Talk Tennis

Talk Tennis (http://tt.tennis-warehouse.com/index.php)
-   Health & Fitness (http://tt.tennis-warehouse.com/forumdisplay.php?f=18)
-   -   Rib Muscle Sprain? (http://tt.tennis-warehouse.com/showthread.php?t=436841)

tennisenthusiast 08-21-2012 10:53 AM

Rib Muscle Sprain?
 
I have been having pain between spine and left shoulder blade area which I thought must have been something to do with disk herniation. But on closer look and some thinking, I feel that it is a rib muscle that I might have sprained or pulled.

This pain started back in 2011 and I took break from tennis for a long time and played a session again last week. Pain returned immediately. I have pain when I rotate my core for forehands from right to left.

How come a muscle sprain or pull is so persistent for two years? What can I do to recover from this? Can you suggest any exercises? How can I prevent it in future? Do I need to strengthen any specific areas?

Thanks a ton!

ollinger 08-21-2012 11:06 AM

"muscle sprain" persists for two years because it's probably not a muscle sprain. With symptoms so posterior that the discomfort is close to the spine, muscle injury at that level is highly unlikely. You have an undiagnosed condition. Have it diagnosed by an orthopedist.

r2473 08-21-2012 11:59 AM

Quote:

Originally Posted by tennisenthusiast (Post 6823346)
I I feel that it is a rib muscle that I might have sprained or pulled.

Rub some sauce on it kid.......

charliefedererer 08-21-2012 12:31 PM

Listen to Olinger - get it checked out before making it worse by doing the wrong therapy/workout.

tennisenthusiast 08-21-2012 12:51 PM

Quote:

Originally Posted by charliefedererer (Post 6823563)
Listen to Olinger - get it checked out before making it worse by doing the wrong therapy/workout.

charliefederer - I am on the verge of giving up everything including tennis. I've tried everything conservative treatment, MRIs, Ultrasound, x-rays, ortho doctors. Nothing conclusive at all but my symptoms are persistent since 2.5 years.

DropTheBaseline 08-21-2012 03:35 PM

Does the pain also go up to your neck/occipital area? I have something on the right side of my body that feels like really tight muscle that travels somewhere deep to the rhomboids and around to my right rib cage. I got it while tweaking my service motion.

Is your pain acute or dull? and how did you hurt yourself?

tennisenthusiast 08-22-2012 11:31 AM

Quote:

Originally Posted by DropTheBaseline (Post 6823992)
Does the pain also go up to your neck/occipital area? I have something on the right side of my body that feels like really tight muscle that travels somewhere deep to the rhomboids and around to my right rib cage. I got it while tweaking my service motion.

Is your pain acute or dull? and how did you hurt yourself?


I do have occasional spasms near neck region but I thought that they were a different problem. Are those connected?

When I play, I have tingling pain for about couple days and then it slowly subsides. I am not sure how I hurt my rib muscles. I returned to tennis after long vacation and started playing without warm up?

tennisenthusiast 08-22-2012 11:36 AM

If this is continuing for more than 2 years, what can it be?

Chiropractor took x-rays of my ribs and said that they look good.

DropTheBaseline 08-22-2012 06:37 PM

Quote:

Originally Posted by tennisenthusiast (Post 6825825)
I do have occasional spasms near neck region but I thought that they were a different problem. Are those connected?

When I play, I have tingling pain for about couple days and then it slowly subsides. I am not sure how I hurt my rib muscles. I returned to tennis after long vacation and started playing without warm up?


If it's on the same side I think there is a very good chance it's connected. Even if it's not, one might be secondary to the other. If I were you I would try some self-massage first. Search for a massage cane and use it on your rhomboid area. If you can't wait, try to use a tennis ball between your back and a wall (not on the spine, duh). Sit back, put some weight into it and dig out any knots. It might help release some of that tension that is traveling to your ribs. I also like just lying on top of a exercise ball and letting my back stretch out. Also, use heat - I love heat. If you have a heat pack or heating blanket, use it on your back to loosen that area out.

tennisenthusiast 08-23-2012 08:37 AM

Quote:

Originally Posted by DropTheBaseline (Post 6826634)
If it's on the same side I think there is a very good chance it's connected. Even if it's not, one might be secondary to the other. If I were you I would try some self-massage first. Search for a massage cane and use it on your rhomboid area. If you can't wait, try to use a tennis ball between your back and a wall (not on the spine, duh). Sit back, put some weight into it and dig out any knots. It might help release some of that tension that is traveling to your ribs. I also like just lying on top of a exercise ball and letting my back stretch out. Also, use heat - I love heat. If you have a heat pack or heating blanket, use it on your back to loosen that area out.

I have tried self-massage but not for more than couple of days. How long do I need to do this massage? Is heat recommended? I have been hearing that cold treatment is better than heat.

Getting frustrated with this injury.

tennisenthusiast 08-24-2012 06:44 AM

any other suggestions?

