RIBS Surf Fitness Index:

• What Should I Do About Pulled Muscles Around My Rib Cage? (6/28/06)
• What can I do to prevent paddling from hurting my rib? (1/21/06)
• Recurring rib injury: What rehab and how long should I rest?
• Rib injury: Do I have to stop surfing for awhile?
• My ribs hurt before & after surfing. Why?
• My ribs hurt. Why?
• My rib hurts from paddling. Would padding help?
  
• My previous rib injury keeps flaring up when I surf. Any advice?
  
• My ribs are irritated from paddling. What can I do?
  

Other Fitness Subjects

QUESTION: Recurring rib injury: What rehab can I do? How long should I rest?

Hello,
I am a 35-year-old male, and I'm new to surfing. In January, a career change offered me the opportunity to surf every day (2-3 hours per day). Since then I have suffered from persistent episodes of severe pain in the intercostal rib region. I originally injured my left side in late February 2003. The pain kept me from surfing, and it continued to be felt acutely while breathing & moving. The pain is a knife-like sensation that occurs while in a back-extension form (e.g. paddling). I have injured my ribs multiple times, so I recently took another 6-week break from surfing. I also started taking the anti-inflammatory Vioxx. The medication provided immediate relief for my every day activities. I started surfing again last week and immediately encountered the same pain on the right side. I stopped surfing during my second session after hearing a 'popping or cracking sound' on my right side.

I can perform other activities, including swimming, yoga, running without significant pain. Whereas, paddling with any degree of effort produces immediate & severe pain, which lingers and carries on to my normal activities for weeks.

I have already seen a couple of doctors about this condition. The most recent being a prominent Canadian physician who represents an NHL hockey team. He was the one who prescribed the 'Vioxx'. Although the Vioxx did alleviate a good deal of my pain away from surfing it did nothing to help my first session in the waves (last weekend) and so far has produced no significant benefits after this incident.

What do you think is going on? How long should I stay out of the water? And can you suggest any rehab techniques or exercises to prevent future injuries?

Thanks in advance for your help,
Kevin

ANSWER:

Hey Kevin,
After many questions of others in my field, and a wee bit of research done by yours truly, I have a little feed back for you.

What I have found is a couple of different "syndromes" that sound like they fit your ailments. One is called Tietze's syndrome, which is an inflammation of the rib and cartilage junction. The rehab suggested for this was ice, rest, anti-inflammatory drugs, and massage. Any inflammation in this area can take a long time to heal and rest is usually the best bet. It is a very sensitive area and a lot of the tissue is thinner than paper (they say cellophane thin).

Another name for something similar to Tietze's syndrome is costal chondritis, which is the inflammation of the intercostals between the ribs. Again, another very fragile area which needs the same rest, ice, etc. as above. Another surfer was diagnosed with this condition, and he said it took him 5 months of rest to get over the pain. And yes, that was rest out of the water.

Now, in order to prevent this from happening again once the symptoms are gone, I assume that realigning your spine may help so that you rest differently on your board. Another option would be to change your paddling position, so you don't rub as much on the rib area.

Since you have had neck and back problems, I would highly suggest getting into a good stretching regime and maybe seeing a chiropractor to check out your alignment. If you live locally (SF area) I know a ripping surfer, who is also a chiropractor. Always a nice combo! By stretching and readjusting your body/spine you may find that you can paddle and lie on your board in a more comfortable manor.

I hope this helps. Let me know if you want the name of the chiropractor.

Hasta,
Beth

QUESTION: Rib injury- do I have to stop surfing for awhile?

Hi Beth,
Last summer, after a couple of days of surfing and paddling around in my 5/3 wetsuit (I am in Oregon), I experienced what I self-diagnosed as an intercostal muscle pull. I felt some irritation in the area from fatigue, caught a wave at the end of the day and felt an excruciating pain on my right side. The pain is not really localized, but it is more along my ribcage towards my back, as opposed to that rib area near the abs that always gets a little sore from surfing. Anyway, it felt like a knife in my chest for about 3 weeks, and it hurt to stand up straight, take deep breaths, or sleep on my stomach. After not surfing for about 6 months, I was still experiencing mild pain in the area, especially after a day of hiking, tennis, or something like that.

