Thread by @BadgleyLaurence

COSTOCHONDRITIS : is more common in women. Etiology can be related to trauma, but IMO most is related to repetitive stress. The loci of pain occur in regions where the rib (bone=costo) joins with chondro (cartilage) tissue of connection with the breast bone (sternum).

https://twitter.com/jasewrites/status/1165192938806239232

The reason for inflammation seems to be that the connections incur repetitive mechanical stress. The structure of the chest wall (all the ribs) is like a barrel. All the ribs connect to the spine in the back and breast plate (sternum) in the front.

Commonly there is a twist in the spine as either a kyphosis (curve forward) or scoliosis (curve sideways) or scoliosis with a rotation (clockwise or counter-clockwise as seen from above). These curvatures shift the ribs askew & the neat lineup of ribs & sternum is interrupted.

As result of the twisted ribs, biomechanical tension is imparted to the costo-chondral junctions. The tissues around the junctions inflame. A SPECT scan can sometime image the hot spots.

The underlying cause is the twisted spine, which is usually not grossly visible to laypeople but oft seen by doctors who look for the subtle curves with their educated examining fingers. However, there are common causes of the twisted spine.

One cause of a twisted spine is Osteoporosis, which can be detected by a DEXA scan. Perhaps most common cause of a twisted spine is joint hyper-mobility, which is genetic & called Hypermobility Spectrum Disorder (#HSD). This genetic tissue variation is seen in about 15% women.

In these women ligaments are more flexible than in most women and some of these women are obviously double-jointed. The vertebral disks are actually specialized ligaments, and allow us to bend our spines.

In these women with HSD their upper body weight burden causes pain post holding up the body, the spine, to twist. There are other consequences of HSD.

There is an high association of #Fibromyalgia & HSD because a bendy body tower puts stress on all the muscle & tendons of upright posture. Gravity is the ultimate force that causes all the muscle, tendons and ligaments to strain & inflame.

Excess body weight can participate in stress imposed upon the entheses, places were soft tissues (muscles, tendons, & ligaments) join bones. The solutions for this problem are varied. Doctors can prescribe non-steroidal anti inflammatory drugs (NSAIDS) both topically & by mouth.

Massage & acupuncture might help to relieve pain. OTC Topical gel of Solanopas might help. The definitive treatment is to inject small amounts of cortisone into the painful entheses, which can resolve the problem in days.

Physical therapists employ iontophoreses (electricity) and phonophoresis (soundwaves) to gently drive, through the skin, cortisone that has been painted on the skin.

Aquatherapy night help by enabling exercise whereby the spine is relaxed by the buoyancy of water; as muscles are toned and thereby compensate for floopy ligaments. Walking can be beneficial, especially “rucking”.

Rucking is the therapy of walking with a knapsack filled with about 10-20% or your body weight. The pack draws the shoulders back into a military posture that is good for the supine.

Rucking strengthens all the muscles of the back, thereby tending to stabilize and line up the ribs as they should be stationed. Chiropractors claim they can straighten the spine, but I don’t think there are studies reporting this.