you is having a heart attack, Call 000 Immediately! Don't wait longer than a few minutes (no more than five) before calling for help. Call 000. Get to a hospital urgently.
What are the Symptoms of Chest Pain Originating from Your Spine?Your spine is a prevalent cause of chest pain. Treating your thoracic spine and rib cage is usually the solution. However, chest pain originating from your spine won't kill you, but a heart attack can! Spinal Discs can refer to pain through your chest wall like a knitting needle. Coughing or Sneezing hurts. Thoracic Facet Joints refer to pain around your rib cage. Trunk movements will aggravate or ease your pain. Rib Joints send pain down and around your rib cage. Pain can increase with coughing, deep breathing and trunk or shoulder movements. Back Muscles will generally be more painful in sustained postures, e.g. sitting at a computer. These are commonly felt between your shoulder blades and can be relieved by massage.
What to Do Next?As mentioned earlier, if you suspect a heart attack, Call 000 immediately and get to the hospital straight away. If your symptoms are not heart attack related, consult your physiotherapist to assess your spinal and chest joints and muscles. Most of your muscular or thoracic and rib joint pain will be relieved after your very first consultation. For more information, please consult your doctor or physiotherapist.
More info:Thoracic & Chest Pain
What are the Advantages of Good Posture?
Good Posture Benefits:
- It keeps your bones and joints in the correct alignment.
- It helps to decrease the abnormal wearing of joint surfaces.
- It decreases the stress on the ligaments holding the joints of the spine together.
- It prevents the spine from becoming fixed in abnormal positions.
- It prevents muscle fatigue.
- It prevents any backache and muscular pain.
- It contributes to a competent and confident appearance.
To Achieve Good Posture You Will Require the Following:
- Good muscle flexibility
- Normal motion in the joints
- Strong postural muscles
- A balance of muscle forces on both sides of the spine
- Awareness of your posture, plus knowledge of proper postural position, leads to conscious correction.
Article by John Miller
What is Good Posture?That's why proud and confident people stand tall with excellent posture. It's a habit! Standing with good posture looks and feels fantastic, plus it's very healthy for your joints, muscles, bones, blood circulation and most importantly, your self-esteem. How you hold your body in space is your posture. Your posture is a direct result of the postural habits that you commonly exhibit. You can choose to hold good posture or poor posture. Gravity is your worst enemy while standing or sitting. You could also refer to this as your spinal posture, back or neck posture. The good news for you is that you can quite easily change your postural habits and train your body to sit, stand, walk, and even rest in great postures. Good posture also places the least strain upon your supporting muscles and ligaments. But, no one posture is good to maintain all day. As a human, you were designed to move from posture to posture to avoid muscle fatigue and abnormal sustained tissue loading. This means that your best posture is your next posture!
Benefits of Good PostureGood posture:
- Prevents postural muscle fatigue.
- Correctly aligns your joints and bones while encouraging efficient muscle activity.
- Help minimalise joint stress.
- Avoids passive ligament overload.
- Prevents backache, neckache and muscular pain.
- It contributes to your enhanced confidence and a good appearance!
How to Improve Your Standing Posture:The number one tip to achieve a great standing posture is to "stand tall"! All the muscles that you need to push you taller are the same ones that improve your posture.
- Stand tall!
- Extend your head directly up (think balloon lifting your head with a string in the top of your skull) - but keep your chin tucked in. Avoid tilting your head forward, backward or sideways.
- Your earlobes will line up with the middle of your shoulders.
- Keep your shoulders back, your knees straight, and your back straight.
- Let arms hang naturally down the sides of the body
- Lightly draw in your core stomach muscles. Avoid tilting your pelvis forward.
- Avoid locking the knees.
- Ensure your feet arches are in a neutral (not flat) position.
- Stand with weight over the centre of your feet.
- Stand with your feet slightly apart (shoulder-width).
- When standing for sustained periods, shift your weight from one foot to the other, or stand in a walk stand and rock your weight from your front to back foot.