/ Intercostal Injury - Help!

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Patrick Roman - on 02 Dec 2016
At the end of August I was doing an ice axe pull up session when I felt the muscles pull along the right side of my chest. The pain was a dull throb that stretched from the top right side of my rib cage to just underneath the right side of the rib cage.

Looking back now it seems crazy that I continued training for the next two weeks although I didn't do any pull ups or climbing specific training (and still haven't). But I did do some upper body stuff like weights and rowing. I then had three weeks off from training and anything I've done since has all been lower body (almost always cycling).

The main issue during this period was my job which involves heavy duties. I did these duties for four weeks after the initial injury mainly because I then had a fortnight's holiday leave and assumed I'd recover during this period. There was some improvement, and when I returned to work at the start of October I asked to be put on light duties. Initially this felt like it would help but I was still using my upper body, twisting and lifting regularly for 36 hrs a week. After 8 weeks of this, the injury is very much still there.

I've now taken a week's sick leave (my first sick days in almost 10 years) and my doctor has just prescribed a 5 week course of anti-inflammatries. I saw a physio back in October and she felt that the training and work I'd been doing was not a bad thing, but my doctor has advised that my chest is now kept as immobile as possible.

Because the injury hasn't really improved over the last couple of months my feeling is that I need to follow my doctor's advice, so stop doing anything that could, directly or indirectly, affect the injured muscles. So I'm thinking I should stop any training too (even though it was only easy lower body stuff).

Suffice to say I'm getting increasingly worried about my situation and was hoping there was someone out there who could share their own experience or offer some advice.

Thanks, Patrick

cb294 - on 02 Dec 2016
In reply to Patrick Roman:

I (partially) tore my intercostal muscles when I cracked my ribcage earlier this year. For me, kinesiotape (other brands are available, I am talking about the stretchy tape that you stick on under tension) helped a lot, especially when getting back into training (early on the tape made sneezing without a towel wrapped around the chest bearable at all) . There are good videos on youtube that show you how to apply the tape depending on which muscles exactly you injured. I am just about back to more or less pain free training after 7 months, so better expect the healing process to take some time!

Good luck,

CB
WildCamper on 02 Dec 2016
In reply to Patrick Roman:

I tore one of mine a few years ago climbing, ended up having to take a few weeks off work as i couldnt cope with my day to day duties (joiner).
After the rest period i gently started working the area with yoga, initially it was very uncomfortable but with perseverance it improved.

good luck
Patrick Roman - on 02 Dec 2016
In reply to cb294:

Thanks, that's a long time to heal. I guess like you, I initially picked up a bad cold which lingered for three weeks. Sneezing and coughing were really sore but that soon went away and I was then able to take really deep breaths without any discomfort.
planetmarshall on 02 Dec 2016
In reply to Patrick Roman:

> Because the injury hasn't really improved over the last couple of months my feeling is that I need to follow my doctor's advice, so stop doing anything that could, directly or indirectly, affect the injured muscles. So I'm thinking I should stop any training too (even though it was only easy lower body stuff).

Get as much (professional) advice as possible, I guess. Especially if you've already had two conflicting opinions. Probably not what you want to hear, but see this from Tony Yaniro, quoted from "Training for the new Alpinism"

"Sadly the load that any tissue can handle post-injury, and which it needs to achieve a stimulation that requires it to adapt via the training effect, is many, many, many times less than was needed to induce a training effect before the injury. Athletes need to avoid injury at all costs. It is the surest way to derail your plans. The training effect is the model that explains the recovery from an injury— rest and reinforcement, then re-stimulation— but now the training or stimulation must be conducted at an exaggeratedly low effort. A very minor tear in a tendon will require many weeks to heal. You cannot train it at the previous levels during this time. After healing, it must be rehabilitated with light progressive loading in order to reinforce itself and be ready for a normal training load— this can take at least many weeks. In total, such an injury needs several months to heal, if the injury was recognized immediately and was not irritated by more stress. Injuries will be bathed in inflammatory cells and fluids. These must be gone before significant stress is applied to the tissues. If they remain, chronic tendonitis, scarring (meaning that the tissues may never fully heal properly), and calcification will occur. Some of these changes can take years to remedy, if not longer. The gradual progression of your training that is advocated throughout this book is the best long-term method of ensuring continued success and avoiding injury. Taking that extra easy day, or more, of recovery as needed is a much better and faster way for genuine long-term fitness gains. There is no secret and quick method of improving fitness. It takes hard work— and time. Train hard, rest hard.

