Pain in Right Ribs - Torn Intercostal Muscle?

[Ash1974]

I have been playing with a pain in my right side for a few weeks now, hurt like hell on my last round, I recon that I may have pull an intercostal muscle in my ribs (like Paul Casey) so I think I am gonna have a few weeks off to rest it, this should coincide with my i15's truning up anyway so I am hoping it will be better by then.

I have not hit a ball this week on the range and it is hurting more than when I was just ignoring it and going to the range to practice, which doesn't make sense to me?

Any idea's or help for rehab from anyone who has had the same?

[MSchumacher]

Hi,

I played with the pain and caused it to get worse. I took 3 weeks off completely for the pain to go away. I still do have some pain (2months passed) but not during the swing. Only when I push out my chest and push on my right nipple area.

Ice helped a lot after playing or practicing at the range. Good luck!

[Ash1974]

Cheers, mine hurts when I press about 3 fingers below my right nipple, it i shurting when I sit down to quick and any sudden movements.

I am hoping that a few weeks totaly off will help.

[enduro]

I've had a similar issue. It was mainly due to playing so much, not stretching and just generally straining the region. I remember first injuring it and it didn't really hurt. Just sort of had a warm feeling in it after a killer day at the range. I practiced the next day and it was OK but started to get bad by the end and I knew I screwed up playing with it. Took a couple days off and it felt fine but when I went to the range I aggravated it and then played the next day in pain and knew I couldn't go on playing for awhile. Took a week and a half off only practicing my putting and chipping and took ibuprofen to keep the swelling down. I don't think I hurt it too bad since it was mainly fine after 1.5 weeks and I resumed play with almost no discomfort. Just take ibuprofen and stretch the region well.

I don't think it's an issue with you swing causing the issue. Just over use and lack of stretching. This type of injury is fairly common in golf and baseball where you torque and twist. You can come through with more force than you might think and carry it over into a big follow through which puts strains on that region. In fact, stress fractures to the ribs aren't uncommon either.

[Ash1974]

Cheers fella, I think your right, It hurts more when I go mad at the range a couple of times a week.

I always stretch before I play or practice, but i might do some more twist stretches

I don't think it is from my swing but just over doing it and how many balls I hit when practicing, I need to take my time more as well on the range as I can hit 100 balls in about 30 mins.

[Ash1974]

Well rested it for 3 weeks, played last weekend after a good easy warm up and it felt fine until I twinged it when I hit the ground full 7 iron swing on a par 3 (didn't pay attention teeing up on uneven tee box) but it wasn't that bad. then had a bad cough for 3 days and since then have been in real pain, almost feels like I have stress fractured a rib?

Anyway seeing a spots injury specialist tomorrow at Bupa so fingers crossed an X ray will show up something or he will be able to help

[Ash1974]

OK update for those who care.

It has been two nearly 3 weeks since I last played and no real improvement except for today when dosed up on Nurofen

I have seen a specialist and the MRI did not show anything which is good news as well as bad as still no diagnosis this is what is on my letter and I quote...

"No rib fracture or costochondral injury, no significant tear of the Serratus Anterior, normal appearance of the Thoracic wall muscles (intercostal etc) and subcutaneouse tissue with no evidence of imflamation"

I do have a T2 signal mass (fluid) around the 9th right costal cartilage but no evidence of costochondral sprain and he does not think this is an issue.

I asked what is causing the bloody pain then and he said not sure and that "he did not want to over diagnose me" so pain relief drugs and physio is next on the cards, I am still convinced I have an Intercostal Muscle strain and will see what the physio says when I see him.

My reason for thinking it is an Intercostal strain is and I quote...

"Intercostal Strain - These muscles can be strained by any activity that involves extreme or forceful twisting of the body or swinging of the arms. Sports that commonly cause this type of injury include golf and tennis"

Ah well no golf again this weekend and I still have not hit my i15's

[O.B. Right]

Man that really stinks. I hope you're in golfing shape again soon and please keep us updated. It totally sucks that you got injured but perhaps it can help others avoid injury.

[pittpanther]

I asked what is causing the bloody pain then and he said not sure and that "he did not want to over diagnose me" so pain relief drugs and physio is next on the cards, I am still convinced I have an Intercostal Muscle strain and will see what the physio says when I see him.

