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Rib Pain…in Pregnancy…

Muscle and joints are a relatively common cause of chest pain¹. Costochondritis a condition that is characterised by point tenderness over the rib and sternum join that reproduces the pain complained of combined with the same side arm movement reproducing that pain too, usually the point is at the 2nd to 5th ribs and sternum join². Not to be confused with Tietzes Syndrome which includes swelling and more likely in older persons and does not get aggravated by same side arm movement. Medical training tells one that costochondritis is a self limiting problem that will go away on its own with advice to take pain killers and do nothing, even if you are pregnant.

The arm movement and a recreation of pain can be indicative of nerve involvement that is unable to slide due to unco-ordination of intercostal musculature. Notably Obliques and Transversus Muscles, but Latissimus and Serratus Anterior can also play a part in faulty rib movement patterns. Yes underlying myofascial imbalance can give rise to costochondritis and can be brought on by the development of the bump in pregnancy. accentuating previously asymptomatic myofascial imbalance.

Treatment of costochondritis has been successful with manual therapy³. The over riding concern of continuing on with muscular imbalance is that our brain will adopt your myofascial imbalance as normal. If you don’t use it you lose it; you lose the body component you do not use from the map of the body in the brain. This map is competitive and neuroplastic meaning it is adaptable and does not have any ideal or starting reference. There is no factory reset or blueprint of ideal / perfect movement of your intercostal, latissimus or serratus muscles. Your normal is what it is.

Having a myofascial imbalance that leads on to chostochondritis during pregnancy can have knock on effects during delivery. Intercostal muscle function has been shown to be predictive of delivery experience and likely complications from the expulsion phase of birth (4).

In my opinion the best interests of any women who is pregnant with costochondritis would be to resolve the issue with manual care as soon as possible. Don’t worry your bump need not get in the way.

References:

  1. Smythe H and Fam. A (1985) Musculoskeletal Chest Wall Pain. Canadian Medical Association Journal 133(5) 379-89
  2. Proulx A and Zyrd T (2009) Costochondritis: Diagnosis and Treatment American Family Physician 80 (6) 617- 620
  3. Rabey I (2008) Costochondritis: Are the Symptoms and Signs Likely Due to Neurogenic inflammation. Two Cases that Respond to Manual Therapy Directed Toward Posterior Spinal Structures. Manual Therapy 13(1) 82
  4. Demaria, F., Porcher, R., Ismael, S. S., Amarenco, G., Fritel, X., Madelenat, P. and Benifla, J.-L. (2004), Using intercostal muscle EMG to quantify maternal expulsive efforts during vaginal delivery: A pilot study. Neurourol. Urodyn., 23: 675–678

Is a Stiff Spine really Stiff?

A recent Scientific Report published by Nature looked into perceived stiffness of the spine and actual stiffness of the spine and found that when people feel as though their back is stiff it is a lack of sensory motor integration and not directly due to stiffness in the back. The prediction system of the brain uses multi sensory information to predict the movement parameters of our body. When multiple sensory inputs are not integrating then the parameters can be confining felt as a stiffness in the back. The ability to co-ordinate the sensory information of the body in the brain can result in a stiffness perception that is independent of actual stiffness.

The integration of multiple sensory signals, is what can be confused or muddled that result in back stiffness problems. When integration occurs it means that Sensation A and Sensation B are needed simultaneously to understand the body in the brain map of the body. When Sensation A occurs out of sync with Sensation B then the back can feel stiff but not actually be stiffer.

I like this paper because it may help people to step out beyond the ageing model of back problems, the lingering injury / degeneration models and the useless ‘out of place’ and ‘symmetrical’ models.

When the sensory motor experience of our body goes out of kilter we can become better at feeling changes in force generated by muscles having the knock on effect of heightening protection mechanisms because we are not expecting that much effort to move in a comparatively small way.

Regular (Annual or biannual) checks of your back by a Chiropractor is important whether you are in a sense of stiffness, or not. A Chiropractor can help to re-integrate the sensory motor experience of your body.

Nature Scientific Report 7: 9681 (August 2017)