Why Does My Back Hurt When I Breathe? What is it and how to fix it?

Overview:

• Pain from the ribs. How’d it happen?
• Why does it hurt so bad?
• Painful but fixable

“It hurts right here (points to middle of back), especially when I take a deep breath in.”

“It’s like someone is poking a knife in the middle of my back”

“Every time I try to stand up all the way, my back spasms.”

“I just want to crack this pinch in my back.”

There are times when pain can literally take your breath away.  That sharp, stabbing pain coming from a very pinpoint spot in the middle of your back.  Sometimes it’s just a really annoying feeling that won’t go away, but other times it can make you feel crippled by back spasms.

In many cases, this pain comes from the joint where your ribs connect to your spine. Sometimes people will say that you have a rib head that’s “out of place”, misaligned, or sprained. For the sake of today’s article, we’ll just call it rib pain.

It’s a frustrating problem because it can happen out of nowhere. Sometimes you just wake up with the pain, other times it’s from twisting or turning too quickly. Fortunately, even though we don’t know much about the pain, we do have effective strategies to help manage it when you feel it.

Why Does It Hurt So Bad?

The interesting thing about pain from a rib head is that the intensity and level of annoyance is really high for a problem that is pretty harmless. It’s not like a herniated disc where you may have other serious complications that arise, but the pain can sometimes be as debilitating.

Although this joint won’t result in pinched nerves that can cause muscle weakness or loss of feeling, it is extremely dense in pain generating tissue.

The ligaments shown on the image above, as well as the direct connection of the rib to the vertebra can be full of pain fibers called nociceptors. This joint is not supposed to have very much movement. If the joint gets overloaded and sprains the ligament, or if there is too much friction between the joint surfaces, then it stimulates an aggressive pain response in the brain.

When the pain response is initiated, the nervous system often looks to brace an area of injury, this typically comes in the form of muscle tightness and spasticity. As the muscles tighten around your ribs, it limits your ability to breathe in deeply. The muscle spasticity may also compress the nerves, arteries, and veins passing around the curvature of the ribs causing additional sources of pain and discomfort.

Unlike other parts of the body like the hand, shoulder, and low back, you don’t have a choice in moving your ribs. Your ribs move whenever you take a breath, and breathing is a little bit important to the maintenance of life. The more it moves, the more it can agitate the painful joint even if there’s minimal tissue damage.

How to fix it?

For most people, this pain will go away within a week without any treatment. However, if you have the pain for longer, you may need a little bit of outside help to correct the problem.

Most chiropractors can address the pain with a spinal adjustment to the thoracic spine or rib head. Typically patients will feel a substantial amount of relief within a few visits. When combined with some corrective exercise, you probably won’t have any further issues unless you reinjure the joint.

 

Whether your problem is brand new or chronic, a Structural Corrective approach to the spine can lead to substantial relief.

Don’t Crack Your Own Neck....

I’m sure you see it almost everyday. Whether it’s the fidgety co-worker who likes to hear all of his joints pop, or the guy on the plane that’s been rubbing his neck all day.

It’s the serial neck popper. They look straight out of the warm up scene of a martial arts movie, sound effects and all. While most will cringe and bite their tongue when they see it, the serial neck popper looks more focused and at ease. In fact, if their joints were capable of it, these people might pop it more often. It might even be you.

“It feels so good, how bad can it be?”

Some of the people who come into my office for care used to be serial neck poppers. Emphasis on the words “used to be”.  One recommendation for people when they get their first adjustment is to avoid popping or cracking their neck. There’s usually a look of defeat on their face when the recommendation is given. The truth is that one of their greatest sources of relief from neck discomfort was actually the very thing that was making their problem a chronic issue.

The loose ligaments, and uncontrolled forces from self-manipulation prevent this neck from staying in place.

The x-ray on the right is an example of someone who spends a lot of time popping their own neck. He had no history of a car accident, sports injury, fall, or trauma. However, he has been popping his neck aka, self-manipulating multiple times per day for years.

The green line represents the center point where a person’s head and neck should line up. The red line represents how the patient’s head and neck currently line up in their “normal” seated position.

The level of displacement is not hard to see. In fact, most of you would probably notice someone like this who always holds their neck off to the side.

Though he always feels his neck is very tight, the neck tends to be very floppy without a strong degree of stability. Even after several corrections, his neck will continue to have a tendency to slip towards the side until the ligaments tighten up and heal.

What Happens?

So what exactly happens when you self-manipulate?

Despite popular belief, there is nothing insidious about the popping sound made by joints. The classic crunching sound that you hear, and is stereotyped with chiropractic has nothing to do with broken bones, or rubbing bones against each other.  The sound comes from tiny gas bubbles within the fluid that lubricates your joints. When the joint opens up rapidly, these bubbles get released and pop causing those sounds.

It’s more like opening a can of soda than the crunching of a bone. If your neck or back cracks here and there with normal movement, it’s not a cause for concern most of the time.

The sound is ultimately not the problem. What truly is a problem is the way the thrust affects the spine.