The pain has receded to the point now to where I can participate in everyday activities without feeling my ribs. However, I have gone surfing a couple of times, and when I do, the area immediately flares up again and hurts for a couple of days. Additionally, throughout this injury I have been rock-climbing 2-3 days a week, and that activity doesn't seem to aggravate the area, but I am sure it isn't helping.

I am contemplating something I really don't want to do, and that is to rest and stop climbing and surfing until all pain in the area is gone. I am sure you are going to tell me this is what I need to do… so…

Thanks for any help,
Scott

ANSWER:

Hey Scott,
It sounds like your injury has been lingering for a long time if it were just an intercostal tear. My best advice would be to get it looked at by a doctor and maybe even get an x-ray to make sure things are all in place. The scar tissue buildup you have could be contributing to the pain, but it has been almost a year since you got hurt. I would be so sick of the constant aggravation and inability to do my sports that a doctor's visit would be a no-brainer. You could at least rule out some things and ease your mind.

Rest may be the call, but what if there is some sort of rehab/treatment that could expedite the process? So, basically I am not saying rest is the only option because you don't know what you have. Check to make sure all of your ribs are in place and that you didn't do some major damage to one of them when you initially hurt it.

Good luck and let me know what is up!

Thanks,
Beth

QUESTION: My ribs hurt before & after surfing- why?

I've been surfing 3-4 times a week for about 2 1/2 months. Slowly, and increasingly, my ribs have been starting to hurt. It hurts between my ribs if I breath deeply. It hurts if I stand up straight. My ribs aren't cracked, 'cuz I can poke at them all I want without it hurting. But sometimes, I'll bend wrong and the pain will literally take my breath away. If I surf, after about 15 minutes the pain goes away, but it comes back by the time I get home after a 30-minute drive.

This ever happen to anybody else? What the #@%* is happening to me? Will I live???

Aaron S.

ANSWER:

OOOHHHH the PAIN!!! Aaron, I think you will live but you may get hostile while doing it!

Sounds to me like you are trying to make an uneducated diagnosis so you can still surf. Just because your ribs don't hurt when you poke them, does not mean you didn't fracture or break your ribs. Unfortunately, the best thing for any fracture or break of ribs is rest (something a surfer coming up on the Fall season does not like to hear). Because of the time frame you are dealing with and the potential killer waves you are about to encounter, I would definitely go and get a doctor's diagnosis. It's better to know what you are dealing with.

You could have also done some tissue or muscle damage to the rib area from repetitive rubbing, pressure, or overuse of this area. Check out some of my earlier answers about ribs that talk about the same problem. The rib area is quite sensitive and the tissue and muscles can easily re-injure themselves if not given the proper rest. Sometimes exercise can make a pain "go away" temporarily due to increased blood flow to that area. However, if the pain comes back after you are through exercising, you should know that you are doing more harm than good.

A Doc may tell you that there is not much you can do for it but to rest. At least he/she can give you a timeline as to when you should be able to get back into the water, and give you an idea as to why this happened and how you can prevent it from happening again.

Deal with this ASAP if you want to surf comfortably. Fall is here and now is not the time to prolong a nagging injury! Let me know what is up.

Hasta, Beth
(Posted 10-26-02)

QUESTION: My ribs hurt. Why?

Hi Beth,
I have only been surfing for one year and I am having bad rib pain after a week long surfing frenzy (every day for 4-6hrs a day)! I did not have a bad wipe out; I just started to hurt. Now I cannot even paddle out because of the pain in my chest/ribs and it hurts to take deep breaths. I know it is not muscle pain, it feels different!

My question is what is the cause of this and how long should I expect to have this pain?

