dislocating a rib from too tight a vest...

a couple of saturdays ago i was out with friends. it was my first time riding since christmas, and i'd received a new vest from my girlfriend to replace the one that was cut off me from my last accident.

anyways, the vest was a bit small - being a large when i usually wear an x-large. also, since i was wearing a drysuit, i was wearing it over a long-sleve t-shirt and a sweatshirt. so it was pretty tight.

but i've worn tight vests before and like my friend troy who was on the boat said, it's natural to think that tight is better as athletes commonly wrap up for proection and to strengthen injured joints, etc.

as you can see from this clip it wasn't a particularly impressive crash:

http://www.wakepics.com/view_single.php?medid=9769 (343K)

when it happened i was convinced it was because my vest was on too tight. when i landed on my back the pressure compressed my chest. being already compressed from the vest it had nowhere to go, so something had to give. and of course a rib pushed out in front.

after the crash, lying in the water i felt the rib moving in and out, like a joint that pops. i couldn't believe it was a part of my body and assumed it was the buckle of the vest moving against me. so i tried getting back up again, but only went a few feet before dropping the handle.

i wasn't in immense pain, but breathing was difficult and i felt like i'd been punched hard in the ribs.

i managed to pop the rib back into place in the water, which made getting back into the boat easier. and when kneeling on the v-drive i got my drysuit and vest off, my chest felt like it visibly expanded - an obvious sign of wearing the vest too tight.

then my rib popped out again while kneeling there - i moved slightly or did something and it popped out again. i pulled up my shirt and could see the bone pushing the skin out. nothing really graphic, just a bump on the right side of my chest just below the pectoral. i worked it a bit and suddenly it popped back into place (much to the consternation of thane and troy who were watching at the time!). it hasn't moved since.

i didn't go to the hospital or get x-rays. we finished out our day normally and i kept videoing the other riders, albeit a bit painfully. my assumption (which has been verified by others with the same injury, as well as medical personnel friends and relatives of mine), was that doctors would just tell me i dislocated a rib and there wasn't much they could do for me. ice it for the first 48 hours and then heat...etc., etc.

in talking to others i found this injury not too uncommon. when it happened i couldn't conceive of anything like it happening and was surprised to find it had happened to others - sometimes more than once!

i taked to aki about it and the first thing he asked me was "how tight do you wear your vest?" turns out he used to wear his vest nice and tight and after suffering the same injury now keeps it looser. in his discussions with others who'd also experienced this injury they'd all had their vests very tight. this was a revelation as everyone else i'd talked to who hadn't had this happen to them found my vest-too-tight theory a bit confusing. it was nice to find it validated.

so i post this little injury journal just to possibly help another wakeboarder avoid a similar fate. if i'd had any idea that wearing a vest too tight could contribute to dislocating a rib on a fall, i never would have ridden that way.

i normally wear my own vest comfortably loose, but since my last accident i've been borrowing vests and never thought twice if it was tight. so long as i could move alright i didn't worry about it. never occurred to me that i might be setting myself up for an injury.

i've been out for two weeks and will probably be out for another two weeks (4-6 weeks seems the normal recovery time). i wish the opportunity for someone who'd gone thru this to speak about it had come up for me. i've seen folks ask in threads about injuries how the injury happened - im assuming they are trying to figure out if it's an injury that could be prevented with knowledge. some are and some aren't. since i didn't hear about this possibility before, im trying to create that by posting here. perhaps it might help someone in the future.

A similar incident happened to me in August. I was, for some reason, trying a front flip. I flailed and rotated about 270°, right onto my side. I had my arm/elbow tucked in upon impact, and at first, didn't seem too bad. Then, when I took some deep breaths, there was pain. Getting out of the boat was not easy either.