In recent years, there have been videos, articles, and books that teach people how to adjust themselves.  Now bear in mind, the neck is one of the most sensitive and important pieces of anatomy in the human body. So people are being taught to manipulate their neck without regard for the following factors:

1. Risk factors – Does your neck have disc bulges or protrusions? Are there plaques or anatomical malformations? Some of these risk factors are susceptible to rotation/twisting forces in the neck. Many of these problems can be identified and planned for with a proper examination, but without one, how do you know?

2. What is the current structure of the spine? – How is the spine currently aligned? Do you know which direction puts you into a better position? Are you moving the right vertebra? Are you pushing the vertebra into a worse position than it already is? 

Our office uses x-rays to identify these malpositions. Can your own hands measure precise alignment in your neck?

3. Constant Manipulation = Loose ligaments = Poor Stability – Every time you manipulate your spine, you are causing ligaments in the spine to stretch like a rubber band. When you stretch a rubber band enough times, it eventually loses it’s shape and becomes less stable. Your ligaments work the same way. If you keep pounding on your neck with self-manipulation, your neck eventually becomes a sloppy mess like the x-ray above.

When people have ligament instability, it leads them down the road where they depend on manipulation to keep feeling good. Not a good situation, and a big reason chiropractors get a bad rap for getting people “addicted to adjustments”.

So what now?

When choosing a chiropractor, it’s important that they are actually measuring what they are doing to the spine. Almost any chiropractor is able to make someone feel better with manipulation. Manipulation sends a rush of feel good signals into the brain. However, a Structural Chiropractic approach is more than about feeling better in the moment.

It’s about restoring your spine and your nervous system to a state of Normal. A normally functioning spine has the ability to heal and maintain itself without relying on constant manipulation.

That’s why the procedures we perform in our office is truly about fixing the problem and getting it to stay fixed. Many times, these corrections can be performed without any rotation or twisting of the spine. It’s very gentle, and very effective.

Self-manipulation, while a temporary rush and feel good sensation can create hyper-mobility and long term structural problems in the neck. Additionally, it’s easy to become addicted to that feeling, and make your body dependent on constant manipulation to feel normal. In our world, we call that getting “hooked on the crack”. There are just too many questions about what can happen when you self-manipulate. It just doesn’t make sense to do something likely harmful for a few minutes of temporary relief.

Do you have a Military Neck?

I Have a Military Neck, Now What?

My doctor told me that I have a military neck and that it was causing my neck pain…

My last chiropractor said that I have a military neck and I needed a year to fix it

Over the past 10 years, the general public is becoming increasingly aware about certain facets of spinal alignment. For years, parents of small children are showing more concern about their child having scoliosis and other postural problems. Today, more and more patients have voiced their concerns about having a military neck in our office.

While it’s refreshing from a chirorpactor's stand point to see a greater awareness about spinal health, there are still a number of misconceptions that need to be addressed.

What’s a Military Neck?

The images on the below show x-rays for 2 people. The top image is a smooth C-shaped Arc representing a normal curve, while the image on the bottom shows a straightened appearance from a loss of the normal curvature.

When people talk about having a military neck, people are talking about the straightened appearance that the neck takes when it loses it’s normal curvature. Military neck has less to do with being injured in the line of duty, and more to do with the straight and stiff appearance of a soldier’s posture.

Normal Curve

The straightened and weak structure of a military neck

How Bad is it Really?

When patients come to our office for a consultation they will mention if they had x-rays in the past. I’ve had several people who had a previous chiropractor promise the world by putting the curve back in their neck. I’ve also had a few medical doctors tell people that the cause of their pain is from the loss of curvature in their neck as well.

The presence of a curve in your neck allows for smoother motion of each of your neck vertebra. It also plays a key role in distributing force throughout the discs of the cervical spine. In essence, a C-shaped curve in the neck can and will prevent early breakdown and degeneration of your spinal joints. As the discs and joints begin to breakdown, it can create the environment for inflammation to build up around the nerves, or even lead to disc protrusions and disc bulges.

You may not feel the effects of a military neck immediately, but just like you don’t feel plaque building up in your arteries, it is something than can and will eventually become problematic as you go.

Can It Be Fixed?

This part is a bit of a loaded question. The answer really comes down to this fact:

Why is the neck straight to begin with?

Many cases are induced by compromising neck positions from texting/computer/screen time and has lead to weakness of the intrinsic muscles of the head and neck. Some cases involve malformed vertebra that force the neck into a straight or reversed position. Then of course are the neck’s that are a result of traumatic injury like whiplash.

Many of the postural and some of the minor traumatic injuries can see their curves restored nicely under structural chiropractic care. However, the cases of misshaped vertebra and some of the traumatic cases may not see a return back to normal, no matter how skilled or how well the intention of that chiropractor is.

I Tried to Get it Fixed, but my Neck is Still Straight. Now What?

Here’s the good news:

You don’t necessarily need the curve in your neck fixed in order to get great results!

