Rib Pain or Intercostal Neuritis – A NYC Chiropractor/Applied Kinesiologist/NKT Practitioner Explains

Every few times during the year, I get a patient with a displaced rib head. (I’ve had one or two myself)  The sensation is an intense stabbing pain that “takes your breath away” in either the back or the front of the chest; sometimes the pain goes round the rib and sometimes seems to go from the back to the front like a knife.

When a patient comes in, we evaluate them via examination and a detailed history to rule out things like shingles or referred pain for heart, lung and gastrointestinal problems. A lot of the times, the patient has already been evaluated by their M.D. for these conditions with negative results.

But it’s usually a rib head displactment either at the anterior attachment at the sterum [breastbone] or at the posterior attachment at the transverse process of a thoracic vertebrae. The intercostal nerve runs from the anterior rami of the thoracic spinal nerves from T1 to T11 and runs [along with the artery and vein] between the intercostal muscles to the breastbone.

intercostal-nerve

intercostal-muscle

Of course it’s not surprising that a rib displacement “takes yr breath away” as the ribs (& the clavicle) and a lot of the muscles attached to them are involved in inspiration and expiration. Some of these muscles are the diaphragm, the external & internal intercostals, the serratus anticus, pectoralia minor, scalene & SCM muscles.

breathing-muscles

Muscles attached to the ribs or thoracic spine which may not be directly involved in breathing but may be compensating for a problem with the breathing muscles. Some of these muscles are the rectus abdominis, the abdominal oblique muscles, the psoas, the quadratus lumborum, the rhomboids and latissimus dorsi; they may be on the same or contralateral side to the displaced rib.

Before I adjust any displacement of the ribs involved or the breastbone or the clavicle as a doctor of chiropractic; I need to balance the muscle pull on the affected area.

I use the muscle testing used in both Applied Kinesiology and NeuroKinetic therapy.

As a Applied Kinesiologist, I test for the function of individual muscles. The questions to be asked are: why is the muscle weak? Is the muscle on the other side hypertonic or “too stronger.” Is the weakness due to a spinal/nerve problem, a vascular problem, a problem with lymphatic function, a nutritional default, a problem with organ function or an acupoint associated w/ that muscle?

The Use of Applied Kinesiology in a Chiropractic Examination

As a NKT practitioner, I ask “Is there a dysfunction in the coordination of muscles working in patterns?” NeuroKinetic Therapy works with that concept that movement is performed in systems or patterns. NKT identifies muscle imbalances by using muscle testing to determine what muscles are inhibited and what muscles are compensating (facilitating) for them.

How a Combination of Applied Kinesiology, NeuroKinetic Therapy and Chiropractic Works

Once the above muscle related questions are answered, I can adjust the involved rib, clavicle or spinal segment.

Stretches are given to the previously facilitated (or hypertonic) muscles and exercises given to the previously inhibited (or weak/hypotonic) muscles in order to break the pattern that caused the problem.

For a blog on the effects of the breathing muscles on asthma, please check out: The Musculoskeletal Aspects of Asthma

© 2016-Dr. Vittoria Repetto

Want more information on Dr. Vittoria Repetto and her NYC Applied Kinesiology/Chiropractic/ NKT practice at 230 W 13th St., NYC 10011; please go to www.drvittoriarepetto.com

And please check out the Patient Testimonials page on my web site.

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Tingling/Numbness/Weakness in Hand/Arm But Not Carpal Tunnel or Yr Neck; A NYC Chiropractor/Applied Kinesiologist/NeuroKinetic Therapist Explains

Do you have tingling or numbness in your hand that goes beyond your first three fingers?  Do you have weakness in your forearm, arm or shoulder despite your weight training routine?

It’s not carpal tunnel since it involves more than the fist three fingers. And you have no history of neck problems, all orthopedic tests and X-rays/MRI of the neck are negative.

You might have an entrapment syndrome of the brachial plexus nerves or subclavian artery/vein to the before mentioned structures.

This entrapment syndrome called Thoracic Outlet Syndrome is caused by three major conditions; Anterior Scalene Syndrome, Costoclavicular Syndrome and Pectoralis Minor Syndrome as well as some minor causes.

TOS

In the first condition called Anterior Scalene Syndrome, the brachial plexus nerves arising from C5, C6, C7, C8 & T1 nerve roots is trapped between the anterior and middle scalene muscles which may be in spasm or compensating for inhibited neck muscles.

This can be assessed by palpating for a decrease in strength of the radial pulse at the wrist. The patient is asked to ipsilaterally rotate, contralaterally laterally flex, and extend his neck at the spinal joints, while the radial pulse is palpated; this called Adson’s Test. Decrease in strength of the radial pulse is positive for the syndrome.

Treatment consists of using spindle work on the bellies of the scalene muscles or golgi tendons of the scalene attachments and of balancing the other neck muscles which can be either inhibited or compensating.

In the second condition Costoclavicular Syndrome, the brachial plexus and subclavian artery and vein run between the first rib and clavicle in the medial pectoral region. If the posture of the relationship of the clavicle and first rib changes and they approximate each other as often happens with rounded and slumped shoulders and impingement may occur.

This can be assessed by palpating for a decrease in strength of the radial pulse at the wrist when the patient is asked to stick his chest out and pull the shoulder girdle back and down similar to the military posture of attention. Again, weakening of the strength of the radial pulse would be considered to be a positive sign. This is called Eden’s test.

