Waiting to Inhale
Monday October 26, 2009
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Although a cracked or broken rib doesn’t usually slow down professional athletes like Brett Favre or Donovan McNabb for long, the pain from any fracture in the thoracic region can sideline members of the general public. This is particularly true for the elderly, in whom serious pulmonary complications can occur.
Because many rib injuries go unreported, the number of rib fractures in any given year is difficult to gauge, although estimates run as high as 300,000 annually. Usually, patients are given pain medication and advised by physicians to wait out the healing process for the four to eight weeks typically needed for bones to heal.
Although physical therapy interventions may not speed bone healing, PTs can improve outcomes by teaching patients proper breathing techniques, helping them manage their pain, and encouraging them to maintain their activity levels, says Tim Tavanbakhsh, PT, primary physical therapist for the orthopedic unit at Santa Monica (Calif.)-UCLA Medical Center and Orthopaedic Hospital.
“We try to be on the case immediately or the next day to encourage them to take deep breaths to prevent decreased lung capacity,” Tavanbakhsh says. He sees patients with rib fractures for pain management and to instruct them in using an incentive spirometer to gauge deep breathing efficacy, and for ROM and posture training two to three weeks later.
Restricting Pain
A key component to treating rib injuries is minimizing pain, Tavanbakhsh says. Although patients are generally prescribed pain medication, some PT treatments can ease pain as well. Depending on the type of fracture and phase of recovery, Tavanbakhsh might use cold packs, localized heating pads, or, in some cases, a TENS unit to decrease pain. “But even with the pain, we encourage them to take deep breaths,” he says.
“We don’t recommend patients wear any belt or abdominal binders because that limits their breathing function,” Tavanbakhsh says.
But binding the chest short-term can be an effective part of treatment, depending on the patient and the type of fracture, if the patient is closely monitored for complications, says Bryan Ruchin, PT, DPT, MSPT, a physical therapist with the Atlanta Rehabilitation and Performance Center.
“The compression is pain-relieving because it doesn’t allow the bone to move even when you breathe. [But] the problem you start to run into, especially depending on the age of the patient, is breathing complications,” Ruchin explains. “People can develop pneumonia. They can start to develop other breathing problems, and be more prone to sicknesses and illnesses because they aren’t breathing effectively. Depending on how much oxygen you’re taking in, you can even start to get light-headed and dizzy. You do have to be careful,” he says.
Although using a compression wrap on a fractured rib can ease pain, it also can increase the risk of pneumonia, especially in older patients. “Long-term use of the wrap is bad, but short-term use, in my opinion, is not that bad. But like I said, it depends on the patient,” Ruchin says.
Treating an athlete and treating less active adults is different, says Ruchin, who estimates 30% to 40% of the patients in his practice are athletes. “If we get an athlete who fractures a rib, I’m going to wrap him, and I may develop some way to splint or tape or pad the area so if he takes another hit there, he’s not going to feel it or it’s not going to hurt.”
But with the elderly, he does not wrap the area. “You really want to be cognizant of their breathing and lung issues because a lot of them already have existing lung issues,” Ruchin says. Sometimes he will train them in the use of an incentive spirometer to promote lung expansion, and he also teaches patients transitional techniques to disperse the pressure and strain on the injured area, such as holding a pillow against the fracture site while breathing deeply or getting up from a sitting position to provide localized compression and pain relief.
Facilitating Movement
Although PTs who treat patients with rib fractures cite anecdotal evidence of the efficacy of intervention, there are no controlled studies documenting that people get better functional outcomes with PT than without it, says Catherine Ortega, PT, EdD, ATC, OCS, associate professor of physical therapy at the University of Texas Health Science Center at San Antonio.
“That doesn’t mean it doesn’t help,” Ortega says. “It just means that we’re back where we are with a lot of our other physical therapy interventions. We don’t necessarily have enough randomized, controlled trials or scientific investigations that validate everything we do.” Based on her experience, the ultimate goal of PT intervention for rib fractures is to prevent complications such as pneumonia.
Tavanbakhsh concurs. “In the majority of cases, when they’re in pain, they’re not active. They just sit around. They sit in their chair and bend over. When they get weak and unable to take a deep breath, they get tired very easily,” he says. “If they don’t get any therapy, they become extremely low functioning.”