We often see Military Necks as Structural Problem.  Although it’s really fun to see a straight neck get it’s curve back, it’s not a requirement for the patient to get improved biomechanical function of their spine again.

Take Home Message

Military necks are associated with problems in the neck, but it’s not a death sentence. While we all want to be perfect, it’s important to understand that your body will always do what it can to adapt to any situation. Curve or no curve.

Some structural distortions like may not have the popular awareness of military neck, but carry far wider implications for spine problems, and brain problems.

The most important thing to remember is that the care you choose to receive makes an impact on the quality of your life.

Do I Really Need To Get X-rays?

That’s a fair question to ask as a patient. In some branches of health care, such as dentistry or orthopedics, x-rays are routine and are performed without any doubts or questions. Patients understand that without x-rays, the dentist or orthopedic surgeon would be flying blind, and the quality and safety of the procedure would be compromised.

However, in other branches of health care such as chiropractic, the use of x-rays is debatable. In fact, the majority of chiropractors do not take x-rays as a standard practice. So when a patient enters Premier Chiropractic and discovers that x-rays are a standard practice for all cases, naturally they have a few questions.

For most patients, the questions arise from the fear of receiving too much radiation and increasing their risk of cancer. Although that fear is valid – excessive exposure to ionizing radiation (like x-rays) can increase the risk of cancer – once our patients understand the clinical need for x-rays, and the actual dosage they receive, their fears are quickly put to rest.

Let’s quickly address the fear of increased cancer risk first. X-rays are form of radiant energy, like light or radio waves, but x-rays have the ability to penetrate body. X-rays occur in nature (called “background” radiation) and most commonly come from cosmic radiation (space) and radioactive materials (most commonly from radon gas). Therefore we are always exposed to them at some level. The dosage is most commonly measured in millisieverts (mSv).

The damage caused by x-rays is like a wound in the sense that, with time, the body can fully heal and recover. So a large dose of radiation from x-rays can be tolerated as long as it’s not too frequent. And a small dose of x-rays can be tolerated on a more frequent basis. To put things in perspective, one chest x-ray exposes a person to 0.1 mSv, which is equivalent to the amount of radiation exposure they would experience from their natural surroundings in 10 days.

The x-rays we take at Premier Chiropractic amount to roughly 0.5 mSv, which is equivalent to the amount of radiation exposure you would get from your natural surroundings in about 2 months.,

Lastly, let’s address why we need to take take x-rays. The bones in your spine are highly variable from one person to the next. Just like no two people look exactly alike (except maybe identical twins), no two spines look exactly alike. Furthermore, the uniqueness of the individual, how they are shaped, how they move, makes it nearly impossible analyze accurately with palpation (touch) alone.

In summary, just as an orthopedic surgeon or dentist needs x-rays in order to perform his or her job and provide the highest quality of care to the patient, so do structural chiropractors at Premier Chiropractic need to take x-rays.

When your health is on the line, you don’t want us to be guessing do you? 

The Pain is in my Back, Why Are You Looking At My Neck???

“80% of the country will have back pain during their life, why would turn away all of that potential business?”

“If you don’t take care of the back, then what DO you take care of?”

In my practice, I focus on Structural Correction and I deal exclusively with the alignment and mechanics of the spine. I’ve seen hundreds, if not thousands of patients with low back pain looking for someone to help them. So, how can a gentle approach to the neck help with back problems?

I can probably cite a complicated study, or explain this long and complex pathway like the infographic shown below:

But really, I’m sure you just want me to make sense of it all. So here it goes:

1. No matter where pain may be felt, it is always processed by the brain. That’s why there are many Secondary Conditions occur where there is nothing physically wrong to diagnose, but the pain is very real to that person. A person with Fibromyalgia deeply understands this concept.

Proper structural alignment of the head and neck allow the brain stem to transmit the messages from the spinal cord properly. It ensures that there is no hypersensitivity to pain occurring at the level of the central nervous system.

2. Anterior head syndrome is a condition in which the head and neck has shifted forward in front of the shoulders. While this may not seem like much, but the weight of a 12 lb head reaching beyond the shoulders forces the muscles of the neck and back to pull harder than normal. This is because for every inch forward the head moves, gravity pulls 10 extra lbs onto the neck and back muscles. So a person with a 10 lb head can suddenly have the mechanics of a 30 lb head with just 2 inches of Anterior Head Syndrome.

An interesting thing to note is that people with both neck pain and back pain will see their back pain go away before their neck pain.

3. According to a recent study in the Journal of Neurosurgery, deformities in the neck affect the alignment of the hips and pelvis. The two structures are linked together through a complex muscular sling. In other words, where the head goes, the neck goes and vice versa.

Whether you’ve been told your SI joint or a herniated disc is the problem, Structural Correction may still provide an answer. Though not all cases of back pain are related to a Structural Shift in the spine, it’s an important factor that is not usually looked at by most doctors or Traditional Chiropractors. Rather than getting pigeon-holed into a symptom-treatment model, it may benefit you to have someone take a global look at the body, and how a structural shift can impact the spine and the central nervous system.