Information about conditions is provided as a service to our patients for educational purposes only. "If you understand your condition, you will be able to do the things necessary to rehabilitate much faster." Please feel free to print the information so that you can refer to it often. Sharing of information is quite risky, however. Do not presume that information is meant for you if you have not seen the doctor and received a specific diagnosis. Some conditions share similar symptoms but require very different treatment. If you have friends or family who may have similar symptoms, please schedule an appointment to see the doctor.

Thoracic Sprain

Injuries to the mid back owed by a sudden movement of the back or ribs backward, forward, or twisting sideways, are referred to as "Sprain" if the ligaments are involved and strain if only the muscles are involved. They very often occur together and so we lump them into the term Sprain. Whether from an accident, or sometimes spontaneous from the build up of stress from daily living, sprains warrant a thorough chiropractic check-up. The biggest danger with sprain injuries is that the symptoms persist for years, particularly if not treated appropriately.

DISCUSSION:

When the rib heads become involved, irritation of the intercostals nerves is often felt in the form of a sharp pain penetrating the chest. This is often mistaken for heart pains. Once the rib head is repositioned, the pain should subside. It may take several days for it to stay located.

 

The condition: Note the ribs in the diagram to the left as they articulate (connect) to the bones of the spine. The fourth one down on the left is out of place upward. Between each pair of ribs is what is called an intercostals nerve. It runs around to the front on each sit. When the rid head is out of place like the 4th left one is here, it will place traction on the nerve. When this happens, there are two kinds of pain that occur. The first is the pain from the ligaments around the rib head in the back. A patient can usually tell that something is wrong back there. The 2nd one is a feeling like a knife is going right through the chest from front to back upon deep inspiration. This is the stretching of this nerve. Once the tearing of the ligaments caused by the movement of the rib head out of place, has healed, the condition will subside. Sometimes this takes several days or weeks depending on the reduced activity of the patient.

STAGES OF HEALING &TREATMENT:

The soft tissues that are traumatized will go through four stages of healing:

  • The first stage involves simply the immediate effects of injury, including bleeding, blood -clotting, and cellular breakdown. The inflammatory response is the primary means that the body uses to respond to-the injury.
  • The purpose of the inflammatory stage is to surround the area of injury in an attempt to protect it. The effect of this response is usually proportional to the amount of injury sustained. This phase can last up to 3 days. At this time the doctor may discuss with you the importance of utilizing ice packs, as this is important to reduce sweI1ing and control pain. Other therapies that will aid in the healing process include electrical stimulation & ultrasound.
  • The repair stage is the process following and is dictated by the severity of the injury. The injury will heal by regeneration, which is essentially the replacement of the surrounding tissues by fibrous tissue, resulting in scarring or adhesions. This phase can 1ast from 2 days to 6 weeks. In this phase of healing, the doctor may recommend such things as alternating heat and ice to create a "flushing effect" in the blood supply and surrounding tissues. He may begin you on a stretching and/or strengthening exercise program, or recommend that you get a soft tissue massage for tightened muscles. Adjustments may be performed on, above, or below the site of injury. The goals of your adjustments are to relieve nerve irritation and pressure, relieve pain and spasm, restore the normal motion of your neck, and increase its strength and stability.
  • The body's response to stress constitutes the remodeling stage. This occurs when the residual scar tissue undergoes reorganization and reorientation along the lines of stress. This phase is significant to the patient. The importance of continuing with the prescribed exercises and continuing to use moist heat on tight and sore muscles will be stressed by the doctor.

TREATMENT

Treatment may be required for 3 weeks depending on patient compliance and complicating factors. It is very important to comply with all of the doctor's recommendations to insure proper healing and lessen the likelihood of recurrence. The resulting instability of the spine and soft tissues are noteworthy and depend on several FACTORS.

Treatment frequency is usually daily for 3-7 days and then three times a week for 3-6 weeks. After that, realignment of the vertebra must be performed to prevent eventual return of this condition. It can be accomplished in 30-60 days of reduced frequency management. Often once a week treatment is sufficient at that point to restore alignment. Thereafter, this condition can be reasonably avoided with monthly correction of spinal alignment.

After the first few days of treatment, you will be given a sheet of stretching exercises to do at home. This is to help reduce the treatment time and speed healing. It is very important for you to do these daily as prescribed. If you have any questions about them or difficulty or pain on performing them, please tell the doctor right away.

