Your ribs are right where you left them. Or not?

June 24, 2009 6:13 AM

"Two of my ribs have been out of alignment"—Does that ever really happen?

I have a friend who writes to me that her doctors told her that two of her ribs have been out of alignment, and that is what has been causing some bizarre and painful symptoms. She's going to see a chiropractor, who is "committed to fixing her".

I was a medical transcriptionist for 5 years, and I've been around the block on the internet, but I've never heard of ribs being "out of alignment", and... well... Basically I want to know if this is real, or is this made-up?

posted by eleyna to health & fitness (19 comments total)

Most ribs are attached at both ends, so barring a fracture, it doesn't seem like they could move around. The two at the bottom are only attached at the back, though, so maybe they could somehow be misaligned. Can't say I've ever heard of it, though.
posted by echo target at 6:33 AM on June 24

It depends on your opinion of chiropractic "medicine". It's not an unusual thing to say if you believe that the alignment (or misalignment) of your bones affects nervous energy. However, though IANAD, I don't particularly believe in nervous energy, and therefore don't believe that realignment can help.

I'd read up on chiropractic. It's an interesting controversy.
posted by PhoBWanKenobi at 6:39 AM on June 24

(Oh, and here's a good place to start.)
posted by PhoBWanKenobi at 6:41 AM on June 24

My mother has had this happen. Diagnosed by a doctor, treated very quickly and effectively by a physiotherapist (they manipulated it back into place). I've had this happen too. A chronic stabbing pain in my back that felt like I'd been stuck on a railway spike. After several years of this my (then) new osteopath (note: the NZ/British kind not the American kind) recognised the specific of pain and popped it back in. Instant and ongoing relief.

Ribs are like all bones, held to the other bones with ligaments and catilage and joints. They aren't physically fused together so yeah, they can move. And sometimes they can move out from where they're supposed to be (generally with help from the muscles around them) and it hurts and it takes physical manipulation to put them back. Sure chiropractors suck and this should be easily fixed, but I don't get why the overall principle of the injury seems so weird to people?
posted by shelleycat at 6:53 AM on June 24

For what it's worth, when I was kid, for about a year one of my ribs would feel like it had popped outwards from my sternum if I lay on my back on the floor while watching tv. It was quite painful, and I'd have to sit up and push it back in to make it feel right again.

So yes, things can get misaligned, but I pass no judgment on whether that should involve chiropractors.
posted by kowalski at 6:57 AM on June 24

Sure chiropractors suck and this should be easily fixed, but I don't get why the overall principle of the injury seems so weird to people?

I just wanted to pop in and say that it's mostly that this would cause "bizarre" symptoms that I'm skeptical of.
posted by PhoBWanKenobi at 7:05 AM on June 24

Maybe the chiropractor means rib dislocation.
posted by Houstonian at 7:06 AM on June 24

this happened to a friend of mine. she thought it was sciatica or something. turns out that her lowest two ribs on one side kind of overlapped. she remembers the day it happened - she had bent over to get something and stood up way to fast. suddenly she was in agonizing pain.

turns out too that she had a LOT of muscle tension down there which contributed to her ribs getting out of whack like that.

she, too, thought it sounded wacky since she works in the geriatric field and figured old people would be ripe for that kind of injury. but, turns out it was real. she just had to take it easy for about 6 weeks and take painkillers.
posted by sio42 at 7:06 AM on June 24

Your car's tyres need to be aligned. Your friends ribs - not so. If she had trauma to her ribs, urge her to visit a medical doctor instead.

I'm very skeptic of chiropractic, and this 'diagnosis' sounds like a made-up synonym of subluxation. This concept is rejected by mainstream medicine.

However, if your friend can afford an expensive placebo, why would you stop her?
posted by Psychnic at 7:09 AM on June 24 [1 favorite has favorites]

A few weeks ago I woke up one night to excruciating pain in my chest. I actually thought for a moment that I was having a heart attack (ridiculous seeing as i have zero risk factors and am in my 20's) until I was able to have a moment of logical thought through the pain and realized it was definitely muscular (skeletal muscular, not heart muscular) pain. A friend of mine had been urging me for weeks to see a chiropractor to correct pain in my ankle. I resisted because that's not "real" medicine.

