Case Study – Mid-back pain and the rib cage

This case study revolves around a client who came with complaints about pain around the upper back (the area surrounding the thoracic spine) to consult with our physiotherapist. The client has had a variety of treatments in the past focusing on the upper back area, but had little or no improvement. Noting that the client has not had much success in the past, we explored the possibility of a mal-aligned rib cage. A rib-cage that is mal-aligned does not rise or fall equally on both side on inhalation or exhalation. One side of the rib-cage may not fall as deeply or rise as high when compared to the other side. Usually this is caused by one or more ribs being stuck, affecting the mobility of the adjacent ribs. The ribs meet your spine at a rather complex joint with several planes of movement. When your rib-cage is not moving smoothly on breathing, it interferes with the smooth workings of the spinal column to which your ribs are attached at the upper back area. Pain is then felt around the area surrounding that joint. To determine a mal-aligned rib-cage, our physiotherapist will get you to lie down and feel your ribs fall and rise as you breath. Once the specific rib is identified, the physiotherapist will treat that particular rib as well as each rib below to return them into their ideal position. Case Study Concepts is an educational series to highlight the complex combination of your body’s musculoskeletal system and how they a seemingly un-connected part can affect another. This case study is not to replace professional advice from your doctor or physiotherapist.

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