A list of PT exercises for intercostal muscle tears?
February 5, 2017 1:46 PM   Subscribe

Can someone tell me a list of PT exercises for what I think are a year old intercostal muscle or serratus anterior muscle tears?

In March 2016, I got sick and tore what I think are three intercoastal muscles (maybe one serratus anterior?) from over a month of violent coughing. I had just gotten pregnant and used ice, heat, and rest. I began massage after a few weeks. In July 2016, I was still having issues with two of them (see photo for location of primary one). The other is under my breast on the same side. My husband spoke to a PT he has business relations with, and he said they would not heal till the pregnancy was over because it was stretching out my rib cage. My son was also positioned on that side with his back/butt pressing against them during the entire pregnancy.

I gave birth in November 2016. I am still in constant pain from the one on the side. One under my breast acts up sometimes too. If I massage too much, I can still feel all three. The third is lower on my rib cage. The pain is generally a dull ache or sharper band of pain that can be felt at all times and especially when breathing or making certain movements. Reaching up or over my head hurts, as does doing a “rotation in laying” (at bottom of link page). If I do something to aggravate them, the pain gets very sharp and knifelike. I apply ice when this happens (heat does not seem to help), and I or my husband massages them every few days like this, but the pain feels much deeper than I can reach. After massages, the entire rib cage feels sore and like it is bruised badly for days.

I live in IL and was told by the PT that he can’t treat me without a doctor referral. I tried to get one but was told I’d have to first undergo a series of tests for my lungs, kidneys, liver, gallbladder, etc. That appointment alone cost $400, and I didn’t go for the tests because I know they are torn muscles—I felt them tear, though I and the PT do not think they were a complete rupture. I have thousands of dollars of medical bills from the birth of my son (the hospital overdosed him and he was sent out-of-network for emergency treatment, which my insurance won’t cover) and can’t afford any more medical bills.

I walked 5 miles a day pre-pregnancy and am just starting to take very short walks again. Something happened to my legs week 39 of pregnancy (a severe burning down the inner thighs that left me using a cane and wheelchair for 4 weeks) and am now just starting to recover. I am not sure if walking could help the torn muscles heal or not.

Can someone suggest a list of PT exercises to try to rehabilitate them? I am not sure if exercises are the correct route since movement hurts them but am willing to try anything that could help by this point and am open to other treatments I can try at home. (My son and I are staying home during cold/flu season so we don't get sick due to my injuries and his hospitalization and insurance issues.)

Can you also keep any exercises diastasis recti-safe. I do not think I have one but do not want to encourage one in case there is a small separation (there may be a small gap under my belly button, but it is hard for me to tell still having 10lbs on me and having lost all my muscle tone).

Also, can anyone reasonably say that these can heal at this point? I am getting very concerned that all the strain from the pregnancy and then having to care for my son has injured them to the point they won't be able to heal, and resting them has no longer been an option with a baby to care for.

Thank you very much for any help you can give.
posted by LillyBird to Health & Fitness (11 answers total) 3 users marked this as a favorite
I'm so sorry you're having to go through this, it sounds miserable.

Because you've never been worked up to diagnose what the issue is, I'm not sure it would be wise or responsible for anyone to willy nilly suggest exercises.

Obviously avoid movements and massage that aggravate; you could be hindering healing that way. Also keep in mind that the flexibility of your ligaments/other soft tissues remains while you're breastfeeding (if it applies to you).

The big series of testing required before you can get a referral sounds like a lot, but I am not a doctor. However you probably do want to see a doctor to rule out something more serious than a muscle strain or tear, especially since it doesn't sound like it's gotten any better in almost a year.

I hope others have more valuable info for you. I hope you can figure this out and start feeling better soon.
posted by sweetpotato at 2:26 PM on February 5, 2017

I suggest checking the IAFCC (Illinois Association of Free and Charitable Clinics) - they provide free/low-cost care to under and uninsured individuals. It seems like you have quite a few health concerns that really should be sorted out by a professional, especially considering your recent pregnancy.

It also might be worth talking to the IL Department of Insurance or filing a complaint with them over your pregnancy expenses.
posted by givennamesurname at 2:33 PM on February 5, 2017

Response by poster: Yes, sweetpotato, I tried to breastfeed till Dec 15 but was unable to get any supply due to my son being in the NICU and having to drive 2 hours to see him. I know relaxin stays in your system for months afterward, as well, and that could be making it worse.

I spoke to many doctors during my pregnancy about the torn muscles and they all just accepted it was muscle tears and they would heal eventually once I gave birth. The GP I went to for an actual referral was kind of crazy, imo, and told me she's never heard of muscle tears from coughing and that it would be a fracture. Bad luck, I guess, picking her.

givennamesurname: Thank you for suggesting the IAFCC. I will see if they can help, but I am insured and am not low-income. It's a marketplace plan with a high deductible, though (we're self-employed). I have filed the complaints with the IL Dept of Ins. already and we are trying to get help from the State's Attorney.

And as far as the leg, all my doctors told me the baby was on a nerve and it would get better once he was born. It did, to a degree, but after his birth, the PT said he thought it was actually muscular, not nerve, and my husband's uncle, a retired OB-GYN, also concurred with the PT's opinion.
posted by LillyBird at 3:58 PM on February 5, 2017

There is way to much going on here for simple excersize recommendations.

