Fractured Ribs and Physical Rehabilitation.

About 300,000 people every year fracture their ribs in the U.S. 72% of these fractures occur in men although postmenopausal women are also prone to  them due to osteoporosis. Rib fractures occur as a result of trauma such as falls and sports activities  but can also come through severe coughing and even CPR treatment in older adults. A broken or fractured rib may result in internal damage to an organ, tendon or muscle. Severe damage can be done if there is a ‘flail’ chest. That is if 3 or more ribs are fractured in 2 or more places and the ribs are separated from costal cartilege or the sternum.

Earlier treatment included wrapping the chest in bandages or corsets to keep the ribs in place for healing however that is not done now as it limits proper breathing. Improper breathing can cause pneumonia and other problems.

The recommended treatment is rest, gentle exercise, pain medication and targeted physical therapy programs when the pain is less severe. Yoga and other strenuous activities are to be avoided for up to 6 weeks in most cases. Time is the main healer as the ribs heal themselves. It is recommended to take deep breathes and gentle exercises to expand the diaphragm. Sometimes even swimming 45-90 minutes per day can be helpful. Walking and moving helps to keep the airways clear and helps to prevent pneumonia and collapsed lungs.

One of the simple exercises recommended is the ”pendulum” i.e. bending forward and swinging the arms around in a circle. When ribs are sufficiently healed a larger range of motion should be attempted to increase arm flexibility.

Physical therapy is indicated in those individuals with a fractured rib who present with a compromised respiratory system, advanced age, or functional limitations associated with postural muscles .The goal of rehabilitation is to decrease pain, prevent respiratory complications and restore function. Local application of heat or cold may provide temporary relief of discomfort, in conjunction with pharmacological treatment. There is evidence to support the use of a transcutaneous electrical nerve stimulator (TENS) for pain management in patients with uncomplicated minor rib fractures (Oncel). The physical therapist should instruct patients in deep-breathing exercises to promote full lung expansion, relieve intercostal muscle spasm, and mobilize lung secretions. Finally, shoulder and trunk gentle stretching exercises may relieve discomfort and promote chest expansion, functional shoulder mobility, and improved posture.

It is noteworthy that intensive hand, arm and leg exercises would not be the treatment of choice for a rib fracture however when someone suffers from stroke, Parkinson’s disease, Brachial plexus injury, Brain/spinal cord injuries, CP, MS or other upper and lower limb semi paresis then physical therapy solutions such as the TUTOR system come into place and can be very helpful in regaining lost movement.

The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR  have become a key system in neuromuscular rehabilitation and physical therapy for interactive rehabilitation exercise. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. This training is customized by the occupational and physical therapist to ensure that the patient stays motivated to do intensive repetitive manual therapy and exercise practice.   The TUTOR system is now  part of the rehabilitation program of leading U.S. and European hospitals.  Home care patients can be supported by the occupational and physical therapist offering tele-rehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

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