Updated: Jun 1, 2019
"I hurt my ribs - I'm not sure if they're broke or just bruised. What should I do?" This is an incredibly common line of questioning that from the combat sport athletes I work with and my fellow training partners I take class with.
One of the more common injuries in Brazilian Jiu Jitsu, or any of the grappling arts, are rib injuries. I have injured ribs in training, and I have assessed & worked with countless athletes that have sustained an injury to their ribs during competition or while training in the gym.
The intent of this blog post is to review some of the details surrounding rib injuries and discuss how athletes can manage them when they do occur. The Basics: Anatomy & Function
The thoracic cage needs to be looked at three-dimensionally. On the posterior or back side, there are the 12 thoracic vertebrae. There are 12 ribs that correspond to each of the thoracic vertebrae, which articulate at the costovertebral joints. It is in this area where you will hear people refer to a rib head as being "out" or "subluxed" or "malpositioned." On the anterior or front side, the ribs articulate with the sternum. The first 7 pairs of ribs are called "true ribs" as they articulate directly with the sternum via their corresponding costal cartilage. Ribs 8-12 are considered "false ribs", and ribs 11 & 12 are called the "floating ribs." The "false ribs" 8 - 10 are named as such because their costal cartilage attaches to the costal cartilage of rib 7 and not directly to the bony sternum. Ribs 11 & 12 are called "floating ribs" because they are short and have no costal cartilage or connection back to the sternum. The purpose of the rib cage is to provide protection to the organs of the thorax, namely the heart and lungs. It also is part of respiration, as there is flexibility of the rib cage enables us to take deep or forceful inhalation or exhalation, and is an attachment point for the intercostals, obliques, and diaphragm.
Common Causes of Rib Injuries: Rib injuries tend to occur during sparing, when you are rolling with your opponent and one of a few things happen:
1) You get direct pressure onto your ribs - for example during a takedowns, during transitions as your opponent goes to knee on belly, or when framing with a knee and lower leg to prevent you from passing guard - which exceeds the load bearing capacity of the bone or costal cartilage.
2) You generate a lot of rotational force, under tension or load, trying to either move or resist your opponent, which exceeds the load bearing capacity of the bone or costal cartilage. In many cases it is hard to tell exactly how it happened because bjj is so dynamic. Odds are it is a combination of these and the end point is generally the same: miserable.
Pain is typically the first and main symptom. The athlete may describe hearing a 'crack' or 'pop' sound when the injury happened. Severity of symptoms generally correlates with severity of the injury, and they may experience pain when asked to take a full deep inhalation and exhalation, with movement of the torso into rotation or flexion/extension (i.e. bending forward/backward), and with direct pressure onto the area. It is important to note here that you should see a medical professional and have your injury evaluated, as this will aid in determining the type of injury sustained and the need for x-rays or further specialist evaluation in the event of a complication. The complications that can occur from rib injury include:
Pneumothorax or "punctured / collapsed lung"
If you experience worsening shortness of breath or chest pain, onset of fever, coughing up blood or dark yellow or green colored sputum, or develop abdominal pain YOU MUST GET MEDICAL ATTENTION IMMEDIATELY. These complications are very rare, and the vast majority of rib injuries are minor to moderate and typically heal within 4 to 6 weeks depending on type and severity of the injury. Some may be slower to heal, particularly if you continue training and continually aggravate the injury.
Types of Rib Injuries
There are a few different types of rib injuries, which we generally classify based on the tissues that are affected: 1) Rib Fracture - an injury where the bony substance of the rib actually breaks or cracks. These are not as common in jiu jitsu, since the structure of the rib cage allows for movement and flexibility via the costal cartilage and costochondral joints. 2) Soft Tissue Sprain/Strain - an injury where the soft tissues are damaged. These are the most commonly seen rib injuries. Soft tissue injuries generally occur as:
Intercostal strains - a strain of the small muscles between the ribs.
Costochondral sprain or separation - a sprain of the cartilage that the bony end or the rib articulates with. This cartilage gives the chest wall its elasticity and flexibility, allowing for expansion during breathing and distribution of forces throughout the torso. These types of injuries can be very slow to heal.
Bruising - impact to the soft tissues that damages capillaries and produces minor bleeding into the surrounding tissues.
Strategies To Manage Rib Injuries
There are number of things you can do to help manage your rib injury, but as discussed above the best advise is to see a medical professional for proper evaluation and assessment. Unfortunately, the treatment options for rib injuries is limited. The strategies that seem to work best with our athletes are as follows:
Rest - yes, I know it sucks to be out of the game for a bit. But if you want to minimize the healing time and return to your sport quickly, rest is key in the early stages of the healing process. And we're not talking about 'Bed Rest' here. Continue to go to class and learn the techniques being taught, but avoid the temptation to participate or drill the movements.
Control Pain - Your physician can direct you to pain relief options such as NSAIDS, and you can also use ice over the area intermittently. Part of controlling pain is also avoiding the movements and activities that seem to provoke pain.
Breathe! - Within tolerance, perform controlled, deep breathing exercises to help mobilize the rib cage, enhance gas exchange, and help to avoid infection.
Taping - In some cases light support using Rocktape or a heavier Leukotape may provide some help &/or relief of symptoms depending on the injury. We will generally avoid wrapping / bandaging ribs with an ACE wrap because most find the compression of the bandage more uncomfortable.
Movement - As tolerated, and usually after a couple days of rest, we can begin training in the weight room again with a few precautions / parameters set to minimize stress to the healing tissues while also attempting to maintain your overall strength and level of conditioning.
While not a perfect fix or solution, these strategies can help get you back on the mats! As always, when in doubt seek out a medical professional who can help you - preferably one who knows and understands your sport!