Rib injury

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Management of rib injuries

Rib injuries are painful and may continue to be so for 3 to 6 weeks, but the intensity will gradually reduce. If you have attended the Emergency Department because of an injury to your ribs or chest wall, you will not receive an x-ray unless there is suspicion of underlying lung damage. This will be established from the assessment carried out. We do not routinely X-ray for rib fractures as this does not change our management of the condition.

If you start to cough up green phlegm and become feverish please see your GP as you may have developed a chest infection.

What can I do to help the healing process?

You will need to take regular pain relief as advised by your Healthcare professional. This will enable you to move and take deep breaths to prevent a chest infection from occurring. You may need to support the injured area in order to do the breathing exercises, or if you need to cough. Use a folded up towel or small blanket wrapped around the area for support.

DO NOT avoid coughing as this helps to keep the lungs healthy and prevent pooling of secretions. In the initial days following an injury, ice can be applied to reduce pain and heat around the area. Ice should be applied through a tea towel, to avoid burning the skin. It should be left on the area for 15 to 10 minutes and repeated up to 5 times a day. If you have any circulation problems, numbness in the area or diabetes please check with your Healthcare professional before applying ice.

Heat

4 days after the initial injury you can start to use heat around the area. Heat can be applied using a wheat pack or a hot water bottle wrapped in a towel. However if the injured area remains warm or hot it is better to continue using ice.

Gentle movement

Is it very important that you keep the area moving from the day of the injury otherwise it will stiffen up and delay your recovery. In the first few days you should move the arm and back with slow controlled movements, within comfortable range. After 4 to 6 days you can start to gently stretch further, producing a mild discomfort at the end of the movement.

Exercises

Please do these exercises daily.

1. Supported cough / sneeze. Sitting or standing, if you need to cough or sneeze, place one hand over painful area, and fold your other forearm over the top and press gently whilst you cough or sneeze to support the area. You should try not to supress a cough as this may increase the risk of getting chest infection.
2. Stretching
   • Sit straight with your legs comfortably apart and your chin tucked in.
   • Raise both arms and clasp your hands behind your head.
   • Push your elbows back as much as you can and expand the chest as much as you are able, gradually stretch a little more as your pain allows.
   • Maintain the position and relax.
   Sets:1
   Repetition:10
   Frequency: 3 times a day.

3. Deep breathing: 1
• Lay on your side on a bed with the painful side uppermost and top arm resting overhead.
• Place the hand of the lower arm on your ribs. Take a slow and deep inspiration whilst trying to raise the ribs outward / upward toward the hand resting on the ribs. Avoid pushing out with the abdominal muscles.

4. Deep breathing: 2
• Sit in a chair or lie on your back with your knees bent and your back in neutral position (slightly arched).
• Place your hands on your stomach and concentrate on your breathing.
• Breathe in as deeply as you can feeling your abdomen rising more than your chest, and exhale without forcing.
• Pause shortly after each exhale before the next inhale. Take three or four deep breaths at a time or you may become dizzy.
Sets:1
Repetition: 3 to 4
Frequency: 3 times a day.

5. Side bending
• Sit up straight in a chair and look directly ahead of you.
• Lift arm up and above your head and slowly bend sideways as far as you can tolerate AWAY FROM THE PAINFUL SIDE while reaching down with the opposite hand, until you feel a stretch at the side of your trunk. Relax. NOTE: When you bend your trunk sideways, do not twist or lean forward. Keep your body straight and facing forward.

6. Twisting
• Sit tall.
• Lock hands together at chest height.
• Turn to each side, gradually increasing the range of movement as your pain allows.
• Slowly return to neutral position.
• In time you will be able to pull yourself further round by gripping the back of the chair with your hands.