Several days following the initiation of treatment, more aggressive exercise routines will be proscribed for you. You will be taken to the rehabilitation center and instructed on how to use the computer monitored exercise routines specifically designed for this condition. The routines are monitored for completion and graduated in difficulty after certain numbers of routines have been completed. You will be expected to perform these routines after treatment during the initial part of the restorative phase and throughout the rehabilitative phase of your treatment. Our goal is to help you get well and stay well. We know from experience that most mechanical conditions return gradually over a period of months and become more advanced each time. The only way this can be prevented is with exercise. We expect you to be successful.

We offer treatment of these conditions at various levels for all patients. We expect that you will follow this treatment plan through to its logical conclusion of restoration of complete function and rehabilitation. Our management system is designed to help you remember all of your appointments and to be fully compliant with all of our recommendations. At any time, should you decide to discontinue the process, please just let us know so that we don't become a bother.

LIFE STYLE CHANGES:

Long periods of stress should be avoided. Do not sleep or lie on your stomach and avoid activities that hyper extend the neck. Water intake should be increased substantially.

HOME REMEDIES AND RECOMMENDATIONS:

Utilize ice packs on the neck back for 10 minutes at a time and moist heat packs on the muscles of the upper back at 20 minutes at a time, not simultaneously and not more often than once per hour. This should continue until the arm pain or numbness disappears. Hot tubs provide buoyancy and may be used after 5 days of onset for temporary relief. Exercises should be specific and in a particular order and performed only under direct supervision of the doctor during the first 3 weeks and then by proscription only. Improper exercise can prolong or arrest recovery. Expectations We understand that you have come here for help. We have spent many years learning the best ways to solve the problems of mechanical back and neck pain. We expect you to comply with our recommendations and follow our treatment schedule completely regardless of the treatment plan you have. We expect you to set all of the recommended appointments at times convenient for you and we expect you to keep all of them. We expect you to respond favorably and know that your 100% compliance is the determining factor. We also expect you to attend our next class on Absolute Spinal Health. The staff can give you a schedule of the next class. Other Information At our class on Absolute Spinal Health, we discuss mechanical conditions of the back, neck and spine and teach you ways to prevent mechanical conditions from occurring. We also offer a wide variety of health information at our web site. www.piclilnic.com All patients are welcome to use our information to improve your life and maintenance your spinal health.

NUTRITIONAL RECOMMENDATIONS:

During the first two weeks after injury it is critical to create an optimal healing environment for the various damaged nerves, ligaments, and muscles. They need adequate minerals, vitamins, water, and amino acids if they are to heal properly. A balanced diet with abstinence from dehydrating substances such as alcohol, caffeine, hot dogs and too much red meat can be beneficial. During the first day after trauma, the body is in its injury-shock phase. Nutritional changes are not advised for the first day because of the potential for disturbing the body's preprogrammed metabolic balance system. Megadoses of vitamins and minerals are not suggested. A well-balanced, digestible multivitamin supplement will suffice. Supplement Suggested Dosage Comments Vitamin C 1000-3000 mg/day Required for tissue growth and repair Vitamin B Complex 100 mg/day Important for stress Zinc 50 mg/day Important in tissue repair Calcium/Magnesium Complex 1000 mg/day Repair of skeletal tissue, and muscle contraction/relaxation.

OF SPECIAL NOTE: Cigarette Smoking Smoking during the first few weeks following an injury may interfere with the normal healing process. If you smoke during this time you may slow your recovery down or end up with pain that you would not have otherwise. This may result in your requiring more treatment and a worse outcome. Cigarette smoking, which results in oxygen deficiency to already injured tissues, also, it can deplete tile Vitamin C supply in your body and should be increased to 4000mg/day. Smoking is not recommended for 4-6 weeks after a traumatic injury. Maintenance: Regular spinal adjustments are important to reduce the symptoms of sprain. Patients who receive monthly spinal manipulation and therapy after symptoms from a sprain injury report fewer complications with sprain. It is important that you follow your physician's advice about the frequency of treatment for your particular condition.

Follow our wellness recomendations for absolute health.

References:

Chiropractic Health and Rehabilitation Group. P.C. Copyright @ 1996 Langlitz Krames Communications @ 1989, 1991. Randanov BP, et al. Long-term outcome after sprain injury: a two-year follow-up considering features of injury mechanism and somatic, radiologic and psychosocial factor. Medicine 74(5):281-297, 1995. Randanov BP, et al. The role of psychological stress in recovery from common sprain. Lancet 338: 712-715, 1991. Nordhoff, L.S. Motor Vehicle Collision Injured. Mechanism. Diagnosis and Management. @1996, Aspen Publishers, Inc. Melton MR. The complete guide to sprain. Body-Mind Publications @1998 Balch PA, Balch JF. @ 1997. Avery Publishing Group.

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