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SLIPPLING RIB SYNDROME

Slipping Rib Syndrome (SRS) is a rare but often overlooked condition that occurs when one or more of the ribs in the lower rib cage slips out of place, causing discomfort and pain. This can be due to various factors such as weak muscles, previous injuries, or repetitive strain on the rib cage. If you're experiencing SRS, we're here to help! Our website offers strength training options, nutritional guidance, and lifestyle support to alleviate pain and improve overall well-being. Together, we'll work towards a healthier, more comfortable you.

Slipping Rib Syndrome

Background

In 2015, Udbhav, the co-founder of PerformEVO, experienced a near-fatal accident while training on his bike. Despite a full recovery, he endured chronic back and thoracic rib cage pain, resulting from muscle spasms, imbalances, and weakness. A broken 10th rib cartilage on his left side had been been one of the key causes of the pain.

Multiple doctor visits and extensive medical imaging failed to identify the cause of his chronic pain, which led to significant mental distress and difficulty in daily tasks. In 2021, the cartilage breakage was finally detected, and our team diligently worked to address Udbhav's challenges. He journeyed across Europe, visiting specialist rehabilitation centers, and after nearly a year and a half of dedicated effort, Udbhav returned to his sport, performing at the highest level without letting the injury hold him back.

Understanding the immense pain, helplessness, and mental distress experienced by individuals with SRS, Udbhav decided to launch an initiative within PerformEVO. Our goal is to provide targeted strength training to address muscle imbalances, weakness, and functional loss due to inactivity, as well as nutritional support and lifestyle guidance to improve the quality of life for those suffering from SRS. We are committed to offering hope and empowering individuals to overcome their challenges, just as Udbhav did, and lead happier, pain-free lives.

The basics of our protocol 

Strength & function

We cover the following aspects:

  • Biomechanics assessment 

  • Physical assessment

  • Understanding symptoms & detailed conversation

  • Evaluation and benchmarking

  • Breathing exercises & function  

  • Creation of customised training plan

Nutritional support

We focus on the following aspects:

  • ​Gut health 

  • Macro/micro optimisation 

Other points are common to performance plans and SRS recovery ​

  • Identification of BMR 

  • Inclusion of Plant flavonoids, anti-inflammatory & senolytic  compounds.

  • Autophagy activation (via fasting)

  • Routine development-time restricted eating

  • Blood profiling -> targeted nutrition

  • Hydration Perfection

Lifestyle assistance

We focus on the following aspects:

  • ​Sleep perfection

  • Optimising dopamine levels 

  • Integrating meditation and Yoga

  • Positive Mindset and parasympathetic activation 

  • Posture perfection 

  • Routine development

Our unique STRENGTHENING protocol 

intercostal strength

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Strengthening the Intercostals 

One of the probable causes of SRS is weak muscles, especially the intercostals, which have a key role in respiration & rib cage function. Their role is especially crucial for the false ribs which have lesser support as they are connected to the sternum only via the cartilage.  

Our protocol in context of intercostals 

1. Building neuroplasticity, control and function of the rib cage through basic breathing exercises 

2. Developing strength in the External intercostals by resisting rib cage expansion- without band, slowly with resistance bands, followed by unilateral exersises

3. Developing strength in the internal intercostals and serratus posterior inferior through forceful exhalation, yogic breathing, balloon breathing. 

4. Rotation exercises to actively engage the muscles in dynamic movements 

Serratus Posterior Inferior Strength

Building function- Serratus posterior  

Serratus posterior aids in respiration, supports the lower ribs and the thoracic vertebrae. In context to people suffering from SRS ensuring proper function of the Serratus posterior inferior is quite important. 

Our protocol in context of serratus posterior inferior & superior  

1. Building neuroplasticity, control and function of the serratus posterior through breathing exercises 

2. Forceful exhalations to build strength and function in the serratus posterior, banded inhalations to train the serratus posterior superior 

3. Releasing the muscles, to tackle unilateral tightness 

This image was made out of, or made from, content published in a BodyParts3D/Anatomography web site. 

The author and licenser of the contents is

"BodyParts3D, © The Database Center for Life Science licensed under CC Attribution-Share Alike 2.1 Japan."

Erector Spinae Strengthening

Strengthening - Erector spinae 

Erector spinae consists of Iliocostalis, Longissimus and Spinalis. We place a key role on the Iliocostalis, as it attaches to every rib. Strength and proper function of the Iliocostalis is essential to be pain free. 

Our protocol in context of erector spinae group 

1. Regular mobilisation and basic exercises to build neuroplasticity and function 

2. Isometric exercises, followed by basic movements- gradual progress to dynamic exercises, rotational exercises to strengthen the iliocostalis with a focus on breathing. 

3. Training the Gluteus Maximus & Minimus, to ensure proper loading of the spine.

Obliques strength

Building function & strength- Obliques

Obliques are a group of two muscles internal oblique and external oblique. These muscles originate from the ribs, and pay a key role in core stability and trunk rotation. We place a key role on oblique strengths as broken rib cartilage leads to atrophy and loss of function of the obliques. 

Our protocol in context of obliques- internal & external

1. Isometric strengthening to build basic function, gradual progress to isometric rotation holds, followed by exercises with movement and tougher dynamic exercises  

2. Releasing tightness, unilateral srs would naturally lead to a slight tightness of the obliques of the unaffected side, release and stretching of these muscles is ensured in our protocol 

Quadratus lumborum

Building function & strength & length -Quadratus Lumborum (QL)

The quadratus Lumborum attaches to 

the lower ribs and plays a key role in 

maintaining proper alignment of the rib 

cage in context to the pelvis 

Our protocol in context of Quadratus Lumborum:  

1. Isometric strengthening to build basic function, gradual progress to isometric rotation holds, followed by movement - active lengthening of the QL, followed by lengthening with rotation under stress. 

2. Releasing tightness, unilateral srs could usually lead to a slight tightness of the QL of the unaffected side, release and stretching of these muscles is ensured in our protocol 

Lats strengthening

Dynamic strength- Latissimus Doris and more

Latissimus Dorsi, the widest muscle of the body attaches to the lower three or four ribs. Ensuring strength in the Latissimus Dorsi is essential especially in context to SRS patients, who are unable to engage the muscle due to lack of stability on the rib cage. Making it extremely painful to do exercises like the pull up. 

Our protocol in context of erector spinae group 

1. Performed at a later stage, building basic function along with the ability to engage the muscles of the rib cage and serratus posterior along with latissimus. 

2. Strengthening, isometric slowly progressed to dynamic exercises like the pull-up, with proper strength in the intercostals, erector spinae, obliques (core) these dynamic exercise will become painless. 

3. Progress to complex dynamic exercises. (FINAL STEP)

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The protocol/key points mentioned above is a part of a complex strengthening plan, therapists usually don't focus on these muscles in context the the problem of SRS therefore we have highlighted the same.

Besides the strengthening Nutrition and healthy developments in lifestyle will allow for a painfree, restriction free life. Full of health and happiness 

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