Laurie,
I filled in for a colleague a week ago and worked with a dog that that is a 10 year old female spayed old english sheepdog mix breed.. She has quite the history and during my exam I sure made her squeal in two distinct spots - first - in the area of her first rib on the right - it was hot to the touch, felt like it had loads of scar tissue build up and boy did it hurt when I palpated the area. I also got a big pain response in her right iliopsoas muscle.
The reason I am contacting you is the owners have been dealing with issues with her for over a year and have had her to myriad of specialists without a diagnosis -- you are the person I learned about dislocated ribs from. (I have only worked with a few cases of first rib dislocations (that I specifically found an issue) and both were cranially dislocated and I did light manipulations on both and within a few sessions they seemed to be cured - a few yelps along with that.) This dog has had MRI's and CT's according to the owner with no obvious findings. Her dad told me when I met him that the onset of issues was when she fell down a hill and she screamed out in pain. She is quite lame on her right fore and she has good days and bad days with it.
Anyhow - I believe the rib is caudally dislocated, but with what feels like loads of scar tissue around the area, I can't totally get my hands on the rib that I know is there. I reviewed your video about ribs and I worked with some light manips (she is SO painful) going from under her shoulder area and pushing cranially. Rads included are from over a year ago -- when she first demonstrated issues.
Questions:
1) Owner is VERY into 'fixing' this issue. He doesn't understand why the surgeons missed this and wants to still do surgery to fix it. (Having worked very closely with board certified veterinary surgeons over the past 5 years, I think most would laugh at the diagnosis...just their mentality.) However, my thought process is that this has been dislocated for about a year according to the owner and even some serious work on her may not be able to break down the scar tissue and move the muscle tissue back to their 'normal' place as it has made a new 'normal.' PLEASE let me know your thoughts -- I may be totally wrong.
2) This dog was originally diagnosed by the therapist as having a medial shoulder instability - I have worked with many of these as well and her angles are slightly increased, but I don't think this is the problem - I think she has lost muscle mass and can't hold her arm correctly due to disuse- any comments?
3) I am trying to link the iliopsoas with the displaced 1st right rib - do you think it is compensation?
4) Any recommendations, comments? I included radiographs -- I don't clearly 'see' a dislocation...do you really see a dislocation with these all the time? Laser, exercises, acupuncture for pain, heat, manipulation of the rib - (the doctor doesn't have ultrasound) - any other suggestions?
Thank you for your help!!!
DG
First Rib Issue
First Rib Issue
LAURIE EDGE-HUGHES
Re: First Rib Issue
Hi D!
So, in a case where things are so very painful and you can feel all sorts of tension / increased muscle tone, I’d start with myofascial holds / scalene stretches. (Training Video 143)
You can ease into the area with gentle work (vs a manipulation). In some cases, I’ve found that the scalene stretch does the whole thing.
We are coming to know that ‘dislocated / subluxed’ joints don’t really happen… it’s been a misnomer for years, decades, maybe a century? Instead, there is abnormal pressure in the joint and abnormal neural firing in and around the joint. So, we can accomplish what we want to accomplish (better movement & reduced pain) with a multitude of different techniques.
In this case, I’d do the laser for sure, the scalene stretches, if able just some lateral distraction / bouncing on the rib - just for easy movement, cookie exercises, and any other massage techniques to scalenes, intercostals, and/ or brachiocephalicus.
The iliopsoas I would categorize as compensatory as my first guess. As an aside, I often see ipsilateral SIJ and 1st rib issues… so perhaps there could be a bigger soft tissue / fascial connection as well that is playing a part. I would treat with laser, slow, long, myofascial type stretches, and rear-feet up reach forward for cookie exercises. (Check out the Articles section and then Protocols to find my iliopsoas protocol).
All the best!
Laurie
So, in a case where things are so very painful and you can feel all sorts of tension / increased muscle tone, I’d start with myofascial holds / scalene stretches. (Training Video 143)
You can ease into the area with gentle work (vs a manipulation). In some cases, I’ve found that the scalene stretch does the whole thing.
We are coming to know that ‘dislocated / subluxed’ joints don’t really happen… it’s been a misnomer for years, decades, maybe a century? Instead, there is abnormal pressure in the joint and abnormal neural firing in and around the joint. So, we can accomplish what we want to accomplish (better movement & reduced pain) with a multitude of different techniques.
In this case, I’d do the laser for sure, the scalene stretches, if able just some lateral distraction / bouncing on the rib - just for easy movement, cookie exercises, and any other massage techniques to scalenes, intercostals, and/ or brachiocephalicus.
The iliopsoas I would categorize as compensatory as my first guess. As an aside, I often see ipsilateral SIJ and 1st rib issues… so perhaps there could be a bigger soft tissue / fascial connection as well that is playing a part. I would treat with laser, slow, long, myofascial type stretches, and rear-feet up reach forward for cookie exercises. (Check out the Articles section and then Protocols to find my iliopsoas protocol).
All the best!
Laurie
LAURIE EDGE-HUGHES