Chronic Thoracic Pain After a Fall

Just discharged a patient with a one year history of thoracic pain after falling on his mid back. He failed PT and was told by workman's comp doctors that he couldn't be helped. We discharged him pain-free, what did they miss?

The thoracic spine is particularly big in the ligament department. This means that ligaments hold much of it together like duct tape. There are ligaments that hold the back of the spinal bones together (supra-spinous and inter-spinous ligaments) and ligaments that hold the ribs to the spine (costo-transverse and costo-vertebral joints). In addition, there are many muscles that attach to the ribs and help guide or anchor movement like guy wires on a sail boat mast. So in a patient with chronic thoracic pain due to a fall or car crash (in many cars there is a seat stiffener in the seat that can damage upper back ligaments in a rear-ender), you think of ligaments first.

This gentleman had a ligament injury that we treated with prolotherapy. This involves injecting some substances into the ligaments to help kick off a natural healing cycle. His problem was that he got "one bite" at the apple, meaning his body had one cycle to heal his ligament injury after his fall and it was too big to heal. The prolotherapy allowed him to get a few more healing cycles in and heal the area. While this sounds simple, regrettably our medical system rarely identifies or treats sub-failure (not completely torn) ligaments. This is regrettable, as hundreds of millions are wasted annually by the medical care system as it spins it's wheels trying to help patients who aren't getting diagnosed correctly with ligament issues (especially in the spine).

This gentleman was also helped with IMS, a technique that involves getting rid of muscle knots with an acupuncture needle. Again, another easy technique which can help allow more normal motion. In the ribs this can help because there is a big muscle around where the rib connects to the spine. When this locks up, so does normal rib motion. This then causes a myriad of other problems from perceptions of shortness of breath to lack of upper back movement).

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