You may be able to negotiate with your hospital about your remaining balance to have your sons medical fees waived or reduced.

You do get a covered well women's visit each year with the ACA. your gynecologist ot OB/GYNEmay be able to make the referral (or call your pcp so she writes it) .
posted by AlexiaSky at 8:12 PM on February 5, 2017

Response by poster: We already spoke to the hospital that overdosed my son. They are unwilling to work with us and went so far as to call overdosing my son "reasonable care." We are on a payment plan with the out-of-network hospital. His care there was about $30K.

My OB-GYN told me to go to a GP, which I did. I have no PCP right now, as my insurance switched this year (to an HMO due to financial constraints), and I have not found a doctor not associated with the hospital that overdosed my son yet.

I just want to clarify that I am not asking for help with what happened with my son or our insurance issues, though I greatly appreciate the replies. I am trying to do something about the torn muscles that have not healed properly. The PT my husband knows thinks PT exercises would help but is legally unable to treat me without a referral, and I can't afford the battery of tests they want to put me through before writing a referral to PT.
posted by LillyBird at 8:35 PM on February 5, 2017

I'm so sorry, this sounds terrible. I'm not a PT and can't recommend exercises for you, but I am experienced with a high-deductible plan and negotiating with my PCP to get referrals. Did you tell the dr you would have to pay for these tests and you can't afford them? I suggest calling or emailing the doctor's office and telling them what you wrote here: you have to pay $400 for a visit that was useless to you and you won't be getting the tests because you can't afford them. It's possible they will agree to give you a PT referral or drop some of the tests. I'm reading your question as the dr was recommending the best course of action, not realizing that it's essentially impossible for you to follow up on. But if you did explain your situation and they still advised this, then yeah, new doctor (low-cost clinic? can your PT friend recommend a dr?)
posted by areaperson at 6:20 AM on February 6, 2017 [1 favorite]

Ugh, I've had a similar injury and it is so awful, and it's slow to heal. I can't recommend exercises because my injury was slightly different (although I can tell you the PT I did involved really, really small, gentle exercises as well as specific types of massage) but I can definitely assure you this will take awhile to heal. Be REALLY careful with the exercise. I was injured several months before I sought PT and the long wait didn't impact my ability to heal, I don't think, it just added time that I was in pain - what made it worse was doing stuff like carrying really heavy groceries on my injured side. I did PT for awhile, it got a little better, I stopped, and then went back again a couple of years later and finally really healed. Mine did flare up again while I was pregnant and it took awhile to calm back down, I didn't really do anything. SO I wouldn't worry that you are permanently damaging yourself! It should heal eventually. I would think you still have a lot of relaxin too which isn't going to help. I agree trying to find another doctor to help with the diagnosis might be a good idea and in the mean time take it as easy as you can on that side (really hard with a small baby, I know!!). My original injury was diagnosed by ultrasound (I think? it was awhile ago) and then later by a manual exam by my doctor, I did not need my gallbladder or anything checked! I did have some other tests done (xray, etc) but I think those could have been skipped - they were just double checking for broken ribs or pneumonia.

BTW my doctor told me you can definitely cause intercostal tears from coughing. Also she told me if you can cause the pain by poking at your ribs, it's probably not an internal organ.... I wish I had better advice but other than reassuring you that this is slow to heal I really do think a doctor is the best bet.

I am so sorry you are having such a terrible run. This must be so stressful! I'm so sorry about your son, that is just awful.
posted by john_snow at 6:49 AM on February 6, 2017

Response by poster: areaperson: Yes, unfortunately, I explained all of this (and followed up with a complaint to the hospital she works at--same one that overdosed my son) and she/they were unwilling to work with me. I asked her for an ultrasound to diagnose it, and she said ultrasounds are not given for muscle pulls, which is not true.

We are going to see if the PT can refer a doctor to me that may be in network and would refer me back to him. We've had a lot of trouble with the marketplace plans saying a doctor accepts the insurance but then calling the doctor and finding out they do not.

john_snow: Thank you very much. What you said is encouraging, and it's comforting to know someone else had a slow recovery but then did get better eventually. I'm not worried at all that it is an organ. Tearing a muscle is pretty unmistakable when it happens! But thank you again for sharing your experience. It's been helpful and reassuring.
posted by LillyBird at 10:16 AM on February 6, 2017

oh yeah, sorry, I was trying to say that the doctor you saw should really have been able to confirm it was a muscle issue just by your description of the symptoms, not something like your gallbladder!

Unfortunately the intercostal muscles are super, super slow to heal in part because there's not much blood flow there. I think the heat helps because it's bringing blood to the area.
posted by john_snow at 12:51 PM on February 6, 2017

Response by poster: john_snow: no worries--I didn't misunderstand you! Yes, the doctor should have! That health system, I've come to learn, is "test-happy." She wanted to test organs that are nowhere near the pain in my body...ugh.

I am in the last week or so applying heat to see if that loosens things up and increases blood flow, esp. before I massage. Heat used to hurt in the early days but isn't causing much pain anymore and I've probably tensed up a bunch of other muscles over the last year trying to compensate.
posted by LillyBird at 1:37 PM on February 6, 2017

I would definitely suggest getting a second opinion from a referring doctor. I'm just adding my voice to the chorus on that. IANYD/this is not medical advice.
posted by treehorn+bunny at 5:10 PM on February 6, 2017

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