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Disclaimer: I am not a doctor or medical professional, I am a person with SRS. These are just things that I have found have helped me to manage pain and may not work for everyone. I have been using some of these for years, when I had symptoms but didn't yet know that they are being caused by SRS.

 

As many doctors are currently unable to diagnose SRS and have no knowledge of what it is or how to treat it, many SRS patients (83% according to Dr. Adam Hansen) are given NSAIDs (anti inflammatories), which are used to treat inflammation. 48% are given neural modulators such as gabapentin or amitriptyline, and 8% were given some sort of narcotic.

The mean amount of pain duration in his study was 38 months prior to diagnosis, but some SRS patients live for years with the pain. For others, unfortunately, again according to Dr. Hansen's study it is important to point out that 30 - 40% of SRS patients have suicidal thoughts, as many of us (including me) are told that there is nothing medically wrong with us, despite living with what for some of us can be excruciating and life altering pain prior to correct diagnosis and treatment.

 

Slipping Rib Syndrome can cause many different types of pain, depending on your situation, the ribs involved and how and how much they move you may not have all of them. For more information on the symptoms of SRS click here.

 

I want to point out again that these pain management strategies that I am sharing with you are from my own experience.

I have found that no painkillers have been able to help my pain. I have tried oral paracetamol, co-codamol, and ibuprofen as well as topical creams with little to no results.

 

Here is how I have managed my own pain and symptoms: These do not stop the pain for me, but some of them do provide some short-term relief.

 

Abdominal Pain and digestive issues: As one of my symptoms is pain from trapped wind in the gut with nausea, excessive flatulence and eructation (burping) after eating, as well as heartburn and and bloating I found that taking peppermint oil capsules before food helped to ease this a little, as well as avoiding foods that increase gas (beans and cabbage for example) and foods that are difficult to digest. I also regularly drink Turmeric and Ginger tea, which has anti-inflammatory properties and settles the stomach. I was prescribed 'Mebeverine Hydrochloride' which is a medication mainly used in the management of Irritable Bowel Dyndrome, that slows down contractions in the bowels, easing the discomfort caused by this and reducing the chance of diarrhoea and other associated symptoms. 

 

For the burning pain under my shoulder blade: I found that avoiding using my arms, relaxing and avoiding physical activity can help it to settle down. On days when I could not avoid this and have had a flare up of the pain I used deep heat, and a 'theracane' to gently massage the area (the theracane is a self massage device that can be found here on amazon). This does not stop the pain as the pain is not muscular, but by relaxing the muscles in the area with the theracane, and increasing blood flow to the area using the deep heat, I found that it offers some, albeit minor, relief.

 

Spine and back pain: I found that for me this pain was brought on by standing for long periods, and being physically active, worsening with time. People often think "It's just back pain" but for me the pain in the spine is like nothing else and at its worst is very debilitating. The spine pain is no joke and has reduced me to tears in a ball on the floor on several occasions. I have found that for the general back pain caused by tightening of muscles in the area as a result of the SRS, Using the 'theracane' to gently massage helped (avoiding the spine and only massaging soft tissues) I also use a 'Shakti' Acupressure mat, which is based on a bed of nails, and works by reducing muscular and soft tissue pain by increasing blood flow to the area. It is not as painful as it sounds and you can find one of these here. 

There is very little that helps the spine pain for me, but I found that lying flat on the floor can help to take off the extra pressure from gravity, and also using heat from a hot water bottle. I sit with the hot water bottle as hot as I can stand, on the painful area and it offers some relief). Some people opt for thoracic nerve block injections but there is limited success in SRS patients. Nerve block injections are expensive, and are only a temporary fix. Typically their effects last for one or two weeks and then wear off. Some patients have several nerve block injections before getting any long-term relief, and others do not receive long term pain relief.

 

Nerve pain: I was given amitriptyline by my doctor, but this does very little for me, although it does help me to sleep. The nerve pain sort of feels like 'electrical pulsing or throbbing', which I mainly get in my torso around the ribs and into my back (caused by the slipping ribs impinging on the intercostal nerves (Intercostal neuralgia). I found that changing position if I am sitting can help to relieve the pain a little in cases where it is being caused by an impinged nerve, and oral CBD oil can also help to reduce it for me if I am having long lasting or intense nerve pain. Some SRS suffers use a TENS (Transcutaneous electrical nerve stimulation) which can reduce the pain signals travelling to the spinal cord and brain. Lidocaine patches work well and can be bought over the counter in most countries, but are available on prescription only in the UK.

 

Flank Pain: (pain in the side, which sort of feels like a stitch, sometimes feels like 'something is stuck in there' and then expands into a sharp, crippling pain in the lower back and abdomen. for me personally, this is exacerbated by walking, which causes my 11th rib to rub on my 12th). I have found no relief for this so far, this, along with the spine pain is very debilitating for me, and, at the time of writing this, I can only walk about 20 metres before this pain stops me in my tracks and I can no longer move. I haven't yet found any relief for this sort of pain other than removing the source of the friction by resting.

 

Costochondritis: I have had 2 experiences of costochondritis, which were very scary and can mimic a heart attack. I found that resting, and using an ice pack (I used frozen peas) helped to reduce the feeling of inflammation, tightness and intense heat, along with simply resting and trying to relax. for me personally, this took 2 days each time to settle. Please note that chest pain symptoms are considered a medical emergency and if you have extreme chest pain it is important to see a doctor. One study (E. Disla, 1994, Archives of internal medicine 154 (21) found costochondritis was responsible for 30% of chest pain in an accident and emergency department setting. It is not nice.