Well, after my midnight scare I decided it was worth a shot. In the time in between making the appointment and seeing the chiro I had several other instances of this stabbing pain. At my appointment the chiropractor told me I had a rib out of alignment and adjusted me. After my first visit the instances of pain reduced by about 70% in frequency. I haven't had another shooting pain since my second visit.

My prejudice against chiropractic care is gone. I've since learned that they can treat all kinds of pains and ailments, and I now plan to go to my chiro for everything but tooth cleanings and pap smears.
posted by philotes at 7:09 AM on June 24 [1 favorite has favorites]

I play rugby. It's definitely possible. It was a physiotherapist who diagnosed and treated me, though.
posted by impactorange at 7:19 AM on June 24

Most ribs are attached at both ends, so barring a fracture, it doesn't seem like they could move around.

Of course they can move around. Your ribcage expands when you breathe, doesn't it?

Your true ribs are attached in the front to the costal cartilage, which is elastic like other cartilage, and attached in the back to the spine via the costotransverse joints, which let them swing in and out through a small range of motion.

Of course, as others have pointed out, there's debate as to whether chiropractors know what they're talking about when they call any joint misaligned or subluxed or whatever. I'm neutral on that — I have friends who are chiropractors, friends who are intense anti-chiropractic skeptics, and I'm not a biologist or a doctor myself so I listen to both sides and stay the hell out of the way. But it's known beyond a shadow of a doubt that the costotransverse joints exist and move. So your friend's diagnosis is no more or less plausible than any other chiropractic diagnosis.
posted by nebulawindphone at 7:36 AM on June 24

There are great chiro's - they combine physical therapy and injury rehab with stretching / tissue massage. They may even be PT's who use chiro techniques. They are medical professionals and can be trusted (as far as that goes). I was referred to mine after back surgery.

There are also shit chiro's that talk about "DIS-EASE" and how cancer is really you needing your neck cracked. They try to get you in for weekly adjustments forever. They also seem to push for expensive ergonomic nonsense and homeopathic medicines. They are quacks and should be ignored. Worse, some of their techniques are dangerous and can lead to injury. I was referred to this guy by a lawyer after an auto accident.

knowing which of these types your friend is visiting will go a long way to confirming the diagnosis. FWIW I've had my ribs broken several times. Not once have I had or heard about them being "out of alignment". I'd avoid reading into the diagnosis and tell her to seek a second opinion from an actual doctor.
posted by anti social order at 7:56 AM on June 24 [1 favorite has favorites]

This isn't a debate on chiropractic, is it?

Look, your skeleton is a bunch of sticks held together with rubber bands. Sometimes, things get out of whack. Hell, I can manually put my own shoulders almost half way out of their sockets. I've seen mechanical deformations of joints where no break has occurred but the joints have been hyperextended into illegal configuration spaces. (Good buddy of mine KNOCKED THE TIP OF HIS THUMB OFF ITS JOINT and the glistening bone joint protruded through the skin. I not only saw it, I took him to the ER to have it fixed. No break, obvious misalignment. Repair was anasthesia and MANUALLY PUTTING THE DAMNED THING BACK WHERE IT BELONGED. )

Point is... joints obviously have a preferred configuration and sometimes, the mechanisms that hold them in place fail catastrophically or more often in a more subtle fashion.

They can be manipulated back in place. One solution is to slice open the envelop around the joint and push things back into the right orientation. That has its costs. Orthopedic surgeons do that sort of thing. They love power tools, too. They look for ways to use them. It is an intrusive practice.

Another way is to use leverage and knowledge of the joints to arrange the body in such a way as to reposition the bones where they belong. Osteopaths and chiropractors do that sort of thing, as do physical therapists. Not all chiros use magnets and homeopathy or energy fields, and while there are frauds in the field, that is also true of 'real' doctors, several of whom sentenced my first wife to death with their expertise and lack of observation skills. Hell, their discipline descended from barbers, for crissake.

Not all chiros are quacks and not all docs are medical gods. Some are idiots. Consult the normal distribution to estimate how many.

