Question
i began seeing a chiropracter in oct07, i was exper. left sided chest pains(stings, burns, ect.) to my surprise they have almost but completely went away.  i had a car accident on thanksgiving of 07 i was struck on my drivers side at a hard impact and i was shifted side to side and my head broke the drivers side window. there was no immediate injury as per er. i continue to see my chiropracter and he says my ribs are out of allignment that one side is higher than the other. i started exp soreness and pain in my upper middle back esp the right side it hurts to stretch or take a deep breathe in that area and in the middle of my chest and lower ribs as well.. the dr said it was my ribs .. but it is now is also protruding to the front of my chest and ribs. it feels as if a balloon is inflating in my chest or if i stretch back it feels extremely tight and if i hunch over it feels like my chest is cavig in. at times it hurts so bad that i begin to get anxiety over this for fear that it is heart related. i did go to er once and everything checked out ok(blood, chest xray, ekg) its also prevalant in my chest just sitting , it feels like a constants pressure or tightess.. it seems to flare up and subside for days at at time. when he adjusts my back laying on my stomache it hurts and i feel it in the front. also if he adjust or moves my neck a certain way i feel it in my chest as well.  i also have pain while i lay on my back or lift my arms in the air.  could his adjustments be too rough that its causing this type of pain? he says it cuz my ribs are twisted but i wonder what else it could be.

Answer
Dear K,

Vehicle crash impacts can be quite damaging to the spine and cause a variety of long-term symptoms.   So on one hand be patient and focus on healing and staying active with exercise.   On the other hand, be sure your DC is not overlooking anything.  The symptoms you describe cause me to suspect a cervical spine injury.  These injuries can damage discs and the interlocking "facet" joints, causing referred pain into the upper back rib areas.  A textbook pain pattern from whiplash injury is a "coat hanger" distribution of pain.  Imagine the shape of a coat hanger behind your neck and upper back.  Cervical spine disc tears or protrusions in the most commonly affected discs, often C5 or C6 discs, will distribute pain into the upper back and ribs, as well as down the arm.  Neck injuries can also affect the spinal cord.  Some people get a fluid-filled, thread-like separation in the spinal cord, called a "syrinx," that can cause pain, extremity weakness, and referred pain into the chest and shoulder.   Ask your DC to consider these things so as to be sure that they are ruled out.   If it is surely a rib, with localized tenderness at the rib connections to the spine, and your adjustments are painful, unpleasant, or simply not working in providing some level of relief, then speak up!  Tell you DC to change up and try something else.  If a rib adjustment from back to front hurts, then try front to back.  If that's no good then switch from high-velocity manipulations to lower-force techniques.  Try adjunctive physiotherapies such as ice/heat/ultrasound prior to see if that lessens the discomfort.  Try low level laser over any locally tender areas using a laser with a few wavelengths that also include a 635 nanometer wavelength (I realize this may be too technical but you can google "low level laser and pain" to see what's out there or have your DC go to:  www.laser.nu/index.htm).  Lastly, be sure that the DC is adding a hands-on soft tissue therapy to the mix such as active myofascial release methods or GRaston Technique.

'Hope this was helpful.

Dr. G