So the next day I went to the doctor, they took xrays, and said they couldn't find anything wrong. Just rest and ice (4-6 weeks). I now think they didn't know what they're talking about. My rib below the pectorial, now sticks out a bit. Didn't think much of it, but now wonder if it is dislocated, or something else. I was boarding in slight pain within 4 weeks and the pain was gone in 8. But I noticed when I do close grip pull ups or other random things, I can feel the rib is not normal. I guess there is not much I can do now, unless I re-injure it again. I hope this helps in any way. Good luck with the heeling process, I'm sure it will turn out slightly better than my situation.

actually peter i think you're a text-book case. one other person showed me that they still have a bump where it happened to them and i wouldn't be surprised if i always have the lump that's there now. don't know if it's scar tissue in the cartilage or what, but i would doubt your rib is still dislocated. if it's out of place you'd know it i think.

my popped back in, but that side still has more of a contusion-type bump there. im guessing it might always.

that was one of things i was worried about - that i now have a weak point that may go again in the future. anyone have any experience with this injury re-occurring?

(Message edited by deepstructure on January 13, 2004)

You seem to on to something. Same thing happen to me on a 360 during the summer. I thought I just got the wind knocked out of me until I got up again. I, not being the bright one, thought is would ease up and even tried another 3 before realizing the pain was getting worse. I just felt stupid that trying to breathe was painful from little crash. I felt bad I couldn't even help clean the boat after riding. Wife made me get x-rays and of course they said go home and ice. I still have the unfilled prescription of Vicoden (spelling?) if someone wants to buy it off me.. I also was wearing my vest pretty tight. I also seem to have a slight bump that never went away. I have started wearing my vest looser.
Christopher, Going to try to get out on MLK day if you up for it.

I did something similar in '94 while snowboarding, apparently separating the bony rib from the cartilage portion of the sternum where the two connect. It has indeed been prone to re-injury. I busted it again about 3-4 years ago when I came up short on a switch backroll and caught the nose of my board. There have been other occasions when I took a hard fall and broke it loose so I once again experienced movement in there.
I have been told that if there is cartilage involved in the original break, then it will never heal, as cartilage does not regenerate. Instead, calcium deposits form around it and act sort of like cement, but they are not strong and are prone to breaking loose again (as I've done repeatedly).
I still have a big bulge under one of my pecks where it never healed up properly. I don't really notice it often except when I'm trying to surf, because when I lay on the board and try to paddle into a wave, the poking-out-part gets pressed back into my body and the pain is surprisingly severe. Sucks for surfing.
Anyway, I don't know if my injury was equivalent to yours, but I hope you guys heal up better than I did. To this day, it makes me think twice when trying that switch roll again.

Phantom, any input on this?

First set first day of a ten day vacation at Shasta I dislocated my rib. It was done on repetative crashes spinning 360's off the DU. After the last crash I could barely move and stopped wakeboarding for some time. Mine was not due to a tight vest, but I feel that if I had been wearing a USCG vest back then it would have helped.

The bad part is it sticks out of my chest slightly. This stops me from being able to surf as it does what you described Christopher by moving in and out, which causes enough pain when paddling to ruin the fun of surfing, and I pay the next three days.

Hope you heal quickly.

hey thanks for the responses and sharing folks - always good to hear from you guys. garrett, i i'd be up for coming out and filming you guys since i probably won't be ready to ride. i have to work at 2p.

ya, i'd love to hear from phantom on this...

Well after some research all I could find was this article:
http://www.physsportsmed.com/issues/1998/04apr/okane.htm
Though it's a little more extreme than what you Boys are describing about yourselves, it should provide some post injury insight on care.

A brief anatomy lesson:
Chest/ Thoracic cavity needs to be able to expand with the lungs.
Wearing something tight, (as you have all felt) limits the ability to taking a deep breathe.
Now think about this for a second:
You're catching serious air, as you're coming down you realize ( which is just a fluke for many of you) you're coming down all WRONG.
So you know you're gonna crash and burn....what do you do??? You hold your breath or
- take a deep breath in ( which increases intrathoracic pressure) .
Combine that with a tight vest and external pressure from crashing......Viola...What happens?
Somethings gotta give. The mechanism of injury may also include the positioning of your upper arm(s) since the Pec Major is attached to ribs 2-5 and the Radiate ligaments attach these ribs to the sternum.
( at least that's what I was taught.)

So I guess the take home message is this:
Don't wear your vest too tight, but make sure it just fits snug .

Chris: thanks for the insight. Nice to have some medical pros on board as well.

Yep, I'm gonna make certain my vest ain't too tight!