Dear Ask The Doctor: I fell off a horse and haveing rib pain. I took Xrays and there is not fracture. but my ribs are "clicking." Still a lot of pain. Is this serious and what is the treatment?
Dear Kay: After a fall like the one that you described, most likely you are having a post trauma intercostal neuritis, that produces the pain on breathing or coughing and this is going to last for a while. In the view that you stated that the X-rays taken did not show any rib fracture, I suggest that you start conservative treatment, meaning: taking anti inflammatory medication (“Advil”, “Aleve”), Complex B vitamin, local moist warm compresses, stretching exercises that lift the arms over the head or to the side to open the chest cavity and stretch intercostal muscles, vessels and nerves found between the ribs. For example, lift the arms above the head and clasp your hands together. Gently lean to your right, holding the stretch for several moments. Return to your starting position, then lean to your left, again holding the stretch for several seconds. Another stretch that may help relieve pain is to stand in a doorway, holding the jambs with your elbows bent and at a 90-degree angle to your body. With your feet shoulder-distance apart, lean slightly forward, feeling a stretch not only in your back between your shoulder blades, but along the front of the chest as well. Stretch every morning and every evening, repeating a stretch between three to five times each. You may find some relief from intercostal neuralgia through exercises that help improve your posture. Standing straight, shoulders pulled back and pelvis tucked slightly under may help. Open the rib cage and stretch intercostal muscles by placing your arms at your side, elbows touching your body. Extend your hands outward until your fists are even with your body. Gently press your hands behind you, trying to touch your shoulder blades together. Press your hands backward in small motions 10 to 20 times. Repeat this exercise throughout the day, or at the least in the morning and evening to help release tension and help with pain relief. You have to be patient, the improvement takes time.