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Rib Pain…in Pregnancy…

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Lee Wickham DC FRCC

Lee Wickham DC FRCC

I'm a non spine-centric, non tissue-centric Chiropractor who is a 'Training Effect' and 'Neuroplasticity' advocate, who believes, degeneration is not inevitable and a wide variety of movement is healthy.

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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
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