Treatment consists of checking muscles such as the SCM and the subclavius that attach to the area, improving the patient’s posture and checking muscles that resist this bad postural pattern such as the rhomboids and the middle trapezius.

In the third condition Pectoralis Minor Syndrome, a tight pectoralis minor muscle compresses the brachial plexus and/or subclavian vessels against the rib cage. The assessment is to bring the patient’s arm up and back. This position called Wright’s Test stretches and pulls the pectoralis minor taut against the rib cage

Treatment consists of checking for either an inhibited or facilitated pectoralis minor, or other muscles that can be inhibiting or compensating such as the serratus anterior, latissimus dorsi or the lower trapezius.

Other minor conditions such as  when both the medial and ulnar nerve getting entrapped by a spastic muscle such as the pronator or by a misalignment of the radius and ulna bone can happen and need to be ruled out.

forearm muscles

For additional information, please check out:  https://drvittoriarepetto.wordpress.com/2015/09/20/a-nyc-chiropractorapplied-kinesiologist-starts-adding-neuro-kinetic-therapy-to-the-mix/

https://drvittoriarepetto.wordpress.com/2010/06/21/muscle-balancing-in-applied-kinesiology/

https://drvittoriarepetto.wordpress.com/2012/05/23/how-a-nyc-chiropractorapplied-kinesiologist-treats-carpal-tunnel-syndrome/

 

© 2015-Dr. Vittoria Repetto

© Revised 2016 – Dr Vittoria Repetto

Want more information on Dr. Vittoria Repetto and her NYC Applied Kinesiology/Chiropractic/ NKT practice at 230 W 13th St., NYC 10011; please go to www.drvittoriarepetto.com

And please check out the Patient Testimonials page on my web site.

 Want to be in the know on holistic information and postings? 

https://www.facebook.com/wvillagechiropracticappliedkinesiologynkt/

Or join me at Twitter: www.twitter.com/DrVRepetto

The Musculoskeletal Aspects of Asthma

Like most of you, I’ve been watching the Olympics and as I watched, I remembered a previous Summer Olympics and watching the start of the Women’s Marathon. I noticed something in the body language of one of the front runners and said to my friends, “That runner has asthma; look at her neck.”  My friends chuckled and then the announcer talking about the runner I pointed out said that she suffered from asthma.

“How did you know?’ asked my surprised friends. Her SCM (sternocleidomastoid) muscle http://en.wikipedia.org/wiki/Sternocleidomastoid_muscle was very pronounced. Instead of using her primary muscles of inspiration, her diaphragm, the external intercostals and the sternocostalis; she was using an accessory one.  http://skeletalmuscularsystem.suite101.com/article.cfm/muscles_of_inspiration It was causing her rib cage to be higher in position on her torso and more barrel shaped: a classic visual for asthma patients

In  my Applied Kinesiology practice, I see a number of patients with breathing problems. To a person they all have problems using their diaphragm muscle properly, they use small muscles higher up in the chest and shoulders creating  a “barrel-shaped” chest. And many have problems w/ their intercostal muscles and the up of down movement of the ribs; their rib joints don’t move properly therefore not allowing the movement of the chest.

Tightness and/or weakness is also found in the Pectoralis major & minor, SCM, the Anterior & Middle Scalenes and the Serratus anterior as well as other accessory muscles, they tested to find out if they are inhibited or compensating. The Psoas muscle is also tested as the upper end of the muscle blends into the diaphragm.

breathing muscles

With applied kinesiology, I can use golgi tendon and muscle spindle reflexes to re-set the muscles and use neuro-lymphatic & neuro-vascular points to flush toxics out of the muscles. I restest the inhibited/weak muscles to get a neural lock in the brain’s muscle center.

I use neuro-lymphatic & neuro- vascular pts to help lymph and blood flow to the diaphragm and also give the patient breathing exercises to strengthen the diaphragm.

I also stimulate acu-points for the lung meridian and it’s brother/sister pair- the large intestine meridian which may indicate that the patient needs probiotics.

The cervical & thoracic spine are checked for subluxations/somatic dysfunction as the nerves from these areas  innervate the before mentioned muscles and the lung and are adjusted as needed.  The articulations of the rib joints to both the vertebrae and the sternum are also important to check.

Once the above is done, the patient is given breathing exercises to do daily in order to strengthen the formerly weak muscles

Working on all these aspects causes the bio-mechanics of the chest to work better and breathing is freed up.

Of course causes of both bronchial and lung and general inflammation need to be found and worked on via nutrition and lifestyle changes; but that is another blog.

Self-taught Breathing Retraining Helps Asthma Patients

©  2010-Dr. Vittoria Repetto

©  Revised 2015/2017 -Dr. Vittoria Repetto

Want more information on Dr. Vittoria Repetto and her NYC Applied Kinesiology/Chiropractic practice at 230 W. 13th St., NYC 10011; please go to www.drvittoriarepetto.com

And please check out the Patient Testimonials at my web site.

 Want to be in the know on holistic information and postings? Follow me at https://www.facebook.com/wvillagechiropracticappliedkinesiologynkt/

Or join me at Twitter: www.twitter.com/DrVRepetto