Rib & vertebral (bones of the spine) subluxations and ribs “going out” are a common finding by various health care providers but controversy continues to brew as to whether these even exist.
Let’s clarify a few things first, some folks get confused with the terminology and the anatomy. A “subluxation” is the medical term for a partial dislocation.
Specifically, a “rib out” is referring to the costovertebral (CV) joint and/or the costotransverse (CTr) joint; explained simply the CV joint is where the backside of the rib interfaces with the side of your spine and the CTr joint is where the rib interfaces with the transverse process of the spine.
Some argue the only way to fix this problem is to “put the rib back in” using rib & spine manipulations to “pop it back in place”.
The main reason for all the controversy and disagreement over the “diagnosis” is that there is a significant lack of evidence supporting the idea that these joints actually “come out”. There is also no evidence as to whether the direct treatment of the rib gets it to “go back into place”.
Some providers stand by the notion that rib subluxation can occur very easily through quick rotation or flexion (bending) of the spine. Examples of these motions would be a sneeze or pushing/pulling a vacuum, both very light loads being placed on the body, right?
So if providers are sitting around claiming that light stuff like a sneeze or running a vacuum can sublux the spine, we could assume that major trauma to the ribcage, sternum and spine would produce multiple subluxations? Said another way, if a force is strong enough to fracture ribs, it should also be able to easily sublux the CV and/or CTr joints. But there are literally thousands of rib fracture cases that have been studied with multiple ribs being fractured and not one mention of a rib “going out”.
In the majority of these studies, the CT scans of ER patients with blunt thoracic trauma from a car accident were looked at. These scans revealed everything from pulmonary contusions (lung bruising), rib fractures, pneumothorax (lung puncture), sternal fractures and hemothorax (bleeding into the thorax). All very serious traumas but guess what those patients did not exhibit? You guessed it, a “rib subluxation”.
So what the heck is creating the pain when someone claims they have a “rib out”?
The most likely explanation is the CV LIGAMENTS, not the bone/joint itself but the supporting ligaments are pissed off. These ligaments are most likely being sprained during the light activities (sneeze/vacuum) that should otherwise not cause harm.
Like with other tissues throughout the body, when these ligaments are sprained it causes localized inflammation and muscle guarding (spasms) over the area. These spasms are simply the brain & body’s attempt to stabilize the affected area.
But my Doctor/chiro/PT said they can feel a “bump” in the area and they said that’s the “rib head poking out”...
When the muscles spasm it creates increased muscle tone (tightness). Imagine the muscles binding down tight over a painful area to try and protect it. This increased tone results in a muscle “knot” that can be felt beneath the skin and described as a “bump”.
But my Doctor/chiro/PT popped the rib back into place...
Regardless of the treatment style utilized, they should all have an element of decreasing the protective tone/muscle tightness over the area and as the spasms & inflammation reduce the “bump” may reduce as well which results in decreased symptoms.
So, to be clear, no ribs/rib heads are getting shoved, placed, rubbed, manipulated, finessed, coaxed or any other version back into place. All of the manual work performed is getting your brain & nervous system to calm down resulting in localized changes in the tissue.