Mid-Back and Rib Pain After a Car Accident

Patients describe it as a knot between the shoulder blades, or a catch when they take a deep breath, or a band of tightness that wraps around toward the front. It is rarely the complaint they lead with, and it is often the one still bothering them months later.

A different kind of spine

The neck and low back are built for motion. The mid back is built for stability, because it has to protect the heart and lungs. Twelve vertebrae each connect to a pair of ribs, and those ribs connect forward to the sternum. The result is a cage, and a cage transmits force rather than absorbing it.

In a collision this means the thoracic spine cannot dissipate energy by moving. It also sits directly between the neck, which is whipping, and the low back, which is being compressed into the seat. It gets loaded from both ends.

The rib joints

Every rib forms two small joints where it meets the spine. These joints move a few millimeters with each breath, which adds up to roughly twenty thousand cycles a day. When one is sprained or restricted after an impact, every single breath irritates it.

That is why costovertebral injury has such a distinctive presentation. Sharp pain with a deep breath, a cough, or a sneeze. Pain that seems to stab through to the front of the chest. Difficulty finding a comfortable sleeping position. People frequently worry it is something cardiac, and the relief when they learn it is a rib joint is considerable.

The seatbelt again

The shoulder harness crosses the rib cage diagonally, and in a frontal impact it delivers its load directly to the ribs it lies across. Bruising along the belt line is visible evidence of force that also reached the joints underneath. Absence of bruising does not rule the injury out.

Why it lingers

Because the mid back does not produce dramatic symptoms early, it often goes untreated while attention goes to the neck. Meanwhile the segment stiffens. A stiff thoracic spine forces the neck and shoulders to compensate for motion the mid back is no longer providing, which is a common reason neck symptoms plateau and stop improving. Treating the neck alone in that situation tends to produce relief that does not hold.

How we treat it

We assess rib motion directly, one level at a time, with the patient breathing. Restoring motion at a restricted costovertebral joint often produces immediate change in how a deep breath feels. From there the work is about getting the thoracic spine moving well enough that the neck no longer has to do its job for it.

If breathing has hurt since your accident, call (725) 255-7333. Henderson, southwest Las Vegas, and North Las Vegas.