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Hi all,
My client did something to her ribs when pull a heavy garbage can. She felt something right away which progressively got worse over the first three days. When she first came to me the pain was all over her low back and side of the body and slightly worse on the right side. She is 72!
Pain and discomfort were present all the time but the worst movement for her was getting up from bed in the morning as well as turning from side to side to in bed. But getting out of bed was definitely the worst.
I addressed the deficiencies of Stomach fluids and kidney yang and did a Bl and Gb sinew channel treatments. There was no sinew pulse. I chose Bladder thinking getting out of bed was a form of an attempt to extend herself as well as location of actual pain. Gb also for location as well as difficult turning side to side.
I have to say the progress over 3 session almost every other day was pretty slow, but there was progress. The area of discomfort reduced and allowed me to suspect either a pulled muscle in ribcage area or an actual dislocated rib! She has been very busy and a bit stressed lately and it’s winter, so I thought these maybe factors for the slow progress.
Fourth session, I did some local cupping in the area and today she has called to say the pain is a lot worse. So I thinking it’s probably a dislocated rib that I might have agitated with the cupping. Can’t think of anything else. Her spine seems good; I didn’t sense any vertebral issues.
My question is:
Does anyone have experience treating a dislocated rib with sinew treatment?
Am I missing something in terms of figuring out a channel? Possibly, Jue yin sinew!?
Should I refer out to a Chiro for a quick pop in of the rib rather than risking another aggravation?
Thank you!
Hi Armin,
I’ve had success (although limited, I’m still new to this!) treating rib injuries, including subluxation, with sinew treatments. In my experience, joints sometimes shift on the table and sometimes go back into place a day or two after treatment–I usually tell the patient to pay attention to changes for 72 hours after a sinew treatment.Since the patient came with constant pain, that indicates jueyin sinew. I would also suggest looking at yangming–getting out of bed and even turning over in bed can be a weight-bearing type movement, like getting up from a chair. My understanding is that taiyang would be suggested in this case by pain with motions such as arching the shoulders/spine backward. Does this match with other people’s understanding?
I hope things are going well!
Hi Erica,
Thanks so much for your input. I, too, have had the experience of dislocated ribs and cervical or lumbar joints going back into place after treatments but this one proved a bit challenging.
Your comment on Yang Ming involvement makes perfect sense. I am still learning how to interpret these movements. Also, the way you described Tai yang is pretty bang on; I do recall Ann describing that way too.
The patient did go to Chiro after the fourth session, but he did not do a traditional Chiro adjustment for her and instead did more the gentle soft tissue work. Things got a lot worse after for 48 hrs but slowing settling down. She is going for one more Chiro today.
If I see her again, I will give Yang Ming a go and will give an update here.
Cheers
Hello Armin,
I would also consider Shaoyin for the treatment. Getting out of bed can include a lot of movements and its can be difficult to know what the patient means. It is the actual movement of getting up when she is already sitting on the corner of the bed ? Turning to get into a sitting position before getting up ? As she mentioned pain when turning side to side in bed, I guess (still new to this also!) it can be seen also as a shaoyin. Often we drag the legs towards our chest when doing this type of movement.
That just an idea, hope your patient is already going well with the last Yangming treatment.
Cheers,
AntoineThanks Antoine for your perspective. My understanding of pulling leg towards the chest is that it would be Tai yin. Shao yin is more bending the limbs and taking them passed the midline.
The patient did come back after two chiropractic sessions. The Chiro did not think anything was out of place that needed popping back in. He did a lot of manual stuff. After first session, there was a lot of aggravation, less so after second session. The patient thinks there was some 15% improvement, but thinks acupuncture was helping more all around. This made me feel better about my fourth session with her when there was an aggravation, but also the first 3 sessions when there had been steady improvement.
This last session I incorporated the Yang Ming (St) and Jue yin. Again, overall improvement and for the first time, she was able to sleep on the side of the pain. I think the Yang Ming makes perfect sense given that it covers the front of the ribcage.
On the right track here:)
Hello Armin,
I agree with for the movement of bringing the legs towards the chest is Taiyin, but I wonder about when you are in this position and you roll your legs on the side to get into a sitting position at the border of the bed. For me this type of movement would indicate a Shaoyin Sinew, but I may be wrong. So I am curious to hear about experiences that each of us can have on the subject !
Nice to have your feedback on the case, and to have more insight on the Yangming. It feels that it is one we often overlook when there is back pain and chest pain. Hope she gets a full recovery with your treatments.
Cheers,
AntoineYangming is so important! So many movements can end up being weight bearing, even if it’s just body weight and gravity. We had a joke in one of Sean Tuten’s classes about starting a “yangming sinew school”—-which was just adding yangming to any of the other channels diagnosed. 🙂
One of the ways I make diagnosis easier for myself is to base it off of movement assessment that happens in front of me. I get the person to go through all the motions. That way I can suss out what movement exactly is causing the pain. And sometimes there are painful movements that the patient wasn’t aware of!
I hope things continue to go well, Armin!After that last session and over the following 2-3 days, she has continued to improve. Now there is only 5% left and I haven’t seen her, just through an email. So thank you for that Yang Ming tip!
It reminds me of a case I had last year. One of my clients had put her neck out, like morning stiffness, torticollis type of thing. She had difficulty holding up her head in order to sit behind the desk and do her work as well as bending forward (neck flexion). Back then, I still had not gotten into the sinew treatments out of fear of hurting people. I gave three sessions of doing my own stuff which generally would help but in this case, it was not shifting. She ended up going to a massage therapist who had studied the Anatomy Trains of Mayers, who works with the fascia (basically the sinews and I have a feeling he got it from our system!!! 😉 ). When she came back to me, she said the therapist had done some work on the front of her neck and torso pointing more or less to the yang ming zone and after that she got better.
I had already taken a course with Ann on sinews so went back to those notes and realized that yes, she had difficulty holding the weight of her head as well as forward flexion, both yang ming, which was missing from my treatment of only Tai Yang/shao yang. And that was when I decided to toughen up and get over my anxiety of potentially hurting people.
After my second course on sinews with Ann, I saved a patient from a $12k back surgery in two sessions. That was my first sinew treatment case as well 🙂
Lots more to learn!
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