A common source of neck, shoulder and chest pain is injury to the joints of the upper rib cage.

This type of injury causes a guarding mechanism of the large flexors, extensors and rotators of the cervical spine and head, including the sternocleidomastoideus muscle, the scalene muscles, and levator scapulae and trapezius. These are all muscles that traverse the region from the upper thoracic, and shoulder area to the cervical spine and head.

In order to protect vital structures, these muscles will become rigid. The result is poor circulation in the tissues and this is felt as burning pain. There will be loss of range of motion, with the movements and positions becoming painful. When people are asked to locate their neck pain, most will indicate the lateral (side) aspects of their necks, which points to an involvement of the scalenes muscles. If the scalenes are involved, almost invariably the ribs are subluxated. Common displacement patterns are posterior and lateral, which has to do with outstretched hands, seat belts, and backpacks, pulling the ribs posteriorly away from the sternal joints. The way we fall, the way gravity interacts with our bodies, pushes the ribs in that direction as the impact is felt. These are the common causes of displacement — all bets are off when a person is thrown from a bike or a jet ski, flying through the air like a rag doll.

When the scalene muscles become rigid, they trap the neurological structures that extend to the arm, hand and fingers. In addition, this rigid muscular guarding will restrict the normal respiratory motion of the ribs themselves, which will produce a restricted breathing pattern. Then a more subtle involvement occurs: the sympathetic chain resides on the costovertebral joints; a minor displacement of these joints will distress neurological structures affecting sleep, digestion, and other autonomic health conditions. I am suspicious that the cardiovascular system is also affected, causing a system-wide vasoconstriction like being on fight or flight mode all the time. In this case coronary arterial structures would shunt blood to other structures, leaving a resident increase in pressure. Over time this could translate into systemic hypertension and would be a likely, though as yet unproven, neurological explanation for systemic cardiovascular problems.

Structural chiropractic views the body as an integral, architectural system; impaired alignment features go against the Universal Building Code of the Body. Remedies for various sources of neck pain and accompanying neurological involvement need to address the body’s building code violations. The goal then of chiropractic treatment is to restore normal motion and function of the muscular, neurological, and vascular structures.

The Dos & Do Nots of Rib Cage Injury

First the don’ts:

  • don’t reach of the back to the car

  • don’t reach for the seat belt with your left hand

  • don’t reach behind you

  • no push-ups, no bench presses

  • no butterfly exercises

  • no yoga

  • no Pilates or rowing machine

  • don’t sleep on your stomach or on your back with your arms above your head

  • don’t lean on your elbows while in the car, at your desk or on the couch or while lying in bed

Now the do’s:

  • Do get laser therapy to stimulate the healing of damaged rib cage ligaments, and ease pain and inflammation.

  • Do get light to medium pressure massage therapy, but do not allow heavy pressure to be placed on back or chest. Do not allow the therapist to position or stretch your arm, especially over your head or behind your back.

  • Do sleep on your side with a pillow underneath your waist (above your hipbone), leaving a space for your shoulder and two pillows for the head and neck.

  • You can roll between your right and left sides unless one side is painful or injured.

  • You are cleared for typing and cutting vegetables, i.e. light activities directly in front of you.

  • There is a discrete window in which to have your arms and hands that is directly from your shoulder height as wide as your shoulders to your waist. If you go above the box, to the side of the box or behind the box, you are adding to the distress of your sternoclavicular joints and rib joints which have been pulled away from your sternum.

  • Do take your right thumb and hook it inside or behind your left clavicle and pull your clavicle towards your midline. While doing this take your left hand and arm and punch it across your chest like you’re trying to punch somebody standing directly to your right simultaneously as you pull on the clavicle. Do this as often as you can and try to reduce the pain and tenderness at that joint complex.

  • Repeat on the right side if needed. After you’ve done that, take your right thumb and go back to the left clavicle and along the top of it and work out all the sore spots or trigger points for the left SCM, repeat until not sore.

    Go to the right side and repeat.

  • The adjusting is the simplest part of the whole routine – this condition is hard to resolve in patients that don’t follow these protocols at home and at work.