House, Steve; Johnston, Scott. Training for the New Alpinism: A Manual for the Climber as Athlete (Kindle Locations 2609-2621). Patagonia. Kindle Edition.


Patrick Roman - on 02 Dec 2016
In reply to WildCamper:

I've been doing some stretching and strengthening exercises (planks, side bends, child's pose) and they feel fine when I'm doing them but later on I'll feel a general ache along the side of my chest which then lasts for several hours. Was that the same with you?
Ged Desforges - on 02 Dec 2016
In reply to Patrick Roman:

I've had a similar thing twice. Horrible isn't it! Mine definitely took less than 7 months. About 6-8 weeks I think, but probably could've been less if I'd taken it easy straight away. I think the main problem is that it's obviously hard to rest your intercostal muscles for obvious reasons. I found a couple of weeks of proper rest, and then steadily building up the exercises. I started with planks on my knees, and worked up from there.

Found climbing was the last thing I could get back to, but wasn't too long before I could do some pullups and fingerboard training
Patrick Roman - on 02 Dec 2016
In reply to planetmarshall:

Funnily enough I read that passage last week, it's pretty sobering. It's difficult when you're getting different advice - to know whether resting completely (at least for a while) is the safest way forward or whether it's best to work the area in the hope that it'll adapt and strengthen. I'm hoping the anti-inflammatries will begin to help too, the doc seemed to think they would.
pneame on 02 Dec 2016
In reply to planetmarshall:

that is excellent advice. I'll have to look that up. As you age, all this takes quite a lot longer, as well!
Patrick Roman - on 02 Dec 2016
In reply to Ged Desforges:

Yeah it's really horrible and like you said it's so difficult to isolate and protect. The fact that I've tried to work through it has had a really wearing effect on me, physically and mentally (hence finally taking sick leave).

6-8 weeks for recovery is what I've come across too as long as everything is done right. The couple of weeks of total rest you had followed by gentle exercises sounds like a sensible way forward. Thanks.
cb294 - on 02 Dec 2016
In reply to Patrick Roman:

Yes, seven months is a bit long. Breaking the same rib twice more did not help, though. Actually, I was back in training after two (not advisable, that caused the first rebreak) and six weeks (seemed OK), but I was limited in what I could do and was definitely not pain free!
In my defense, I had an Xray and was told that the bone was OK. Turned out to be wrong, but that was only spotted when I broke it again and developed a nice callus. The second refracture was a freak accident, not much chance to avoid it.

CB
Patrick Roman - on 02 Dec 2016
In reply to cb294:

That's a story! I can't imagine how difficult that must have been, to be knocked right back down again. Hope you never experience anything like it again.
cb294 - on 02 Dec 2016
In reply to Patrick Roman:

Thanks, but that is the risk if you do judo, not lawn bowling....

CB
Dave the Rave on 02 Dec 2016
In reply to Patrick Roman:

Are you sure that this is an intercostal injury and not a latissimus dorsi injury?
You were doing pull ups and this muscle is heavily involved. It also has anterior rib attachments?
Patrick Roman - on 02 Dec 2016
In reply to Dave the Rave:

You're spot on as it turns out. I had an appointment with a fantastic doctor this afternoon who took the time to properly examine me and he said it was the serratus anterior muscle. Everything he described made sense. I'd never heard of the muscle before but I did suspect on a couple of occasions that it was something other than the intercostals (or in addition).

