How to Fix Rib Injuries from Jiu-Jitsu (From Injury to Back to Sport)

Show Notes

In this episode of the Dr. JJ Thomas Podcast, I take you through a compelling case study of Max Livingston, a Brazilian jiu-jitsu athlete who faced a challenging rib injury. Through a blend of cutting-edge treatments like laser therapy, dry needling, and meticulously tailored exercises, we navigated the path from pain to peak performance. Join us as we explore the intricacies of sports injuries and the path to recovery, proving that with the right guidance, anyone can make a triumphant return to their passion.

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Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.

Max Livingston: 00:00

Hey, guys. It's, Max Livingston here. I just wanted to talk to you about how my recovery with primal physical therapy helped me. In my most recent Fury match probably about 4 to 5 weeks ago, I was trying to defend the Darce, and during one of my rotation, I may have popped a rib or a cartilage in my rib. Any sort of China training or quick twitch movement, there was a sharp pain, felt like a stab in my rib.

Max Livingston: 00:27

I took that to doctor Eric and JJ at Primal Physical Therapy. Immediately, they were able to get me in. They asked about my injury, how it happened. From there, we got to do some laser treatment, and some dry needling. I before all of that, I had some bruising and some swelling.

Max Livingston: 00:47

The red light therapy immediately, took some of the swelling and the bruising away. And then as I continued to feel some pain throughout the weeks, we continue to do dry needling in every single session. I felt more flexibility in my rib, less pain, no sharp pain. The more I went and continue to talk to them, they gave me exercises to do in between, and I'm back to full strength. I'll be headed over to the UK to compete, and I feel a 100% as of now.

Max Livingston: 01:20

So it's great. The hospitality there was fantastic. I couldn't thank them enough. So any sort of injuries that you guys have, make sure you get yourself over there. They're the real deal.

Max Livingston: 01:31

It is real. It's really good stuff. Thank you, JJ. Thank you all. Welcome to the doctor JJ Thomas podcast.

Dr. JJ Thomas: 01:43

Hey, everybody. I'm doctor JJ Thomas. Welcome to the doctor JJ Thomas podcast. This podcast, we're doing a clinical round. And in the clinical rounds, what we do is we go through real life scenarios of patients of mine, and we talk about the the thought process in both the evaluation and the integration of treatment, all the way to return to activity levels.

Dr. JJ Thomas: 02:02

So this is I'm always, you know, I can't help it. I'm always picking my favorite patients. And the ones that I think are really cool and also have a lot of applicability to many different patient scenarios that you guys might see. So this scenario today is from my friend Max, who's a Brazilian jiu jitsu athlete. He's a former wrestler as well, and, just an awesome all around competitor and person.

Dr. JJ Thomas: 02:29

He texted me one day, after a competition in it was just in January. It's February now. It was early as January. He said, JJ, I was, what he was doing, he said, I popped my rib. I'm in a lot of pain, there was no bruising, and I didn't really feel like it was too too swollen.

Dr. JJ Thomas: 02:48

He did say there was a little bit of swelling, but he said, but I felt it pop in my pec area, it was on the left side, and and it's really bothering me. It's really limiting me now. I can't compete. I'm not able to do the things I wanna do. Can we take a look at it?

Dr. JJ Thomas: 03:03

So he was traveling, by the time we got to look at it, it was a couple weeks later, but it was still really limiting his function. So when I looked at him, let me back up. The mechanism of injury was, he said I was he was doing a roll. He was, doing like a rolling twist to defend a Darce. So a Darce is a type of choke.

Dr. JJ Thomas: 03:26

If you don't do jiu jitsu, a darce is a type of choke, and so he was trying to roll out of it, and I believe his hands were clasped, which is why his pec muscle, got tweaked on this. So on palpation, we confirmed that he one of his pec major muscle, striations was tweaked right on the rib attachment near the sternal attachment. So I'm gonna show you on the screen record on the screen here. And, so here we have if, I'm gonna zoom out a little bit. Here's the pec major muscle.

Dr. JJ Thomas: 04:02

Remember how it attaches, you know, this this actually, this image doesn't give it enough. It has finger like attachments onto the ribs as well and onto the sternum. I'm actually gonna remove the external oblique here, so you can kind of appreciate a little bit better. Let's also remove rectus abdominis. So you can see these pectoral attachments kinda coming onto the sternum and onto the ribs.

