Slipping rib syndrome- Part 1 Basic explanation. Why and How.

This post explores our protocol in context to SRS and helps you understand the scope of our services.

In itself we do not offer a treatment or a cure for SRS, rather we provide guidance towards general wellness, which is targeted to improve strength and function of the rib cage, back and core, in combination with Nutritional and Lifestyle intervention.

We do this by integrating strength training/exercise, nutrition and lifestyle.

Our protocol is robust, unique and isn't a quick fix, rather a progressive, incremental progress targeted towards better health and general wellbeing. Our ultimate aim is not just to be pain free, rather it is to get past that- Become stronger, fitter, healthier and happier.

In this post we explain why and how of certain aspects of our SRS protocol.

Why Nutrition and How:

Looking at SRS blogs and the considerations raised by Udbhav, it was evident to us that digestive distress may be a symptom of SRS and Broken Costal Cartilage. Dietary intervention therefore felt evident to us. With a special focus on gut health. In our gut health blog post we discussed how important it is for us to have proper digestion and gut health.

How:

1. Improved gut health- Introduction of Probiotics, Intake of Prebiotics, Increased fibre consumption, gut friendly foods. GUT HEALTH BLOG

2. Supplementation- essential vitamins, minerals and amino acids for general well being. Targeted and timed. Vitamin D blog

3. Flavnoids introduction- Cacao/Dark chocolate, Green Tea, Berries, Garlic, Ginger, Herbs. improved mental wellbeing

4. Anti-Inflammatory foods: Turmeric+Pepper, Pineapple, Sulforaphane via cruciferous vegetables, Omega 3 optimisation and more. End result- Reduced inflammation, better recovery, reduced pain, improved general wellbeing.

Why lifestyle and how:

Looking at the blog post and the mental health struggles of Udbhav. It was of utmost importance for us to target lifestyle which cover mental health, sleep, posture, general wellbeing. Most patients after suffering from chronic issues often develop symptoms of anxiety, impatience, lack of motivation, fear and depression. Udbhav suffered from the same. Targeting this is therefore very important to us.

How:

1. Flavonoid drinks: Introduction of flavonoid drinks/ foods with flavonoids have been shown to increase dopamine levels (happiness hormone). - Improved motivation and encouragement to do daily tasks

2. Vedic meditation / pranayama: Pranayama and meditation has been shown to improve telomere length (a biomarker of ageing) and mental health.

3. Sleep excellence: Supplementation + change in sleep habits + sleep monitoring + biohacks. Improved sleep quality, better recovery from strengthening exercise, improved wellbeing. SLEEP BLOG

About Udbhav

Udbhav suffered for a near fatal training crash in 2015. He was discharged from the hospital after 12 days. However, he continued to suffer from chronic back/rib pain, difficulty in breathing.

Over time due to lack of targeted rehab/treatment Udbhav developed spinal asymmetry

The X-Ray on the Right shows spinal asymmetry (scoliosis under 10 degrees).

The condition caused extreme pain. He was unable to sit or do basic tasks, due to pain. Prior to the accident Udbhav, had been a top tier athlete, competing in National Championships (cycling), despite the symptom he managed to win a Bronze medal in 2016 in Individual Time Trial at National Championships, during the event he suffered from chronic unexplained breathing problem and back pain. Soon as the years progressed, the pain kept increasing and he was forced to quit sport.

The accident had also lead to desiccated disc/spinal wedging at T11-T12

The combination of wedging with, the muscle imbalance caused by a broken 10th rib cartilage lead to a minor degree of kyphosis.

RECOVERY:

Scoliosis, Kyphosis, Desiccated disc, Broken rib cartilage and breathing discomfort. Life was tough, and future didn't look too bright. Despite this Udbhav, I didn't give up. After giving up on physiotherapists, chiropractors, doctors. Udbhav along with the team at PerformEvo, worked from ground up. We worked on Nutrition, added key supplements to aid recovery from training and improve wellbeing. Biomechanics testing and understanding the biomechanics of the issues faced by Udbhav were key. Besides the back/rib pain, he also suffered from chronic knee pain and imbalance at ankles (collapsing feet arc), considering our body is a kinetic chain, these problems were understandable.

We started with basic exercises, focused towards neuroplasticity, minimal weight, focusing on muscle function, and gradually we progressed to more dynamic and exercise with weights.

However the journey to recovery wasn't as straight as it sounds, despite improvements in strength and function, the pain had no change; sitting was painful and performing daily tasks were tough.

We looked back, and found key areas we missed, for instance, exercise which involved hanging were incredibly tough and despite months of training Udbhav saw almost no improvement, rather an increase in symptoms of pain post exercise.

Serratus posterior Inferior

This for instance made us asses the strength of the muscles supporting the rib cage, we noticed that one side of the rib cage would always lift up more while performing Pull-ups, apparently the Serratus posterior inferior, which is responsible to keep the rib cage in place was dysfunctional on the side of the broken rib, the muscle attaches to the 9-12 ribs. We included protocol to strengthen it. Pull up form improved.

Iliocostalis thoracic

When it came to strengthening the spinal erectors, the major muscles of the back, Udbhav made little progress again, considering that he had been active all his life and had been a top tier athlete, this should not be the case. We realised that the Iliocostalis, one of the muscle of the spinal erectors was very weak on one side. Iliocostalis attaches to all the ribs, this made us focus on this muscle more as Udbhav had a broken rib cartilage and had pain in then rib cage.

Basic, yet functional rotational exercises worked like a charm, we saw improvements within a few days itself! Remarkable the human body is!

Internal and external intercostals, Serratus posterior superior, Scalene muscles

At this point, more than a year into rehab, Udbhav could do daily tasks with easy, sitting with support was possible. However the improvements had stalled, we had hit a plateau, or maybe we were missing something. After numerous conversations, daily pain journals made by Udbhav. We narrowed down on possible disfunction within the external intercostals.

Udbhav had difficulty in lifting the rib cage while breathing.

We had been including forceful exhalation exercises in our routine, however couldn't find a robust way to train forceful inhalation- i.e Serratus posterior Superior, External intercostals, Scalene muscles.

We went back to the drawing board, found an innovative way to train the process of inhalation. A combination of resistance bands and a mirror was enough. Post inclusion of resistance inhalation exercises, there was substantial improvement. We had broken the plateau.

Final steps in the protocol to being pain free and back to sport:

After fixing major muscle imbalances and addressing the issue of strength, and function in the muscles, regular activities became possible, Udbhav was back to living a normal life and was pain free. However, he wanted more, he wanted to compete in cycling at the highest level. Some degree of disfunction seemed to limit the amount of gains he was seeing in training.

After a series of biomechanics assessment, we found some key pointers 1. Excessive mobility on the left (Broken rib side) Internal Oblique and Quadratus Lumborum, and 2. tightness and limited muscle length on the right. This is to some extent intuitive from the point of view of the human body, in-order to achieve the same level of strength on the left side, after breakage of the costal cartilage, internal oblique on one side had to have increased length. What we did: Muscle release, Rotational exercise with targeted breathing, active stretching, avoiding bad/poor posture.

After following the protocol for a week we saw results, posture improved and the itty bitty of pain was also gone.

We are at the 6 week point now, and Udbhav is getting stronger each day, a step forward to get back to the highest level in the sport of Cycling. We will keep you all updated.

Even in the darkest of times, Hope never dies; So stay strong and don't give up.