Feature Story
The Hockey Doc on rib fractures
QUESTION: I am a high school player and I got checked into the boards
and felt a crack in my chest. I went to the emergency room and had x-rays and
was told I had a rib fracture but no other injuries. When can I return back to
playing?
ANSWER: Rib
fractures occur commonly in ice hockey, usually in older adolescents or in
college hockey players. Luckily, most rib fractures are minimally to nondisplaced fractures, which means
that the structures in the chest cavity which the ribs are supposed to protect
(liver, spleen, kidneys, and lungs) usually do not get injured. Rib fractures
usually occur when a player is checked against the boards or into the goalpost.
I have not seen them occur with on-ice collisions.
While rib fractures by themselves do not
contribute to serious long term problems, it is important to make sure that
there are no other injuries present which could be serious. If there is an area
over the ribcage which hurts when it is pressed on, or if the player feels like
some of the bones are crunching when they take a deep breath in and out, then
they should have x-rays taken to determine the amount of fracture displacement.
It is especially important to follow up with a physician if they have any
difficulty with breathing or any abdominal pain.
A very small percentage of hockey players
can have damage to the internal organs with a rib fracture. Therefore, it’s
important to have follow up for these to make sure that your injury is not a
more serious than what it seems initially. A rib fracture could cause a tear in
the lining of the lung, which could cause it to collapse. Rib fractures could
also cause injury to the liver, spleen or kidneys, which
needs to be evaluated by a physician.
In your case, where you have a rib fracture
and you do not have any other injuries, the first thing you should do is make
sure you have enough pain relief so you can skate. These injuries can be quite
painful because of the motion of the chest wall when you breath.
Since we typically breath approximately 15 times per minute, which will
increase significantly with the exertion of on-ice activities, this can cause
the broken ends of the ribs to move frequently and it can be quite painful. It
may be necessary immediately after the fracture to have pain medications
prescribed, or you may take acetaminophen as necessary.
We most commonly provide a rib strap to
help “splint” the broken rib. The purpose of the rib strap is to prevent your
chest wall from moving as much when you are taking a deep breath, which in turn
will cause the rib fracture to be splinted and less painful.
You may return to play as soon as you can
tolerate the pain. We most commonly let our players go back with the use of a
flack jacket to protect the fractured rib so they can skate with minimal pain,
while minimizing the chance of taking another blow to the fractured area. Our
players usually need to wear the flack jacket from anywhere from a few days to
up to three weeks depending upon the location of the fracture and the severity
of the initial contact that they had.
You should not be on any medications
stronger than acetaminophen when you return back to play. We do not recommend
the use of anti-inflammatory medications, such as Ibuprofen or Naprosyn, in the initial period after this type of injury
because they tend to increase bleeding and it may slow
down rib fracture healing.
Rib fractures usually heal quickly. In
most cases, they are pain-free by three to four weeks after the fracture. It is
important that you be assessed by a physician to make sure that there are no
underlying injuries and be monitored closely by your athletic trainer to
determine when you should return back to competition.
Dr. Rob LaPrade,
MD, PhD, is the team physician for the