Bruised Ribs

Mechanism of Injury

An injury typically occurs with a direct blow to the ribs or the cartilage. Broken ribs commonly occur as a fracture of the bony prominence in the middle of the rib, which is normally in the midaxillary line (the area directly below the armpit). Costochondral separation describes an injury that divides the ribs from the cartilage and can occur from landing hard on the feet or even a forceful sneeze or cough. Bruised ribs indicate an injury to the bones, intercostal muscles, or cartilage.

Symptoms

An athlete develops pain directly over the rib or in the area in between the ribs. Pain can also occur with a deep inspiration, hard cough, or sharp movement. In addition, sudden shortness of breath could indicate a rib fracture that could have punctured a lung.

Diagnosis

The sports medicine physician can perform a physical exam, including auscultation (listening to the lungs), percussion (tapping on the lungs), palpation (touching the ribs), and examination of the entire length of the ribs. Ecchymosis (bruising) near the site of injury can provide a clue in the diagnosis. A chest X-ray may be ordered to confirm the diagnosis or to evaluate more complex cases.

Treatment

Treatment of bruised ribs depends on the type of injury. First and foremost, patients should rest. Ice, nature's anti-inflammatory, should be applied intermittently for 20 minutes at a time throughout the day. Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen sodium, may help over the first 10 days of the injury. A sports medicine physician may recommend a rib belt for compression to decrease the symptoms. The rib belt's compression decreases the movement of the injured rib, allowing the intercostal musculature to heal.

Additional therapy may include osteopathic manipulative therapy (OMT), especially if an athlete presents with a locked-down or locked-up rib. Ribs become “locked” when there is a spasm of the surrounding rib intercostal muscles, thus preventing the rib from moving up during inspiration. A sports medicine physician may perform various osteopathic manipulative techniques, such as the high-velocity, low-amplitude technique, underneath the rib that is locked down to break the spasm. A myofascial release (the area between the muscle and the bone) is then performed passively with direct palpation in between the rib muscles to decrease the local rib spasm. The patient would then continue applying ice and taking anti-inflammatory medicine as previously stated.

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