DEFINITION--Injury to any of the muscles or tendons that attach to the ribs. A muscle, tendon and rib comprise a unit. The units stabilize the chest, breastbone and upper spine and allow their motion. A strain occurs at the weakest part of a unit. Strains are of 3 types:Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to a rib. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-rib attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Tendons and muscles of the chest, back and abdomen that attach to any of the ribs.
Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
SIGNS & SYMPTOMS
Pain with motion, breathing or stretching.
Tenderness to the touch.
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the muscle or tendon (visible with X-rays).
Loss of strength (moderate or severe strain).
Prolonged overuse of muscle-tendon units that attach to the ribs.
Single violent injury or force applied to the muscle-tendon units in the chest.
RISK INCREASES WITH
Contact sports such as wrestling.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Previous rib injury.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
To prevent a recurrence, tape the rib area before practice or competition.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Application of tape or elastic wrap (sometimes).
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the chest to rule out fractures.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Inflammation at the attachment to the rib (periostitis).
PROBABLE OUTCOMEMost rib strains are more painful than disabling. If this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDFollow instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION (if possible). See Appendix 1 for details.
Continue ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Wrap the injured chest cage with an elasticized bandage or rib belt between treatments.
Massage gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain (rare).
Injection of corticosteroids, such as triamcinolone, to reduce inflammation (rare).
ACTIVITYResume your normal activities gradually after treatment.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe rib strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.