ANSWER:

Hey Todd,
Sounds to me like you have got the bug....and not a job!

Also sounds to me like you may have done some tissue damage or a bit of a bruising of the rib cage, which is not uncommon, at all. There is a bunch of super thin muscle sheaths and tissue that surround our ribs which, when aggravated, take forever to heal. In this case, steering clear of things that annoy it is a good healing process. If you did some bruising to your rib cage or rub them enough to bug the hell out of them, then rest is also the cure.

Check out some of my old responses on rib pain. I have answered quite a few of the same sort of question. There are definitely different ways to paddle to stay off of the pained area. It is always a good idea to switch up your body position a bit- especially if you are going out for 4-6 hours a day. It is like sitting in one position for too long: your ass starts to hurt, neck kills, etc. You gotta switch up the bod'!

Hope this helps.

Hasta, Beth
(Posted 10-6-02)

QUESTION: My rib hurts from paddling. Would padding help?

I have a rib problem from an old injury. My sternum-rib area is really sore when I lay on a surfboard. I wanted to know if you have some idea what I could do - like padding inside the wetsuit, padding on the board - whatever. Maybe you would also know how to make these things - which materials to use, etc....

Thanks for your help,
Michael T.

ANSWER:

Hey Michael,
Not an uncommon problem. Everyone's body is shaped differently so the way we lay on the board varies. Unfortunately, over time we can cause a bit of a bony growth or extra buildup through repetitive motion on a board. There are various ways to paddle so that you can mix up the positions that your ribs connect with the board. If you arch your upper back a bunch while paddling, try dropping your upper chest down towards the board. Try to turn your pelvis under and engage your gluts so your lower ribs come off the board and your lower back doesn't arch as much.

For wetsuit padding, I would contact a wetsuit company or ask one of the local surf shops. Hope this helps.

Hasta,
Beth
(Posted 5-25-02)

QUESTION: My previous rib injury flares up when I surf. Any advice?

Beth,
I read your section about bruised ribs with great interest. Almost 10 years ago I had a major rib injury which keeps recurring when I try and get back into the water no matter how long I rest it. Is there any rehab that I can do that would prevent/protect this area? I've tried surfing with braces and padding, none of which seems to do any good. I was crushed, which broke and seperated the ribs on my left side. If you could get me back into the water pain free, I would be in your debt forever.

ANSWER:

In debt FOREVER? Wow, that would be killer! Then I guess that means I could drop in on you at any time!

With regards to your ribs, it sounds to me as though you may have some scar tissue or "binding" of tissues either in the intercostal muscles which surround the ribs or in the actual fascia or connective tissue in the area you damaged. If this the case, then I suggest both stretching and massage. You need to break up this scar tissue so that things flow properly in this area. This area is totally sensitive and if things are bound down, not much activity can cause a significant amount of pain.

Stretching: Try to do stretches that open up the rib cage area like lying on your bed on your back with much of your upper body off of the bed. Put both arms up over your head and form a "Y" with your arms and let your chest area stretch and open up. Any stretches that stretch your pecs and front area may help. Side and lat (your wings under your armpits) stretches may work as well.

Massage/body work: This practice can really aid in quick recovery. I have the name of an incredible body worker here in Mill Valley if you are close to this area. If you have what I am guessing, then massage could be quite painful on this area but for once pain may be a good thing as you are breaking up old scar tissue.

So, work with this info. Hard to diagnose without seeing you but this may give you an idea of where to start. Let me know if I am totally off or if this actually works! Good Luck!

