What is it?
A rib fracture may occur when a rib(s) sustains a direct impact from a ball, bat, punch, kick or fall. They may also occur with constant repetitive movements in sports such as weightlifting, throwing sports and rowing. With violent or direct force over a rib an athlete may also sustain injuries to internal organs. Athletes can fracture a single rib or multiple and potential additional injuries need to be considered.

Symptoms
• Pain directly over the injury site
• Pain with exercise, especially with rib stress fractures
• Pain with breathing, twisting and bending
• Difficulty breathing
• Bruising or swelling in the area of injury
 

Sports Medicine Evaluation and Treatment
A sports medicine physician will examine an athlete’s chest to evaluate for open wounds from the injury, and for bruising and pain. The physician will listen to the lungs for signs of possible underlying lung injury. A chest x-ray may show the area of injury and is a very good test to rule out injury to the lung. In more serious injuries, a CT scan may also be done in order to examine for injury to heart or other organs. Treatments involve pain control and providing time for adequate healing. Possible treatments may include anti-inflammatories, ice or stronger medication in order to encourage deep breathing to help prevent pneumonia.

Injury Prevention
Although accidents are unavoidable, proper protective gear is important depending on the sport you are participating in.

Return to Play
The athlete may return to activity when he or she is able to perform activity pain-free without medication, and does not have pain when the involved rib(s) are touched. It may be in as little as three weeks depending on how many ribs were injured and what other structures were damaged. If you are involved in contact sports, you may consider rib protection initially to protect against re-injury. Proper nutrition is always beneficial to help with bone healing.

AMSSM Member Authors: David Berkoff, MD and Raul Raudales, MD

References
Bracker M. Five-Minute Sports Medicine Consult. Lippincott Williams & Wilkins; 2012.
Casa D, O’Connor F, Davis B, St. Pierre P, Sallis R, Wilder R. ACSM’s Sports Medicine: A Comprehensive Review. American College of Sports Medicine; 2013.
Madden C, McCarty E, Putukian M, Young C. Netter’s Sports Medicine. Saunders Elsevier; 2010.