This really burns me up! When a pro athlete has a physical issue, they would never tell him "take some aspirin and go to physical therapy." There's too much money at stake, and physical therapy, even if effective, takes too long. Go that route, and you'll still be hurting 3-6 months from now. But because you're not a pro athlete, doctors assume you won't mind living with the pain for a few months, and hey, it might even just go away on it's own after a year...

What's my point? Demand to be treated like a pro athlete! Don't take "I don't know" for an answer. Demand a cause and solution. The downside is, of course, that the likely next step will be "exploratory surgery"...

[Supermanwoot]

Does it hurt when you take a deep breath? Cough? Sneeze? Even when relaxing all other muscles in the area?

If so there was obviously trauma to the ribs or intercostal muscles/tendons. Diagnosing a hairline fracture in the ribs is pretty tough. I'm not sure on the sensitivity of an MRI but I know Chest X-Rays often don't pick them up.

Here is what you can do. Take some naproxen, max of four 220mg tablets a day in separated doses spaced 10-12 hrs. Thats an anti-inflammatory and wouldnt hurt. Also if it is an intercostal muscle tear, here is what you can absolutely do to largely relieve your pain. Get some cloth tape (first aid section at a pharmacy) and run the tape along this rib, starting at the breast bone (sternum) and continuing to the spine (you can run more than one "line" of tape). Give it a shot as it will restrict your ribcage from expanding only on that one side and give it a better chance to heal. One thing to watch out for is if your breathing becomes very difficult, you need to remove the tape because it may be limiting your lung expansion. Also if you are developing a cough, could be fluid build up in the static lung, in which you would be wise to attempt to cough it up or remove the tape and give it a good cough although it may hurt then. Also it may hurt to remove the tape so get gentle tape if possible and run a few lines of it.

Let me know how this works! Also those things to watch for are gonna be very very rare especially with a clean MRI, but just something to look out for!

[Ash1974]

Cheers all, the pain the last two days has been pretty good with regular doses of 200mg Ibuprofen (2x tab 3 times a day)
It has been 3 weeks tomorrow since I last played so hoping it is an Intercostal sprain/strain that hurt extra bad due to the fact I played after only resting it for 2 weeks and had a very bad cough for two days after playing, which meant it hurt like hell.

It only hurts when I have a full breath in depending on what position I am in, mostly sitting and lying down but even then the pain is not that bad any more. I can once again move round in bed with little to no pain.

I would still have expected them to see any strain on the MRI but as said it could be stress fracture to the rib which will not show up on an MRI and only on a deep bone scan or CT, which the doc said he was happy to do in 3 months after some Physio and if it was not any better.

To be honest I am hoping that the Physio and some rest for a few more weeks (although it is killing me not playing) will do the job, I am half tempted to say to the Physio "as the doc aint got a clue I want you to treat me for an Intercostal strain/cartilage strain" as from what I have read recovery and strengthening for these injuries is the same.

As for any major lung issues etc, I had a full chest X ray 1 year ago this month (October) to cover off anything like Lung Cancer etc and that X Ray was clear with the lungs looking in good shape. Plus the initial strain in the area which went around to centre of the chest was after hitting the ground on a shot and the pain has come and gone when doing this or over swinging/practicing and never form any other activity, again hence me thinking it is a Intercostal Strain due to golf.

I am gonna book in with my GP Doc and ask for another X ray of the chest area and maybe and ultrasound just to cover off anything with the lungs or liver again.

[Ash1974]

Does it hurt when you take a deep breath? Cough? Sneeze? Even when relaxing all other muscles in the area?

Yeah it hurt like hell at first, more when coughing and breathing, moving when lying down etc which is why I was going for rib/intercostal/costochondral etc

Also the area of the pain was below my right nipple and towards the armpit and the most tender will full lungs of air, when the rib cage was at full stretch. This pain has eased the more I rest which also points to a muscle strain of some sort, if it were Plurasy/Cancer etc I would expect the pain to be getting worse or staying the same after rest.

