Pain management and respiratory physiotherapy are the mainstays in the treatment of fractured ribs. How do these strategies help heal? We analyze it.
In fractured ribs there is a break in any of the bones that are part of the rib cage. It can involve a single or several ribs at the same time.. Also, there may be a complete break or a split into very small pieces.
The most common cause of rib fractures is chest trauma. Most of the time it is a closed trauma, that is, without the internal tissues communicating with the outside.
Open chest injuries respond, in general, to injuries generated by sharp objects.
How can trauma cause fractured ribs?
Fractured ribs as a result of chest trauma can appear in the following scenarios:
- Direct trauma: This is the case of car accidents, physical assaults or falls.
- Repetition: in high-impact sports or in chronic cough pictures. Repeated minimal trauma culminates in a stress fracture.
- indirect trauma: the broken ribs occur indirectly due to a trauma that did not impact the thorax. This transmission of forces can also happen in car accidents.
complications
Fractured ribs in older adults who fall tend to be osteoporosis-based. In young children, they are secondary to a lack of bone consolidation.
Depending on the involvement of other organs, the risks and recovery may be variable. However, the older the patient, the greater the risk of contracting pneumonia as a complication.
Symptoms and diagnosis
Rib fractures tend to be very painful. and even interfere with normal breathing patterns. In addition, it can be evidenced what is called call toračico. It occurs when two or more successive ribs fracture into several pieces, creating instability of the chest.
The result is that the chest moves in the opposite direction to the rest of the rib cage when taking deep breaths. This prevents adequate expansion of the lungs and is associated with severe adjacent lung injury.
On physical examination there is usually pain on palpation or on breathing in, coughing, sneezing, or performing any Valsalva maneuver. People often look stiff when breathing, due to discomfort.
Bruises or open wounds on the chest may be evident.
A chest X-ray is done to diagnose fractured ribs. However, if the image does not present alterations, but the suspicion is high, a computed tomography should be continued.
Tips for recovery of fractured ribs
Treatment of fractured ribs includes pain control and breathing exercises to prevent complications. The pharmacological basis is non-steroidal anti-inflammatory drugs and incentive spirometer therapy.
The healing process usually takes between 6 to 8 weeks. Breathing exercises are used in order to maintain expansion of the lungs to avoid the accumulation of secretions, which can be complicated by pneumonia.
Managing pain is paramount
Fractured ribs can be so painful that they prevent adequate inspiration and expansion of the lungs. That is why pain management is necessary.
Prescription pain relievers include non-steroidal anti-inflammatory drugs (ibuprofen and diclofenac). When they are not enough, opioids such as tramadol are added (only under strict medical supervision and indication).
Sometimes gabapentin is also indicated. In any case, there is no scientific data on this option that fully validates its usefulness. Muscle relaxants are efficient in enhancing the effect of analgesics aforementioned.
Sometimes nerve blocks or infiltration of anesthetics (lidocaine) are required to control pain.
Surgery is not usually indicated, unless the displacement of one of the fractured ribs punctures the lung. In that case, fixation of the ribs with metal plates is performed.
local cold
It is recommended to apply cold compresses for 20 minutes of every hour, without interrupting sleep, the first two days. Then it is decreased to 20 minutes, three times a day.
This helps reduce pain and inflammation. The cold compress should be rolled up in a cloth before applying it, as it can cause a skin burn.
active rest
Fractured ribs take time to heal. Absolute rest is recommended the first week and then incorporate low-impact exercises. They are suspended in case the pain increases.
High-impact sports should not be performed until authorized by the doctor.
Staying active after the first week of rest will decrease the risks of contracting pneumonia or other respiratory infections. As well as the risk of producing emboli decreases.
Breathing exercises are the main rehabilitation of rib fractures
Breathing exercises, in conjunction with pain relievers, are the ones that will really help heal fractured ribs. Chest stretching exercises can also be used.
It should be executed slowly and gently, with a gradual increase in difficulty. However, no routine should be started if the doctor indicates that it is not yet safe.
Using the incentive spirometer
The incentive spirometer is a device that helps to achieve deep inspirations correctly. It is recommended every 1 or 2 hours and perform 10 to 15 breath cycles.
During its use, the mouthpiece of the incentive spirometer is placed in the mouth, keeping it sealed with the lips. The exercise consists of inhaling (inspiring) deeply. You should try to raise the parts of the spirometer as high as possible. You can also try to keep one of the pieces in the center.
In more critical patients, an alternative is the positive pressure bottle. It has proven useful when there are more than 3 rib fractures concomitantly.
diaphragmatic breathing
Also Known As belly breathing, allows full expansion of the lungs. The inhaled air is capable of going to the most extensive part of the lung parenchyma. This prevents trapped air from causing future problems or complications.
Bucket Handle Breathing
This type of breathing exercise seeks the elevation and expansion of the ribs. Increases the transverse diameter of the rib cage, allowing deeper inspirations.
yoga positions
There are certain yoga positions that can strengthen the muscles between the ribs (intercostal muscles):
- charge the bhujangasana.
- cat/cow or marjaryasana/bitilasana.
- extended dog or adho mukha svanasana.
They must be practiced carefully and under the guidance of a master in the discipline. Overstretching can make the injury worse.
Fractured ribs recover with constancy
Breathing exercises and even yoga for broken ribs need perseverance. There will be no immediate scarring. Perhaps these aids can reduce the discomfort, but it is prudent to consider that 6-8 weeks is the necessary time.
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