Anne Federwisch is a medical writer for Gannett Healthcare Group.
Because many rib injuries go unreported, the number of rib fractures in any given year is difficult to gauge, although estimates run as high as 300,000 annually. Usually, patients are given pain medication and advised by physicians to wait out the healing process for the four to eight weeks typically needed for bones to heal.
Although physical therapy interventions may not speed bone healing, PTs can improve outcomes by teaching patients proper breathing techniques, helping them manage their pain, and encouraging them to maintain their activity levels, says Tim Tavanbakhsh, PT, primary physical therapist for the orthopedic unit at Santa Monica (Calif.)-UCLA Medical Center and Orthopaedic Hospital.
“We try to be on the case immediately or the next day to encourage them to take deep breaths to prevent decreased lung capacity,” Tavanbakhsh says. He sees patients with rib fractures for pain management and to instruct them in using an incentive spirometer to gauge deep breathing efficacy, and for ROM and posture training two to three weeks later.
Restricting Pain
A key component to treating rib injuries is minimizing pain, Tavanbakhsh says. Although patients are generally prescribed pain medication, some PT treatments can ease pain as well. Depending on the type of fracture and phase of recovery, Tavanbakhsh might use cold packs, localized heating pads, or, in some cases, a TENS unit to decrease pain. “But even with the pain, we encourage them to take deep breaths,” he says.
“We don’t recommend patients wear any belt or abdominal binders because that limits their breathing function,” Tavanbakhsh says.
But binding the chest short-term can be an effective part of treatment, depending on the patient and the type of fracture, if the patient is closely monitored for complications, says Bryan Ruchin, PT, DPT, MSPT, a physical therapist with the Atlanta Rehabilitation and Performance Center.
“The compression is pain-relieving because it doesn’t allow the bone to move even when you breathe. [But] the problem you start to run into, especially depending on the age of the patient, is breathing complications,” Ruchin explains. “People can develop pneumonia. They can start to develop other breathing problems, and be more prone to sicknesses and illnesses because they aren’t breathing effectively. Depending on how much oxygen you’re taking in, you can even start to get light-headed and dizzy. You do have to be careful,” he says.
Although using a compression wrap on a fractured rib can ease pain, it also can increase the risk of pneumonia, especially in older patients. “Long-term use of the wrap is bad, but short-term use, in my opinion, is not that bad. But like I said, it depends on the patient,” Ruchin says.
Treating an athlete and treating less active adults is different, says Ruchin, who estimates 30% to 40% of the patients in his practice are athletes. “If we get an athlete who fractures a rib, I’m going to wrap him, and I may develop some way to splint or tape or pad the area so if he takes another hit there, he’s not going to feel it or it’s not going to hurt.”
But with the elderly, he does not wrap the area. “You really want to be cognizant of their breathing and lung issues because a lot of them already have existing lung issues,” Ruchin says. Sometimes he will train them in the use of an incentive spirometer to promote lung expansion, and he also teaches patients transitional techniques to disperse the pressure and strain on the injured area, such as holding a pillow against the fracture site while breathing deeply or getting up from a sitting position to provide localized compression and pain relief.
Facilitating Movement
Although PTs who treat patients with rib fractures cite anecdotal evidence of the efficacy of intervention, there are no controlled studies documenting that people get better functional outcomes with PT than without it, says Catherine Ortega, PT, EdD, ATC, OCS, associate professor of physical therapy at the University of Texas Health Science Center at San Antonio.
“That doesn’t mean it doesn’t help,” Ortega says. “It just means that we’re back where we are with a lot of our other physical therapy interventions. We don’t necessarily have enough randomized, controlled trials or scientific investigations that validate everything we do.” Based on her experience, the ultimate goal of PT intervention for rib fractures is to prevent complications such as pneumonia.
Tavanbakhsh concurs. “In the majority of cases, when they’re in pain, they’re not active. They just sit around. They sit in their chair and bend over. When they get weak and unable to take a deep breath, they get tired very easily,” he says. “If they don’t get any therapy, they become extremely low functioning.”
Anne Federwisch is a medical writer for Gannett Healthcare Group.
To comment, e-mail pteditor@gannetthg.com.
Monday October 26, 2009