Just before I had to close my clinic due to Covid 19 restrictions I worked on a client whose case really emphasized for me the deep interrelationship of the breathing passage with rib positioning and back pain. This new client came in with a host of different issues, including a big twist through his torso and shoulder and back pain. He told me that his pain was worse in the morning and got better through the day as he worked long shifts as a server. I also noticed his runny nose, which he told me was a chronic issue he thought was mostly due to allergies — a week before the pandemic became serious here in Canada I just noted this down as relevant clinical information rather than breaking into a panic and asking him to leave.
Postural Evaluation showed Rib Flare
Often the cause of back pain can be narrowed with postural evaluation. A glaring issue with his posture was a HUGE rib flare on both sides.
The most common cause of this issue is an upregulation of the muscles of the diaphragm, low back or the hip flexors and a downregulation of the muscles that hold the costal margin down. The abdominal muscles which hold the costal margin down importantly include the transverse abdominis and the internal obliques. These two muscles are especially important because they are both connected to the deep laminate layers of the thoracolumbar fascia. These connections mean they are partially responsible for the maintenance of intra abdominal pressure and core stability. However, after testing with Neurokinetic Therapy we found these muscles all relatively strong. This wasn’t a cookie cutter case at all. His core stability loss and back pain weren’t coming from his core.
Reflexive Stability Testing helps pinpoint the issue
Luckily I am also able to use reflexive stability testing to help narrow down the area that might be the most important. This client didn’t lose stability around his pelvis or ribcage, which is what you might expect with a big rib flare and low back pain. Instead we found that he lost most stability in the area of his face. What did this mean? Thank goodness for histories! His nose was straight so it wasn’t obvious he had broken his nose twice (once on either side). I did some nerve testing and found decreased sensation in V3 areas of the facial nerve on the right side. This meant that the scar tissue from the nose break was potentially entrapping a nerve. His jaw, neck and everything down from there was compensating for this unhappily stretched nerve.
Scar Tissue was blocking his air passage
Maybe more importantly, the scar tissue had partially closed off his air passage. This meant his diaphragm was having to work EXTRA hard to create a vacuum in his lungs for air to pour into. This overworked diaphragm was causing his rib flare and contributing to his back pain. How do we know? His ribs dropped after 10 minutes of release work. I released the scar tissue around his nose and adjusted his nasion (the bridge between the nasal bones/ forehead). This drop in his ribs also reduced the strain on his back significantly, returning core stability and reducing back pain. Of course, blocked air passages can cause even worse problems than that back pain. Read my blog post about another client’s struggle with fascial scarring here.
His Blocked Air Passage was Causing Back Pain
So why were my client’s symptoms worse in the morning and got better through the day? This pattern was another clue in the analysis and had a pretty simple answer– sinus drainage. His horizontal sleeping position made breathing even more difficult. It took hours upright during the day for his diaphragm to relax from the marathon of strained breathing during the night. While his ribs only dropped partially during this time, it was enough to give him relief.
Scar Rehab takes Time
Scar release does often take quite a bit of time to do. However, often my clients are able to do it on their own after I show them how. This client’s homework was bifold. 1) Continue the release around his nose a few times a day for at least 4 more days, and 2) focus on exhalation when doing conscious breathing exercises. I heard back from him 6 days after his appointment. He was happy to report that his left nostril had cleared up significantly. This was a big shift from what felt like a lifetime of stuffiness. I am looking forward to what we find when we finally get to work together again – hopefully soon.
Pain Assessment means looking beyond the Obvious
If you have back pain it could be related to core stability loss. However, it might also be connected to something less obvious. Chronic stuffiness, a previous broken nose, fascial scarring, time of day that the pain gets worse or better– these are all hints that help lead me to the real causal agent of chronic pain issues. This work brings out the detective in me — I follow the body of evidence in front of me and then test using NeuroKinetic Therapy to verify my hypothesis. If you have chronic pain or a movement disorder that you’ve been having trouble getting good treatment for, contact me firstname.lastname@example.org or book an appointment.
Image credit from strongfirst.com which has a great article on breathing, strength and posture; which explains the more common causes of rib flare and how to correct them. I highly recommend it! https://www.strongfirst.com/avoid-injury-maximize-strength-correcting-rib-flare//