ribs: broken or bruised, it doesn’t matter

Monday, November 26, 2012

Predicting winning lottery numbers is a lot like guessing when the body is going to heal and I would bet that Rex Ryan and the New York Jets coaching staff haven’t had a winning Powerball ticket in a long time. Tim Tebow, their backup quarterback, hurt his ribs a couple of weeks back and continues to have pain. It’s no surprise to most people who have suffered broken or bruised ribs that it takes a long time to get better and one cannot rush time. But to the Jets’ coaches, it came as a surprise that a pro football player couldn’t muster mind over body.

The basics about rib injuries:

  • Broken, fractured or cracked all mean the same thing.
  •  A bruised rib usually refers to the structures surrounding the rib, like bone and cartilage and not necessarily the rib itself. Regardless of whether the rib is broken or the area is bruised, damage has occurred to the rib area and that disrupts the ability to breathe easily.
  • We breathe like a bellows; the ribs spread wide and the diaphragm pushes down sucking air into the lungs.
  • Pain can prevent deep breaths, preventing the lung underneath the damaged area from completely expanding.
  • The lung is a dark, warm place and if air isn’t moving through every nook and cranny, infections can sprout. Pneumonia is the major complication of a chest wall injury that can develop in a few hours or a few days.

Patients and doctors are on different pages when it comes to diagnosis. Patients want to know if a rib is fractured and expect x-rays to look for the break. Doctors are more interested in what else might be damaged due to the injury. A plain chest x-ray is all that is needed, not necessarily the multiple views and radiation exposure that comes with a detailed rib series. The CT and MRI scans that Mr. Tebow underwent seem like overkill.

The ribs also protect the upper abdomen where the liver (on the right) and the spleen (on the left) live. This is where a CT scan is helpful, if the suspicion of abdominal organ damage exists and the diagnosis can be confirmed, the need for an operation may be potentially prevented. Often solid organs, like the spleen, heal themselves (see Jason Witten of the Dallas Cowboys).

But rib injuries hurt and take time to heal, only because they cannot be rested. If you hurt an arm, it can be placed in a sling. If a leg is injured, it can be rested by using crutches. But a person can’t stop breathing and 12-14 times a minute, the injured rib is forced to move, stretching the muscle fibers or bone edges, delaying their ability it mend. The only treatment is adequate pain control so that a deep breath can happen and pneumonia can be prevented.

Aside from breathing, the muscles that surround the chest help move the arms and twist the trunk. It usually takes time at night for the patient to get comfortable enough to fall asleep. Usually, they prop themselves up with pillows or sleep in a recliner. Lying flat makes the pain worse because the chest has to rise against gravity to get that deep breath in and sitting upright takes gravity away. Morning is perhaps the worst time of day. After a few hours of sleep, the chest wall muscles have become tight and the first twist or turn to get out of bed can be excruciating to the point that the same move on morning two is dreaded.

The bottom line is that rib injuries take 4-6 weeks to heal and there is no rushing Mother Nature. The Jets’ coaches should not have expected a football player to suit up and play in 10 days and Mr. Tebow was a victim of wishful thinking. Mind over matter doesn’t work when the mind is more interested in how much the next breath is going to hurt, not whether that linebacker is closing in for the tackle.

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