Athlete’s Pain Could Be Fractured Rib

It may not be the most serious injury an athlete can sustain but a fractured rib stabs you where it hurts— each time you take a breath.

Most of the time when we see a patient with a fractured rib, he or she has come in contact with a fast-moving or immovable object— like the tree that jumped out in front his car or the teammate in field hockey who approached the ball blindly at top speed.

One highly publicized example caused the Ultimate Fighting Championship to be postponed after Jose Aldo suffered a fractured rib. In this case, a teammate nailed Aldo with a kick to the midsection— yup, that will do it.

However, non-contact sports can also result in a rib fracture. Rowers, for instance— participants in the ultimate no-contact gentleman’s sport— also have been known to suffer rib injuries. In this case, the force is the rower’s own body, pulling against the drag of the water. With the popularity of dragon-boat racing, this type of stress fracture is being seen more often. (The back, shoulders and hip flexors are also vulnerable in dragon-boat racing.)

You know immediately if you are the victim in a collision. But how do you tell when your ribs are taking a beating from your own exertions? Generally, patients with stress fractures of the ribs feel an ache in the rib cage for several days before the pain erupts. If we catch this condition as it’s developing, we can sometimes avoid the fracture by advising our athletes to take up another activity for a few weeks. Athletes who try to tough it out may find they need all the toughness they can get for recovery.

Breathing Made Difficult

Back in the olden days, treatment for a fractured rib involved taping the rib cage to stabilize it. But while this may have eased the pain, it prevented the patient from taking a deep breath— which could lead to a collapsed lung or pneumonia. Now we instruct our patients to cough or take a really deep breath periodically (once an hour, if possible).

Some suggestions for relieving discomfort include:

• Ice the injured area to reduce inflammation.
• Get extra rest and listen to your body. Don’t do anything that causes or exacerbates the pain.
• Take a pain medication such as aspirin or ibuprofen. (We may prescribe something stronger if this doesn’t relieve the pain.)
• Try lying on the injured side for easier breathing.

Diagnosing a Rib Injury

A stress fracture can be difficult to see on x-rays because the cracks that develop are hairline-thin. In some cases, we can see where the bone is manufacturing new tissue, called callus. It’s usually the first rib that’s involved with this type of injury— the topmost one that’s located beneath the collar bone. The pain may be worse when you cough or take a deep breath. We confirm the diagnosis of a rib fracture with a physical exam, and by ruling out other possible reasons for your discomfort.

Ironically, it’s the elite athlete that is often seen with rib injuries. Pitchers, tennis players, golfers, wind surfers . . . any athlete prone to pushing their limits are also prone to self-induced fracture. Weightlifters, too, are at risk. (Among some groups, pain is like a badge to be worn, showing extreme dedication.)

If an athlete is on the field and is tackled or thrown to the ground with extra force, he or she will probably not be jumping back into the game. But in the case of a stress fracture, it’s up to the coach to stay tuned to signs such as midsection soreness, or intermittent pain.Children especially need to be supervised.

They should not be sent back on the field after they complain of an aching chest or if they are doubled over after a hit.