[golfdad]

ash, good luck with your recovery. from your description, concur that most likely it is of muscoloskeletal etioglogy. (a side note: i see that you are from uk. currently in the usa we have that health care reform debate and once in a while, uk's service level came up with some arguing that uk's service level is inferior to that of the usa. from what you have described, that you in fact got a mri already, with bone scan or ct to come if indicated, i am quite impressed but i digress...)

one modality used in physio is called ultrasound. in this case it is used therapeutically instead of diagnostically, as you have mentioned in your post to further check out other parts near the pain site. if the pain does not subside with rest and antiinflammatory pills, the physio ultrasound may be of help. the wavelength penerates couple cms into the tissue and increase perfusion and repair near the muscle/bone junction. of course, whether this is indicated or not, it is up to your doc/physio.

fyi,,to diagnose a stress fracture with bone scan, it must be done immediately, not 3 months later, because the scan catches only the active rebuilding process. incidentally, bone scan is good at picking up malignancy or infection in the musculoskeletal system.

[squaddie]

It sounds like the ribs are recovering better, if you aren't feeling any pain when walking around. Four weeks ago I injured a rib or muscle on my right side under my shoulder, though doesn't sound like the injury was as bad as yours. I tried swinging after a week or two but the pain persisted, but now I've finally recovered.

I would take rest this weekend and perhaps take some practice swings sometimes next week, maybe just half swings in the air hitting nothing. If you feel pain while doing that then you aren't ready to swing. If no pain then swing for about 10 to 15 minutes, pausing 30 seconds between each one.

If you feel pain besides muscle soreness the next morning after practice swinging then you are still not ready, but you are getting close, perhaps by next weekend.

If no pain at all then you are probably ready to hit the course again.

[Ash1974]

ash, good luck with your recovery. from your description, concur that most likely it is of muscoloskeletal etioglogy. (a side note: i see that you are from uk. currently in the usa we have that health care reform debate and once in a while, uk's service level came up with some arguing that uk's service level is inferior to that of the usa. from what you have described, that you in fact got a mri already, with bone scan or ct to come if indicated, i am quite impressed but i digress...)

LOL UK NHS it is not that good, I have private health care paid for by work which is not done on the NHS, it is done by BUPA hence the quick turn around.

As for the bone scan I will be getting them to do that sooner if I still have issues, cheers for the info though fella

[Ash1974]

It sounds like the ribs are recovering better, if you aren't feeling any pain when walking around. Four weeks ago I injured a rib or muscle on my right side under my shoulder, though doesn't sound like the injury was as bad as yours. I tried swinging after a week or two but the pain persisted, but now I've finally recovered. I would take rest this weekend and perhaps take some practice swings sometimes next week, maybe just half swings in the air hitting nothing. If you feel pain while doing that then you aren't ready to swing. If no pain then swing for about 10 to 15 minutes, pausing 30 seconds between each one. If you feel pain besides muscle soreness the next morning after practice swinging then you are still not ready, but you are getting close, perhaps by next weekend.

Great minds think alike fella

I went to my club yesterday and did some chipping and putting around the practice green (mostly putting) whilst there I resisted the urge to go hit some balls on the range as my pain has mostly gone now, the change in pain since 4 days ago is massive so what ever is broke is healing well at the moment, but I am taking Ibuprofen regularly. I did have a few swings of my PW through the grass though with no ball and it did not hurt at all, no real pain this morning either, so next weekend (4 weeks of no playing at all) I think I will have a good few swings with an iron and 3 wood in the garden (again no ball striking) and if no pain the next day I will play the next weekend (that will be five weeks) hopefully with no issues. Will keep you all posted.

[Bubba_13]

Have you tried any ART (active release therapy)? I am having it done on my shoulder to try and relieve a repetitive strain injury. I have gone for 4 treatments so far and it is starting to ease the pain and give me more range of motion. You can get it done at either a Chiro. or a good Sports therapist.
It is essentially a really deep tissue massage that works at stripping out the scar tissue build up.

You can read more about it here www.activerelease.ca

[Ash1974]

Have you tried any ART (active release therapy)? I am having it done on my shoulder to try and relieve a repetitive strain injury. I have gone for 4 treatments so far and it is starting to ease the pain and give me more range of motion. You can get it done at either a Chiro. or a good Sports therapist.

Cheers will have a look at that