Dr. JJ Thomas: 04:30

What happened with Max is his pec attachment onto the rib, I believe the pop he felt was a little bit of those some of those fibers on, one of his rib attachments. Now by the time I got to him, it was, you know, it was almost 2 weeks later, so the actual healing process had already, taken, it had been 2 weeks, so it had already gone through some proliferation and healing in and of itself, but he was still really tender on that. The way we treated it, there was no swelling, like I said, just tenderness. We did, our class 4 laser, which is great for facilitating healing. We did that a couple of times.

Dr. JJ Thomas: 05:07

We did soft tissue work, and actually I used the wind back machine here as well, which is high frequency electrocurrent. But a lot of modalities to loosen the soft tissue musculature in the entire pec region and the abdominal region. So remember, I removed in this here, I removed the abdominals, but if you notice, they're attached. You can see on this side, the abdominals attach right up. They have aponeurosis right up with the pec major.

Dr. JJ Thomas: 05:36

So whenever I have someone with a pec injury, I a 100% will treat their abdominal muscles just to take the stress off that pec attachment. Same thing is true from anterior delt, like all of these muscles we wanna treat to take pressure off the the site that was actually pulled or, or injured. So we did a lot of soft tissue to the abdominals, the pec itself, the anterior delt, and then I sent him with some early exercises, which I'm gonna show you in a little bit. I wanna just give one more treatment intervention, suggestion, and that's by the second time I saw him, his healing, it was, at least 3 weeks, maybe even 4 weeks post, post injury, he was progressing much better. But that was a time where I said, you know what, Max, let's really let's treat this a little bit more aggressively.

Dr. JJ Thomas: 06:28

He has a competition coming up, I wanna make sure he's ready. And we dry needle the proximal pec, again to take, on this side, to take the stress off that rib attachment here. So I grabbed the pec major, I needled the muscle belly proximal to the injury itself. That improved his symptoms dramatically. So tests, retests of pec activation, he was able to do much more.

Dr. JJ Thomas: 06:51

He reported to me that next day that he went to train that night and was able to do a lot more in training, very active, he's like getting back to a 100% now that we did that last little bit of muscle work, with dry needling to the proximal portion of the pec. We're gonna switch over to exercise now, I'm gonna show you the exercise progressions we did with Max to help him get back to training faster and get him ready for his competition. To get Max back, as soon as possible to competing in training, we wanna get that pec muscle firing and loaded in a safe way. As we know as clinicians, one of the best ways we can load a muscle is isometrically. So it's very safe after a muscle pull to isometrically get those fibers contracting and firing to stabilize, which will support healing, bring blood flow to the area, get the nervous system engaged, and really support the healing process.

Dr. JJ Thomas: 07:43

So the way I like to give isometric pec activation for post pec strain or even pulling on the periosteum like Max's was is really just by taking a good sized ball and having them activate here. So I had him just do regular isometric presses that first couple weeks, so just squeezing and pressing, squeezing and pressing. When he tells me that's okay, then the next phase of that is squeezing, holding, and now changing elongation by having a slight push out and then control back, but I'm having him compress that ball the whole time. So compressing, getting that pec activation, especially at the sternal region there, and then holding that compression as he comes out and back. After weeks of that and him feeling better and starting to integrate back into rolling, we bring it to explosion.

Dr. JJ Thomas: 08:38

So now we take that ball and we get close to the wall and we press, press, press, press like that. And then, we can speed it up. So, explode in fast. I'm gonna go closer for it. Fast, fast, fast, fast.

Dr. JJ Thomas: 08:53

Like that. Right? And then we wanna get rotation. So we can have it here, and we're still gonna get pecs, right? And we're gonna rotate, catch.

Dr. JJ Thomas: 09:02

Rotate, catch. Rotate, catch. Rotate, catch. Rotate, catch. Or don't catch.

Dr. JJ Thomas: 09:10

So that's it. So the progression is really safe isometric, static, not static but not dynamic. And then isometric with dynamic, and then isometric initiation with some explosion, but paste explosion, and then speed up explosion, net add rotation. Now all the while he is training within his comfort level. Like when we got him back to training my advice to him was like, look, roll with, roll meaning in Brazilian jujitsu, if you don't do it, rolling is training, essentially.

Dr. JJ Thomas: 09:44

So I said to Max, train with partners that you're comfortable with, train with partners that you can, do positional, guidance with so that he's not just all out putting himself in compromised positions, and it's that's how you return to sport in that environment. So this worked great, Max is doing great, he's about to compete very soon, actually out in London, so I'm super pumped to watch him and, see his ex see his success. Talk soon.