It's a long story (but quite an interesting one). I picked up an ankle injury way back in 2003 which, although pretty painful and swollen at the time, didn't cause me any problems until 2007 when the bottom of my foot (around the ball of the foot) swelled up. I later (not until 2013) discovered this was because of a lack of dorsiflexion in the ankle (brought on by that initial injury in 2003), which was exacerbated by wearing winter climbing boots. Because of the rigid sole, every time I took a step (so on the approach to routes or the walk out) my toes would claw at the ground. Over the course of a winter, this would cause swelling that was so painful I used to wince if the sole of my foot even touched the sides of the boot when I was tying to put the boot on. Ironically, when climbing it was absolutely fine.

The swelling would go down when I hadn't been wearing the boots for several months but over the following few years the swelling would occur sooner and sooner until the very first day of wearing them would result in severe swelling. I sought a lot of help during this time but the problem was always diagnosed as a biomechanical issue, and even though the swelling was only occurring in one foot, corrective aids like orthotics were given for both feet. The actual core problem - the lack of dorsiflexion - wasn't identified as the problem until 2013 when I met with an excellent podiatrist. It might seem like a no brainer in hindsight but he was the only person who checked my dorsiflexion in both legs and, when he noticed that one was much worse than the other, asked if I'd ever had an injury in that ankle. I had to think initially, it hadn't ever occurred to me that the swelling in my foot could be linked to an injury I sustained 10 years before when I missed the kerb when walking home from work one day and went over on it.

The podiatrist gave me a bunch of different exercises to work on and things started to progress ever so slightly by the end of 2013. The main exercise I was doing was to stand facing a wall, a few feet back, and just bend my knee in toward the wall while keeping my foot flat. By February 2014, I had only gained a few mm of movement but at least it was movement. And then during one session, the area I was stretching just gave way and my knee lurched forward. I had suddenly gained about 2 inches of extra movement.

The net result, however, was that over the next few days I was flooded in pain. One night, I experienced a tingling sensation down my whole left side, from my head to my toes, when lying in bed. I didn't know what was happening but it scared me. It had gone by morning but was replaced with a deep throbbing ache around my right shoulder blade, shoulder, and right arm. Over the course of the next few weeks I discovered my shoulder blade would protrude straight out of my back whenever I did a plank or lay flat on a bench with my arms raised. This winging caused a bit of alarm with a fairly new physio I saw, but her more experienced colleague had seen it before.

More exercises, and a referral to a professor, who told me that the cause of it was because my immune system had experienced so much pain that it led to an electrical misfiring of my nervous system, with the nerves controlling my shoulder blade ceasing to work as normal. When he carried out nerve tests on the area around the start of 2015 there were positive signs of response but he did warn me that it could take up to three years from the time of the initial winging to fully recover. I still do four sessions a day of ankle physio to try and increase my dorsiflexion and I'm pleased to say that I now have almost full flexibility restored. But there could still be a long road ahead, I just don't know.

When I was doing the pull up session that's caused this latest injury, it felt like a slippage of the muscles from the shoulder blade area round to my lower rib cage. The injury just felt like it wrapped around my right chest wall. And there have been a couple of instances since then when I could feel an ache coming from the shoulder blade that made me stop and think it could be related to that previous weakness.

Sorry for such a long post, it's been quite therapeutic to write all of this down. It really emphasises just how linked our muscles are, and that a seemingly innocuous injury can have huge consequences later on.

If anyone has any experience of an injury to the serratus anterior, I'd be grateful if you could let me know.
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mike barnard - on 02 Dec 2016
In reply to Patrick Roman:

Nice one with getting a correct diagnosis. I did wonder regarding the intercostals as they are usually strained by a twisting motion in the body (often reaching at the same time), not just straight pulling down.

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