Hal 08-24-2012 07:15 AM

Cold/heat have different purposes...cold is good after you exercise to reduce inflammation. Heat is good before you play to warm up your muscles. In any case, I think you may want to try to build your core (stomach/back) for a while and see if you can do that without pain? You should be simulate ground strokes with some of the rotating core exercises.

Also, if you're experiencing tingling pain, what you're describing could be some sort of pinched nerve that may not show up on diagnostic imaging equipment? It sounds like you should see a different doctor for their opinion.

charliefedererer 08-24-2012 09:57 AM

Quote:

Originally Posted by tennisenthusiast (Post 6825825)
I do have occasional spasms near neck region but I thought that they were a different problem. Are those connected?

When I play, I have tingling pain for about couple days and then it slowly subsides. I am not sure how I hurt my rib muscles. I returned to tennis after long vacation and started playing without warm up?

Where is the tingling?

To me, there are four possibilities worth looking into:

1. cervical disc disease



"Depending on whether primarily motor or sensory involvement is present, radicular pain is deep, dull, and achy or sharp, burning, and electric. Such radicular pain follows a dermatomal or myotomal pattern into the upper limb. Cervical radicular pain most commonly radiates to the interscapular [area under the shoulder blades] region, although pain can be referred to the occiput, shoulder, or arm as well. Neck pain does not necessarily accompany radiculopathy and frequently is absent."
- http://emedicine.medscape.com/article/305720-clinical

2. thoracic outlet syndrome



" Symptoms include neck, shoulder, and arm pain, numbness, or impaired circulation to the extremities (causing discoloration). Often symptoms are reproduced when the arm is positioned above the shoulder or extended. Patients can have a wide spectrum of symptoms from mild and intermittent, to severe and constant. Pains can extend to the fingers and hands, causing weakness."
- http://www.medicinenet.com/thoracic_...me/article.htm

3. Shoulder impingement syndrome with referred pain to under the shoulder blade



"Impingement tears of the rotator cuff are common after 50 years of age. Many of these patients have no prior history of trauma, and an attrition defect develops insidiously. In this setting, the rotator cuff tear is brought to the attention of the physician when the patient presents with a long standing history of intermittent shoulder pain that has become progressively more symptomatic. At this juncture, pain is usually constant, worse at night and with overhead activities, and only mildly improved with anti-inflammatory agents. The pain is commonly referred to the base of the neck and upper arm."
- http://www.isakos.com/innovations/shoulder.aspx

4. Peripheral nerve compression



Nerves emerge from the neck going to the shoulder can be compressed or entrapped. This can happen in the neck or in the shoulder.

The most common is the Suprascapular Nerve. — (See illustration A) It comes from the neck directly to the top of the shoulder diving deep into the back of the shoulder blade. It can be pinched at the neck or irritated at the top of the shoulder by a muscle. The rubbing of this muscle can irritate the nerve and cause a painful neuritis. This pain should not be ignored. It is often misdiagnosed as a rotator cuff problem. Unfortunately, if left untreated this nerve can be permanently damaged and very painful. If unchecked it can cause serious pain and disability in the shoulder.

Another nerve less commonly affected is the Long Thoracic Nerve. – (See illustration C) It too originates in the neck and dives deep after emerging from the muscles in the side of the neck. It supplies the muscle to the inside of the shoulder blade between it and the ribs. It holds the shoulder blade close to the ribs. If it is affected the shoulder blade can “wing out” away from the spine. Strong downward force such as carrying a heavy suitcase with a strap or backpack can irritate and compress this nerve. The winging of the shoulder blade is tested by having the patient push against a wall and see if the shoulder blade wings out from the spine Scapular Winging. – (See illustration D)

Lastly, another nerve involved in the shoulder is the Axillary Nerve. – (See illustration A) The patient describes vague pain on the outside of the shoulder where the deltoid inserts on the arm bone. This innervates the deltoid and teres minor muscle as well as the skin on the outside part of the shoulder. This nerve can be injured during shoulder dislocation, because it is a taut nerve and passes through the bottom of the shoulder joint (armpit). It also can be injured by excessive chicken winging (abduction) of the shoulder and the arm. I’ve noticed when a patient has an injured tight shoulder this nerve is easily stretched when the arm is moved away from the body."
- http://newsletter.tristatehand.com/2004/may/

charliefedererer 08-24-2012 10:02 AM

The difficulty with coming to a firm diagnosis of any of the four problems above is that alost everyone has at least some evidence of cervical disease over the age of 40, and none of the other problems show up on x-rays, CT or MRI.

It will take a doctor interested in these problems to do a very careful history and physical exam.

A neurologist may be the best person to see - they often are used to seeing patients with somewhat vague symptoms that don't immediately fit into a precise category.

