There are several joints in the spine such as intervertebral joints, costovertebral joints, etc. The joints that are formed between thoracic vertebrae and ribs are called costovertebral joints. In sports injuries, sometimes ligaments or cartilage that supports the joints may be damaged. Some compressive or stretching forces will act on costovertebral joints whenever there is any movement, which involves rib cage and spine.
Symptoms of Costovertebral Joint Sprain
Some common symptoms are as follows:
- Sneezing, deep breathing and coughing causes pain.
- Slight movement of the spine, either side bending or twisting, causes pain.
- Movement in the thoracic spine is decreased.
- Joint is tender to palpation.
- Usually pain in the spine is concentrated on one side and can radiate to the chest and/or shoulder blade.
Causes of Costovertebral Joint Sprain
Costovertebral joint injuries commonly occur due to sudden and spontaneous movement of the spine which involves arching or over-extending of the spine, bending, or twisting. Most commonly, these injuries occur because of repetitive movements of thoracic spine especially bending and twisting activities.
The joint where a flat part (section) of the body of thoracic vertebra meets the end or apex of the rib is called Costovertebral Joint. Cartilage present in between these bones act as cushion at the joint and at the same time ligaments act as a bond and holds these bones together. A sports injury can damage this bond and can lead to adverse affects.
In any activity involving movement of the spine, both torsional and compressive forces act on the joint. When the impact of forces is more than the normal acceptable capacity of the joint that it can sustain, then the joint structure, cartilage or ligament will be damaged. Head of the rib maybe dislocated in some cases.
Other Contributing Factors Include
- Below mentioned factors should be assessed by the medical professional or physical therapist:
- Sudden lifting of load without using proper technique.
- Poor or improper posture.
- Tightness or weakness of muscles.
- A lifestyle which is sedentary.
- Weak core stability.
- Work activities that involve constant lifting, sitting or bending.
Treatment Modalities for Costovertebral Joint Sprain
Usually in minor cases, costovertebral joint sprains will heal on its own without medical intervention when proper care is taken. A few things that may help in speeding up the recovery process are as follows:
- Initially RICE (rest, ice, compression, elevation) treatment should be tried at home. This will help in reducing pain and swelling. 15-20 minutes once in every four hours is usually suggested.
- Refrain immediately from activity that is the cause of pain.
- Take rest till the pain subsides and if pain persist consult orthopedist immediately.
- Orthopedist will initially write a script for anti-inflammatory medication to help reduce pain and swelling.
- After the pain and inflammation subsides, gentle mobility exercises like side bending movement and twisting motions are recommended in order to keep the joint mobility intact and also to prevent joint stiffness.
- In some cases, acupuncture treatment is also recommended to help reduce symptoms of pain and swelling.
- Orthopedist may also recommend soft tissue mobilization/therapy or electrotherapy depending upon the severity.
Physical Therapy for Costovertebral Joint Sprain
In most of the sports injury cases, once pain and inflammation subsides, regaining of strength and going back to normal daily activities is very important. Physiotherapist would suggest strengthening and mobilization exercises. If required, in severe cases, the physiotherapist would formulate a rehab program and suggests the patient to follow this program which will help in regaining lost strength.
What does a Physiotherapist do?
- Soft tissue massage.
- Will educate as to how to protect spine from future injuries.
- Will educate on what needs to be done in case of injuries in future.
- Will perform and educate on how to perform exercises such as strengthening exercises, flexibility, core stability, and stretching exercises.
- Will perform gait training exercises if required which may include activity modification using devices.
- Will use hydrotherapy.
Some Common Exercises For Costovertebral Joint Sprain:
In general, two types of exercises will be preferred by the physical therapist and they are shoulder blade squeezing and thoracic rotation in lying position. These exercises should be performed under the supervision of a physical therapist or medical professional. For effectiveness, these exercises can be repeated 4 to 5 times in a day.
- To perform shoulder blade squeeze exercise, you should sit or stand tall keeping your back in straight line. Then squeeze the shoulder blades (both shoulder blades together) as hard as you can and also to the maximum pain-free limit. Hold this position for at least five seconds and then release it. Usually, a minimum of 10 reps would be suggested.
- To perform thoracic rotation exercise, you should lie down on a flat surface on your back and bend both the knees. Then lower the knees slowly to one side making sure that the shoulders and feet are in contact with the surface of the floor. Then repeat the same to other side with a minimum of 10 reps. Increase the duration and reps as tolerated.
Which Products Would A Physiotherapist Recommend To Help Cope With Costovertebral Joint Sprain?
Follow are some common products that a physiotherapist can suggest depending on the condition and severity:
- Heat and cold packs.
- Lumbar rolls.
- Postural braces.
- Massage balls.
- Use of foam rollers.
- In case of postural taping may suggest protective tape.
It is always suggested to seek professional medical advice before following any treatment regimen.