Dr. Johnny Benjamin - Aldo's rib injury assessment
Article here on MMA Junkie
http://mmajunkie.com/2015/07/how-ser...ry=/eiUjC1UTmG
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The MMA world, internet and social media seems to be consumed with the ever-evolving saga regarding the health of UFC featherweight champion, Jose Aldo. Apparently, Aldo has now been scratched from his eagerly anticipated title defense at UFC 189 against Conor McGregor.
Aldo’s (25-1 MMA, 7-0 UFC) rib injury has been called everything, including a bruise, sprain, fracture and even phantom.
What is the medical thinking regarding rib injuries, and what are the potential ramifications from a fighter health and safety perspective?
First, I must state some very basic facts. Major rib functions include maintaining a semi-rigid, but flexible cavity to permit breathing and the protection of vital internal organs. In fit individuals, ribs are very superficial with little soft tissue covering to absorb and dissipate blows. The semi-rigid nature of the thoracic cavity (chest) allows sufficient motion necessary for respiration.
Rib fractures (breaks) are notoriously difficult to see with standard plain X-ray techniques. Many people are initially under-diagnosed with simply a bruise or contusion and then later – with more elaborate radiographic techniques – noted to have in fact a fracture. More elaborate techniques (i.e. spiral CT, reformatted 3D CT and/or MRI – see Aldo’s scans here) are not indicated initially in non-life threatening cases due to their significant radiation exposure, cost, and minimal benefit for the medical decision making and treatment for the vast majority of simple rib injuries.
As anyone who has ever suffered a rib fracture (myself included) will certainly attest, they hurt like HELL! Everything, and I mean everything, you try to do, including merely breathing, is a struggle. Laughing, coughing, clearing your throat and breathing deeply are virtually impossible. Training MMA – even cardio – is often beyond the question without the use of local anesthetic pain injections and often narcotic medications.
Due to the constant motion of ribs during breathing, fractures are notoriously slow to heal and often never completely do. Imagine if you broke your forearm and instead of properly immobilizing it with a cast for 6 weeks, I wiggled it 16 times per minute every minute of every day. There is no specific treatment for rib fractures. There are no casts or adequate splints. Treatment is basically grin and bear it, limit your activities as much as possible until the pain subsides, and you can get on with your life, often taking 6-12 weeks. Many rib fractures never completely heal and cause chronic pain.
For those whom forgo medical wisdom and choose to take local anesthetic injections and narcotic pain meds, they can certainly limp along usually with significant restriction in their activities. For elite contact and combat athletes choosing to train and compete with a broken rib may end up far worse. With a blow a sharp spike of fractured rib can easily impale and puncture vital underlying organs such as the lung, liver, spleen or kidney, just to name a few. Now a painful situation (rib fracture) has been converted into a potentially life-threatening complication (think deflated lung, chest filling with blood and unable to breathe with eminent death in the cards if not properly and urgently treated).
It should be noted that the use of the local pain anesthetics and/or narcotic painkillers without proper prior authorization may run afoul of USADA anti-doping regulations.
Could Jose Aldo have hidden his now confirmed rib fracture, continued training & compete? Possibly. From a medical and/or fighter health and safety perspective should he be medically cleared to do so?
Absolutely not!"
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