The phenomenon of blocked ribs is quite common at handball players. In training and game mode, the use of the throwing arm, depends on a thoracic rotation involving spine and rib gage. The forced backwards rotation initiated by the oblique stomach muscles and further put through by upper thoracic muscles, puts an enormous pressure on the rib joint at the spine which ultimately might lead to blocked ribs or spine segments.
Restricted ribs or spine segments will transfer the work load on the shoulder joint, which has to compensate for this loss of. Here the shoulder might well be the first sign of a problem and treatment at this joint in form of physiotherapy, medication or shock wave therapy will not give any satisfied result and the problem might spread to the whole arm or neck.
Players with acute or long term shoulder pain/problems should be checked for movement in spine segments at thoracic level and the movement of ribs. If any restrictions are found and there are no contra indications to manipulative treatment, the rib at first should be unblocked by a high velocity thrust. If contra indicated, soft tissue and mobilizing techniques should be used. After this the thoracic spine should be treated. Only hereafter you can work on the shoulder.
The mechanics of the rib/spine segment are the first to treat , a proper working joint mechanism is at the base of any treatment.
To reduce the problem of blocked ribs, training sequences should consist of mobility exercises for upper thoracic area as well as strength and coordination exercises for this part. Together with a regularly physical check up, this will keep players fit and avoid injuries.
Remco Brouwer, Osteopat/Fysioterapeut, Vika Fysikalske Oslo.