While in Austin, TX I met a 36-year-old woman who was in an intense amount of pain in her left chest and breast. Apparently she had been this way for about 5 years. She had seen many doctors and therapists, had many tests, and still had no idea why she was in pain. I want to tell you what I felt when I assessed her. I was teaching an SMRT: Shoulder, Axilla, Ribcage, & Upper Back course in Austin and during the first trade, which was the lateral shoulder, I heard her making noise as if she was in pain.
I went to the table and began to palpate below and along the lateral side of her left breast. The area was inflamed. I was extremely light with my touch and it was still very painful for her. I went along the sternum and felt the cartilage of the ribs. I then felt the rib cartilage on the right side. The right side felt like it was in a normal position and it had a fair amount of mobility. I could not move the left ribs enough to check mobility because of her pain, but I could tell that the cartilage of the left ribs (I believe ribs 4 through 7) at the sternum felt posterior.
I followed the ribs to the lateral side of the breast tissue with the mild expectation that all four ribs would be posterior. But they were not. What I felt was subluxations at the costochondral joints of all four ribs. I have found this on clients in the past, but generally it is one rib. SMRT is fantastic when an area is so tender that any touch hurts. I used positions from remote structures (read: structures around these four ribs and the inflammation) to alleviate the inflammation.
On the second day of class, she said she felt less pain and it had held through the night. I coached her partner in working on her ribs. We finished our rib trades the morning of the third day. Her pain was lessened again, but still there. With her supine on the table, I began to use SMRT directly on the area, telling her what I was going to do. She was terrified because I was going to touch this area directly. I asked about pain and pressure with each step as I worked on her for 5 minutes.
After applying the SMRT, I reassessed. The cartilage of these four ribs was more anterior, meaning it had moved toward a more neutral, happy place. The subluxations were decreased by a substantial amount, but not gone. This, for me, was one of those moments when I wished I could work on her regularly. I knew she needed more, but she was just so happy to finally have something change. The fear of some deeper issue had been with her for a long time. Ribs, it was all in the ribs, an area that needs much more work.