 

The single best piece of advice I can give you is this:

 

Listen to your body.

As they say, prevention is better than cure. Had I listened to my body before my SRS got to the stage it is now, I might be in a slightly better position, but I put my work before my health until it got too late. It goes without saying that avoiding stretching, bending, and anything else that might move the rib area excessively can perhaps help to prevent things from getting worse than they already are. 

I pushed myself before I knew that this was Slipping Rib Syndrome and even though I knew there was something wrong and my body was telling me to stop I carried on. It didn't help that doctors were telling me that there was nothing wrong with me, and part of me started to believe them, despite the multitude of pains that I was experiencing. Had I listened to my body more in the early stages, perhaps I wouldn't have gotten to the stage where I can't walk (That doesn't happen to everyone). You are not lazy, you are not weak, you are not a hypochondriac and the pain is not all in your head.

 

'Prehab': Prehab is a term culminating from 'pre' and 'rehabilitation'. If you are having surgery for SRS some people with SRS recommend gentle exercises to strengthen the abdominal muscles, which will make recovery easier after surgery. Obviously, you want to avoid the sort of exercises that may make things worse, such as sit-ups and twisting exercises. "Planking" is excellent for this, as it strengthens the core without moving the ribcage.

 

Post Surgery: At the time of writing this, I haven't had my SRS surgery yet, but I did have major abdominal surgery in 2016. Surgical pain is a different sort of pain altogether. Your surgeon will prescribe you painkillers (The good news is that for this sort of pain, although it's hard, and intense, painkillers DO work) and anti-inflammatories. Ice Packs (or a bag of frozen peas) on the surgery site are great for relief, and having foods that are high in protein (the body uses protein to heal) and anti-inflammatory foods will help to speed up the process.

 

A note on Chiropractic Treatment:

Some SRS warriors said that seeing a chiropractor helped them short term but if you have, or think you have SRS make sure they know what slipping rib syndrome is. You only have to search 'slipping rib syndrome' on Youtube to see lots of videos of chiropractors claiming to curie SRS by 'popping a rib back into place'. There is a difference between a rib that is slightly out of place, and slipping rib syndrome. A syndrome is a set of symptoms which are related to each other, and in SRS patients, the costal cartilage that was holding the rib in place has broken. Think of it as acting like elastic. If the cartilage that was fixing the rib to the sternum breaks, no amount of trying to put it back is going to fix it in place permanently without it bouncing back. The only permanent solution is surgery to secure the ribs. I'm not saying chiropractors are bad, I have been seeing a chiropractor for 4 years, and it did help to ease some of my symptoms a little, since, with the ribs being out of place, muscles and joints around them can tense up or try to overcompensate but I am taking a break for now, as I am at a stage where my ribs are moving so much, I don't want to risk making my symptoms worse by moving them around more than they already are themselves. 

 

A note on Physiotherapy:

Physiotherapy can successfully reduce some pains in some SRS patients, can help to strengthen the core before and after surgery, and can help some patients with mild SRS to avoid surgery altogether, but it is important that the physiotherapist is aware of SRS as some exercises (such as situps or crunches) can make the condition worse. 

 

 Ciaran Keen is an Osteopath based at the Centre for Health and Human Performance, Harley St, London. Ciaran has worked closesly with Dr. Ali Abbasi (Consultant Msk radiologist) and Mr. joel Duning (Thoracic surgeon) to develop an isometric physiotherapy plan for patients with Slipping Rib Syndrome, which he can tailor for individual patients specific level and circumstances.

 Ciaran says:

"From what I've seen this patients have become very deconditioned following an acute onset that may have hidden an abdominal injury, so no longer providing adequate tension on the costal margin so the rib can slip under the one above. As a result I like to start with inner range isometrics to build strength and recondition connective tissue, provide a more stable base targeting pelvis musculature, then progressively leading towards outer range rectus work and eventually rotation through multiple angles in short. Progress is usually steady but slow, little difference in first 4 weeks as it takes time and often lots of fear but as impetus builds usually speeds up. Taping has also provided pain relief on occasion as a coping mechanism"

 

Dr. Edward Lakowski explains Isometric exercises very well:

"During isometric exercises, the muscle doesn't noticeably change length. The affected joint also doesn't move. Isometric exercises help maintain strength. They can also build strength, but not effectively. And they can be performed anywhere. Examples include a leg lift or plank.

Because isometric exercises are done in one position without movement, they'll improve strength in only one specific position. You'd have to do many isometric exercises through your limb's whole range of motion to improve muscle strength across the range.

Since isometric exercises are done in a still (static) position, they won't help improve speed or athletic performance. Isometric exercises can be useful, however, in enhancing stabilization — keeping the affected area's position. These exercises can help because muscles often tighten without movement to help stabilize joints and your core."

 

You can find some physical therapists who are SRS aware and have been personally recommended by SRS patients by clicking the link below. Physical Therapists are highlighted in blue. If you are, or know of a physical therapist who is slipping rib syndrome aware, please let us know via the contact form.

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The link below will take you to a google drive folder where you can download some example isometric exercises for post surgery core strengthening (These are from Matt's program which was developed specifically by a senior chartered physiotherapist in the UK). These are safe exercises that also contain an element of breathing mechanics, but are provided for informational purposes only. I would always recommend seeing a PT in person to check that they are suitable for you and that you are doing them correctly. Below is video in which Matt discusses the importance of post surgery Physical therapy, what we should be doing, what we should avoid, why, and when.

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