Not sure about your ribs, but I have been effectively serviced for certain types of body strains by chiros, and the blanket repudiation of the ENTRIE group is unwarranted. Like any tool, it has restricted application, but it has some legitimate aspects.
posted by FauxScot at 8:06 AM on June 24 [3 favorites has favorites]

I've got a rib out of joint right now, and it pops out on occasion if I'm not careful lifting and stuff. (This instance is, I think, because I've been carrying my dog, who has a broken leg, up and down the stairs lately.) It causes a sharp pain in my back that extends to my front when I stress it.

Saw my chiropractor this morning, so it should be fine by this afternoon.

So yes, I'd say it definitely happens. I don't know if it's misalignment, dislocation, subluxation, or something else, but it's real and it'll slow a guy down pretty well.
posted by booth at 8:16 AM on June 24

Yes, rib injuries like this can happen (though if it were diagnosed by an actual medical professional, it would not be labeled as such). No, it is not likely that this is the source of your friend's problems--your ribs are held in place by enormously strong intercostal muscles and costal cartilage, and it would require a fairly significant blunt thoracic trauma to cause two of them to actually be forced out of their normal positions. No, she should not seek treatment for the problem with a chiropractor--would you ask your dentist to remove your appendix? How about if your dentist got his credentials from a six-week class at a correspondence college, and thought he could treat your irregular heartbeat by capping a tooth? PhoBWanKenobi's link is quite salient: subluxation therapy for non-spinal-related ailments is patently insane, and is not backed by any reputable study ever conducted.

A real doctor will be able to properly diagnose and treat this, most likely in the span of an afternoon. A chiropractor will continue to make up diagnoses and treatment options out of whole cloth, preventing your friend from actually addressing her problem.
posted by Mayor West at 8:48 AM on June 24 [1 favorite has favorites]

Middle ground here. I've been getting regular therapeutic massage for over 10 years. Misaligned ribs occur with me rarely, but it does happen. In my case, the discomfort is insistent, but not debilitating. When they are manipulated back into place, the relief is instantaneous and definitive. As I am on the computer all day, the biweekly realignment of my wrist bones is much more dramatic. My therapist is retiring soon to begin his PhD in Molecular biology. He's no flake... and I have zero chronic muscle or joint issues. Causal relationship? I have no idea. It's certainly worked for me so far.
posted by Carmody'sPrize at 3:39 PM on June 24

Mayor West it depends on the health care provider. I have been to western docs that couldn't wait to line me up for ongoing expensive tests based on far fetched diagnoses. I go to a chiro from time to time who wants to fix me and not see me again.
posted by pointilist at 10:30 PM on June 24

I just wanted to pop in and say that it's mostly that this would cause "bizarre" symptoms that I'm skeptical of.

The post doesn't say what the bizarre symptoms are. If they're systematic or not related to her torso then yeah, it may be dodgy.

But FWIW I have a lot of chronic back, neck and shoulder problems and am used to a variety of pain back there but always differentiated this one pain from the rest. It really was weird. It clearly wasn't a sore muscle, didn't get better or worse, didn't seem to correlate with anything else going on in my back, didn't respond to massage or heat or ice or treatment like any other pain would, caught/stabbed in a weird way when I moved, and generated a distinct angry, hot spot whenever my boyfriend rubbed my back. As soon as I described it to my osteopath in one sentance ('like a solid spike is stuck through me') he recognised what it was and fixed it that visit, he agreed that it's a very distinctive feeling. So I can imagine it being described as bizarre by someone who hasn't experienced it before.

A lot of answers here are dismissing this simply because of the chiropractor association. But the original question says it was diagnosed by her doctor not the chiropractor. I agree that the whole subluxation thing is total horseshit and many chiropractors are snake oil artists, but physical manipulative therapy isn't (is both validated by the medical literature when used appropriately and is practised by a wide variety of medical professionals). In this case the person in question has a medically diagnosed disorder, one that definitely does exist, and the therapist who is treating it just happens to be a chiropractor: one of the many types of people trained to treat this specific disorder. Probably not the one I'd choose but appropriate none the less.

I'm not a doctor but I do have a Masters degree in physiology (including a number of graduate level classes on the musculo-skeletal system), I know how the body works. Those people saying ribs can't be mis-aligned or it's not possible your friend has this problem simply have no idea what they're on about.
posted by shelleycat at 3:46 PM on June 25