Doctors are often "busy" and "pressed for time". Often the first visit is spent on pursuing a very common problem like cervical disc disease. The second visit is often occupied with going over the initial battery of tests. For thoracic outlet syndrome, shoulder impingement with referred pain, or peripheral nerve compression are often not diagnosed until a third or fourth visit.


Orthopods main activity is evaluating patients with bony abnormalities "fixable" with orthopedic surgery. A few pride themselves on making diagnoses for which no surgery is needed. But many feel their role is to exclude the need for their exclusive remedy (orthopedic surgery), and puzzling cases are for neurologists or other specialists.

charliefedererer 08-24-2012 10:16 AM

All four of the above problems can be caused or made worse by imbalances of muscle or posture.

All four of the above problems can often be improved by physical therapy, and indeed physical therapy is usually the first line of treatment.

But what kind of physical therapy? Most doctors want a specific diagnosis before referring a patient for PT.


A very different approach is taken by Egoscue therapists. They take the view that improving the muscle groups around a site of discomfort by physical therapy exercises usually improves the pain by taking pressure off the area that is being abnormally compressed.

If I were you, I would get the book Pain Free by Pete Egoscue, turn to the pages involving your area, and do the recommended range of motion movements (light exercises).
http://www.amazon.com/Pain-Free-Revo.../dp/0553379887
You might also check to see if there is an Egoscue therapist in your area.

charliefedererer 08-24-2012 10:27 AM

Quote:

Originally Posted by tennisenthusiast (Post 6828025)
I have tried self-massage but not for more than couple of days. How long do I need to do this massage? Is heat recommended? I have been hearing that cold treatment is better than heat.

Getting frustrated with this injury.

Suzanna McGee who sometimes posts here has a great book (Tennis Fitness For The Love of IT) and tennis web site (Tennis Fitness Training).

If I were you, I would at least try the following regiment for myofascial release:
Release Tight Shoulders and Neck Pain with Upper Back Myofascial Release http://www.tennisfitnesslove.com/201...scial-release/

DropTheBaseline 08-24-2012 09:14 PM

Quote:

Originally Posted by tennisenthusiast (Post 6828025)
I have tried self-massage but not for more than couple of days. How long do I need to do this massage? Is heat recommended? I have been hearing that cold treatment is better than heat.

Getting frustrated with this injury.

I like to massage until I feel relief. If the massage stick is nearby and I'm in pain, I'm using it. Heat is recommended after 10-15min cold with a cycle occurring nearly every hour if I remember correctly. Sometimes I just go right to heat because my muscles are more stiff than inflamed.

Injuries suck. This game can be very cruel.

tennisenthusiast 08-27-2012 06:28 AM

Thanks Charliefederer and dropthebaseline!

I bought a yoga ball last week. Here is what is relieving my rib cage pain temporarily -- resting my lower back on the ball AND rib cage onwards on a futon (all in one stretch) with some gap in between futon and ball, I feel comfortable.

Any pointers/suggestions?

charliefedererer 08-27-2012 08:28 PM

I'm glad to hear you are at least getting some partial relief by a myofascial release technique that sounds like the one recommended by Suzanna McGee: http://www.tennisfitnesslove.com/201...scial-release/


Suzanna has taken care of tons of tennis players, so reading and implementing all of her recommendations in the above reference may be in order to fully recover and prevent an early recurrence:

"Stretch regularly! Try this great stretching routine. (It is also available in interlinked PDF format for your phone or iPad)
Focus on your posture until it becomes a habit.
Bring your shoulders back and keep your head straight up. Remember that slouched shoulders can cause rotator cuff problems.
Strengthen the upper back muscles with a variety of rows and pulls.
Reposition the shoulders with elbow touches and arm circles."





[What are these areas that require "myofascial release"? I think they represent small muscle/tendon/ligament tears depend on the inflammatory process to heal. But after a certain amount of protein strands are laid to repair the tear, some of those protein strands stick to adjacent tissues. Movement pulls on these areas, causing discomfort. The area never smoothly glides along like it should during normal movement. The myofascial release helps to mechanically break down enough of these protein strands, so the muscle can subsequently move normally without causing discomfort.]

frenzy 01-03-2013 10:29 AM

What kind of job do you have? If you have a job where you spend a lot of time behind a computer screen, it could be the cause too. Make sure to set up your seat according to YOUR needs.
Secondly, it could be that your major pectoral muscles are shortened. This may put pressure on your rhomboid muscles, and overstretch them. Try to stretch your pectorals and strengthen your rhomboids.

I have no medical experience, but this is what I currently do since I am having the same issue (although only for a few days now). It helped.

And please do warm up properly. You may feel uncomfortable when other people see you doing is (I rarely see people warming up without using a tennis ball on court), but you aught to. It saves you a lot of misery and pain. Good luck.


All times are GMT -8. The time now is 04:15 AM.

Powered by vBulletin® Version 3.6.9
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
© 2006 - Tennis Warehouse