Question
I sustained an injury resulting from lifting a heavy fixture.  At the time, I felt and heard a pop like sound at the center of my sternum and felt an unzipping feeling going down my right rib cage.  The pain was so intense that I almost passed out.  Upon going to many doctors the end result appears to be a fractured sternum and the cartilage was torn off my rib cage, only to be attached at the far end towards my back.  This cartilage has caused tremendous pain.  At times it appears to get "lodged" somewhere and I experience a tugging pain in my back.  And then at times it dislocates and pushes its way through my ribs and protrudes out.  Extremely, extremely painful.  I have gone to four doctors and all of them say that nothing can be done for me.  Do you have any advice?  I have become very frustrated and down.  I am afraid to move, lift, twist, etc. for fear of that excruciating pain.  I don't get any warnings of the onset and the pain gives me nausea and at times vomiting.  Please help.  Thank you.  

Answer
Dear Lisa,

There is a newer type of therapy aimed at the alleviation of pain by re-establishing a measure of corrective inflammation to stimulate collagen growth/repair of injured tissues.  Collagen is the building block of soft tissue such as cartilage, ligaments, and tendons.  This may offer you a measure of success in repairing the injury.  This therapy is called Prolotherapy and is performed with local injections, which will not require time away from work.

I do not have detailed knowledge on the subject, so I am going to send you one of the best websites to look over.  

http://www.prolotherapy.org/

The information on this site is well organized, and extensive.  This therapy is growing throughout the United States and many medical doctors can be found who are prolotherapy proficient.  At this point I would not recommend chiropractic care for the injury even though it is likely that you have vertebral fixation issues concerning the articulating ribs.  I think that with the incomplete healing as well as the pain, you would be better served by Prolo to jumpstart the resolution of the primary problem.  If you elect to try prolo, I would recommend a chiropractic follow-up after treatment resolution to analyze the biomechanical relationship of the sternum/rib/vertebra interface.

Additionally some nutritional recommendations should be considered.A well-balanced and healthy diet obtains vitamins and minerals from natural sources. You should always use food first and supplements second. However, in times of physiologic stress, such as injury, it can be hard to meet the body's increased needs through diet alone. It is also important to stress that nutritional supplements do not work immediately and must be taken consistently, even if effects are not immediately and directly noticed.  The underlying repair mechanisms of the body only work when they have the correct substrates and cofactors. Following are some notes on nutrients for bone and wound healing.

Glucosamine/Chondroitin/MSM:  Glucosamine is thought to promote the formation and repair of cartilage.  Glucosamine hydrocloride is the form that is best absorbed by the body, but glucosamine sulfate is utilized more appropriately for repair. Chondroitin sulfate promotes water retention and elasticity in cartilage and inhibits enzymes that break down cartilage. MSM is also important in cartilaginous repair.  You need to consume a minimum of 1500 mg of Chondroitin and Glucosamine, as well as 750mg of MSM per day after injury.  A minimum dosage period would be for two months.

Bone-Healing:  rates may be enhanced by following some of the recommendations for preventing and reversing age-associated bone loss, such as supplementing with the nutrients calcium, magnesium, boron, and vitamin K. It should also be noted that you must have sufficient vitamin D (D3) to facilitate the absorption of calcium and magnesium.  The preferred forms of calcium and magnesium are the citrate forms. Do not use calcium carbonate. You can obtain enough vitamin D from 20-30 minutes of sun exposure daily.  In addition you must eliminate the intake of carbonated beverages and sodas.  These products will inhibit the repar mechanism of the bone and leach calcium from the bone structure.

Copper: supplementation is important in fracture healing and in the early formation of collagen in a wound. Eight milligrams of copper daily provides adequate supplementation and should be taken for six weeks for a fracture of a non-weight-bearing bone such as ribs or the upper extremities. It should be taken for 2-3 months for a major weight-bearing bone such as the femur or pelvis. Because copper is also a pro-oxidant, supplementation should be stopped after this period of time.  In addition you will need to have an increased intake of antioxidants such as vitamins a, c , e, selenium, bioflavanoids, quercetin, pycnogenol, co-enzyme q-10, and ginko biloba  to combat the excess oxidant actions of copper.

Zinc:  has been recommended at a dose of 90 mg daily (as recommended for early healing of wounds). Zinc's enhancement of fracture healing may be related to its effects on increasing IGF-1 and TGF-beta.

Vitamin-C: and additional anti-oxidants have also been shown to speed the healing process.  Whole food complexes of vitamin c are preferred over synthetic forms.  Ascorbic acid is a poor form. Vitamin C is a major constituent concerning collagen repair.

Omega-3 Fatty Acids:  act as anti-inflammatory agents, making them beneficial for patients with any inflammatory condition. There are three major types of omega 3 fatty acids that are ingested in foods and used by the body: alpha-linolenic acid (ALA)-18 carbons, eicosapentaenoic acid (EPA)-20 carbons, and docosahexaenoic acid (DHA)-22 carbons. Once eaten, the body converts ALA to EPA and DHA, the two types of omega-3 fatty acids more readily used by the body. Extensive research indicates that omega-3 fatty acids reduce inflammation and help prevent certain chronic diseases such as heart disease and arthritis.  Typical dosage after injury is 4000 to 6000 mg daily for 3 months.  Then reduce to a maintenance dose of 3000 to 4000 mg daily.  In addition the supplement should be molecularly distilled, pharmaceutical grade, and free of toxins.

Flaxseed-Oil:  One or two tablespoons of flaxseed oil daily is considered optimal for a healthy individual. Capsule doses are 3,000 mg per day for disease prevention and 6,000 mg per day for treatment to reduce inflammation.  Flaxseed is not utilized as well by the body as omega III fatty acids, but it is still important in eicosanoid management.

Linolenic-Acid:  A diet that gets 1-2 percent of its calories from Alpha-linolenic acid has been shown to give maximum tissue levels of DHA, avoiding any apparent deficiency symptoms.  ALA does have to be converted in the body through an enzymatic process using delta-5-desturase, before it can enter the cell membrane.

Precautions:  The ratio of omega-3 fatty acids to other essential fatty acids is important, but some caution is warranted. Take omega-3 oils cautiously if you bruise easily, have a bleeding disorder, or take blood-thinning medication. Excessive amounts of omega-3 fatty acids may increase the amount of time that it takes for the blood to clot following a cut or other injury.

Possible-Interactions:  First and foremost you need to make sure that none of the nutreints listed will interfere with Prolotherapy since it is jumpstarting another controlled inflammatory reaction.  The nutrients listed above are to aid healing so I don't think there will be any interactions, but you wouldn't want to reduce the effectiveness of the treatment.  Omega-3 fatty acids may increase the blood-thinning effects of aspirin. While this combination may be helpful in the treatment of some diseases, you should only take omega-3 fatty acids under the guidance and supervision of your healthcare provider if you are on aspirin therapy. That being said, it is not advisable to take aspirin or NSAIDS like ibuprofen and Tylenol for pain after injury, due to research showing that it interferes with the normal inflammatory process, and will hinder optimal healing of bone and cartilaginous structures.  Healing times are actually increased when aspirin and NSAIDS are consumed.

Good Luck Lisa.
Respectfully,
Dr. J. Shawn Leatherman