To breathe or not to breathe…

Tuesday, September 15, 2009

Trying to interpret an NFL injury report is akin to reading hieroglyphics. The words have to be placed in context to understand their meaning. For the Philadelphia Eagles’ Donovan McNabb, the cracked rib will yield the same outcome regardless of what word is used to describe it. Cracked, broken and fractured all mean the same thing and yet, the fact that the rib is broken doesn’t really matter. The big deal is that the chest has been damaged.

We breathe like a bellows. Air is sucked into the lungs because the muscles of the chest wall swing the ribs up and out while the diaphragm, the muscle that separates the chest from the abdomen, pulls down. If the chest wall is damaged, either by breaking a rib or bruising a muscle, each breath can cause an incredibly sharp pain. The body reacts by causing the muscles in the area to go into spasm, making it even harder to breathe in. No matter how tough an athlete, the pain makes it difficult to function.

Chest wall injuries are common events football and also in the home. There are plenty of accidental ways to damage the chest. People trip and fall, striking their chests against table and counters and other odd and sundry edges and corners found in the home. They trip and jam rakes and snow shovel handles into their ribs. They fall off bikes and ladders. No matter what the mechanism, ribs can break and bruise.

Regardless of the mechanism, the doctor will not necessarily focus on the potential of a broken rib. Instead, the worry is all about the lung and where it is bruised or collapsed. The chest x-ray will help answer that question but may not find any broken ribs and doesn’t matter. Additional x-rays looking for a break don’t affect treatment.

Treatment is all about pain control and deep breathing. With damaged ribs, any movement will cause pain, but allowing broken or bruised ribs to move, allows the underlying lung to expand and prevent pneumonia, which is the major complication of rib injury. The lungs are a dark and moist place and if they don’t expand and allow air to circulate, they become a great place for infection to brew. It also means that ribs are no longer wrapped to help with pain. That wrapping defeats the purpose of deep breathing. So it’s up to pain medication to make the breathing happen.

Recovery takes a long time, often more than a month. When an arm is hurt, a sling can be used to rest it; when an ankle is sprained, crutches can help with rest. Unfortunately, you can’t stop breathing and each breath that moves the damaged area, delays the healing process that much longer. During the slow recovery process, any movement of the trunk is going to be painful. Sleep may be hard to come by with many people preferring to sleep in a recliner. But the first move to get up in the morning, after all the muscles have stiffened, is one to be feared.

The ability of Mr. McNabb to play football depends upon his ability to withstand the pain of breathing, of getting up from a chair and from twisting to put on a shirt. If he can tolerate those inconvenient actions, all he has to do is take the ball from center, drop back, evade the rush and throw a football 50 yards and then absorbing hit by a 300 pound lineman. It’s no wonder the Eagles signed a replacement quarterback, just in case.

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