Hernia or cracked rib?

[gijokah]

I have been experiencing a new short pain just at my lower right rib cage (right at the inside corner – near the sternum) while playing intense racquetball. It feels like a pulled muscle or sharp cramp. It happens only occasionally, but it’s right when I make a strong stroke to hit the ball (as I swing the racquet). During a two-hour session, it might happen two or three times. I play once a week and it started happening 3-4 weeks ago. I am a 52-yo male but otherwise in good health – not obese or smoker or anything – although I have had acid reflux for many years. When the pain happens, it feels like some kind of weird rib cramp or sprain or something popping out of place. Although I’ve never had a hernia to know what it feels like, I suspect it. The pain is so bad that I have to stop play and hold the spot until it kinda goes back in place – only a few seconds. There is no residual pain, although I can kind of feel it right now as I push in on that spot. (Again, the spot is right on/under the lower inside corner of my right rib cage.) I’ve been researching hernias and can’t find anything that I understand to fit my symptoms exactly. But I read that bad coughing can cause hernias, and I had a very bad flu a couple of months ago and coughed so hard I thought I would die. Someone also told me that coughing can crack ribs and/or cause a dislocated rib. I kinda hope it’s the rib thing because I heard that hernias never heal on their own (even if I stopped all sports for a while). But I’ve heard cracked ribs are very painful, and I’ve had no chronic pain. I started back playing racquetball about 5 years ago and have went through several reoccurring pains that had me worried, but playing though revealed that they were only minor weak points that needed strengthening – I hoping this is only another one of those. Please advise. Thanks.

[Dr_Brody_DC]

I have been experiencing a new short pain just at my lower right rib cage (right at the inside corner – near the sternum) while playing intense racquetball. It feels like a pulled muscle or sharp cramp. It happens only occasionally, but it’s right when I make a strong stroke to hit the ball (as I swing the racquet). During a two-hour session, it might happen two or three times. I play once a week and it started happening 3-4 weeks ago. I am a 52-yo male but otherwise in good health – not obese or smoker or anything – although I have had acid reflux for many years. When the pain happens, it feels like some kind of weird rib cramp or sprain or something popping out of place. Although I’ve never had a hernia to know what it feels like, I suspect it. The pain is so bad that I have to stop play and hold the spot until it kinda goes back in place – only a few seconds. There is no residual pain, although I can kind of feel it right now as I push in on that spot. (Again, the spot is right on/under the lower inside corner of my right rib cage.) I’ve been researching hernias and can’t find anything that I understand to fit my symptoms exactly. But I read that bad coughing can cause hernias, and I had a very bad flu a couple of months ago and coughed so hard I thought I would die. Someone also told me that coughing can crack ribs and/or cause a dislocated rib. I kinda hope it’s the rib thing because I heard that hernias never heal on their own (even if I stopped all sports for a while). But I’ve heard cracked ribs are very painful, and I’ve had no chronic pain. I started back playing racquetball about 5 years ago and have went through several reoccurring pains that had me worried, but playing though revealed that they were only minor weak points that needed strengthening – I hoping this is only another one of those. Please advise. Thanks.

Dear gijokah,

It sounds like it might be a type of tendinitis or muscle pull. It does not sound like a hernia. You can confirm this suspicion by reproducing the offending motion isometrically. (Try making that swing against a wall that doesn't budge as you try to finish the motion, for example.) If you can reproduce the pain, do so again, this time pressing into the painful spot as you repeat the motion. If counterpressure reduces or relieves the pain, it's even more likely to be a muscle strain/tendon issue.

A bad cough can cause costochondritis, an inflammation of the rib-sternum junction that can persist way beyond the cold/flu that caused it. This too would make use of the associated muscles more painful if you moved just right. (Just wrong?) While it's not likely that you cracked or dislocated a rib, a bad cough may have thrown the rib alignment off a bit where the ribs join the spine in the back. This in turn could torque your torso enough to cause pain when you make certain angular movements. In other words, I think your symptoms are biomechanical in nature.

To be thorough, have your doctor review your symptoms, perhaps poke around a bit, and decide if further testing (x-rays, etc.) is necessary. A chiropractic adjustment to correct any alignment issues and a personal trainer who can evaluate your playing form may be all that you need.

Dr. B.