Hasta,
Beth

FOLLOW UP... (Posted 3-10-02)

Hi Beth,

I wrote to you a while back regarding my rib injury and would like to give you an update on my condition. (Well, you asked!) I've been rigorously stretching the area to the point where I can feel things start to move around and have been to a few "massage therapists" who don't seem to have a clue about bodywork. I don't know which is more beneficial, but I have been in the water more in 2002 than in 2000 and 2001 combined. I haven't had a single episode of pain in my ribs since November,

I believe that was right after I wrote you. The only suffering I have is trying to relearn and get back into shape after being out of the water for so long. Surf buddies can be cruel. I did buy a longboard which may have helped things along, but I have surfed shortboards on a few occasions with no ill effects. So now I am forever in your debt so you can cut me off and drop in on me anytime, and I'll even buy drinks afterwards.

Mahalo nui,
Tom

QUESTION: My ribs hurt from paddling. What can I do?

I have this problem where my solar plexus gets bruised when I go surfing. It actually can get pretty painful. It seems to happen because I arch my back when I paddle, so my head and feet are up and my midriff is the point of contact for the board, and also probably the board smacking me a little as I'm going through waves on the way out.

Is this common? Does your body adapt to it over time? Am I doing something wrong? It seems like the most obvious thing I could do is crunches to pad the area with some muscle. Any advice you have would be welcomed.

Thanks, James (8/10/01)

ANSWER:

Hey, James:
I think what you may be experiencing is a bruised rib area as opposed to the solar plexus. (I didn't think you could bruise the solar plexus as I don't think it is an actual bone or muscle but please correct me if I am wrong).

It is not uncommon to bruise the rib area above the solar plexus while surfing. I usually get a major bruise in that area while surfing in warm water when I am just wearing a rash guard and surf trunks. My wetsuit seems to provide enough padding to prevent pain while surfing at home. The problem with the rib area is that the ribs are surrounded by a thin sheath of muscle and connective tissue that when once hurt, take a long time to heal. If you are rubbing the actual bone back and forth or continually impacting that area, you can also cause calcification growth which is a bitch because it is as hard as bone. That is in extreme cases like heel or bone spurs you get when skiing in hard ski boots 100 plus days a year for 5+ years (unfortunately a personal experience)!

We are all put together differently and some of us have protruding parts of the rib cage as yours may stick out a bit further than others. So, what can I say to help you? The only thing I can think of is to maybe change up your paddling technique a little.

I would try to keep the lower part of my body on the board more and arching only your upper body (from the waist up). To do this, you want to "pelvic tilt" which requires you to engage your lower abs by tucking your pelvis and pubic bone up and in (email me if this doesn't make sense). Next, you want to tighten your gluts a bit, yeah... your ass. What this will do is prevent your body from "teetering" all it's weight on top of your breast bone. Try this and let me know if it helps or if you think I am crazy!! Sit ups can always help to add more muscle for your body to rest upon not to mention the 6 pack the women love and all the benefits of strong abs!

Talk to you soon. Pray for swell!
-Beth (Posted 8/14/01)

Disclaimer:
The opinions in "Ask Beth" represent the opinions of Beth Price, not those of Surfpulse. Surfpulse makes no medical claims nor does SurfPulse assume any responsibility for any opinions or information shared about fitness and health subjects. Anyone who is willing to try any suggestions from this column (or any other section of SurfPulse) for health, fitness, nutrition, injury prevention, or anything relating to any of these areas, is responsible for doing their own due diligence before undertaking any new activity, or continuing a current activity relating to health, fitness, nutrition, injury prevention, or anything else in order to minimize the possibility of injury or death. The information shared herein has not been approved by the FDA, AMA nor any other health or regulatory agency. And therefore, anyone considering to use any of the information shared in this column, in any other section of Surfpulse or anywhere outside of SurfPulse.com, should always consult a physician and/or a personal, certified fitness instructor before implementing any exercise routine or program- especially when significantly modifying one's physical fitness regime or lifestyle in any way.

In other words, Beth is going to be sharing some information that she believes could improve the average, healthy surfer's well-being. But don't complain if you get hurt. Surfing, especially big wave surfing, can be very dangerous and everyone participating in sports such as these should thoroughly evaluate all of the possible consequences before getting involved... and especially before pushing their limits in any capacity. Surf hard but surf safely.