Is Massage the Right Treatment for Periostitis?

Is periostitis treated by rubbing?

I have pain in a certain area of my right last rib when I press on it (and when I bend or twist my waist), but it's not extremely painful.
My family doctor said it's periosteitis, and the treatment method is to apply a massage cream to the affected area daily until it feels warm.
However, isn't this treatment similar to that for a bruise or strain? Also, I didn't engage in any intense exercise or have any significant impact to the area before this pain started.
The doctor suggested it might be due to poor posture, but can poor posture really cause such severe pain? Thank you! PS: Although I shouldn't doubt my family doctor, his explanation does seem a bit strange.

Gu Gu Tong~, 10~19 year old female. Ask Date: 2004/08/01

Dr. Sun Ruisheng reply Orthopedics

In adolescents, rib pain is most commonly caused by tendonitis, periostitis, or sprains, with malignant diseases being rare.
The majority of cases arise from a lack of recollection regarding the injury; often, individuals do not remember how they were injured because the pain is not severe at the time of injury.
It is usually only after a day or two, when tissue swelling or inflammatory hormones are released, that discomfort is felt.
Therefore, it is common for young individuals to continue vigorous activity on the field after an injury, only to seek medical attention the next day when their foot is swollen like a "dumpling." Most cases of poor posture can lead to muscle pain and fatigue in the back.
In response to the reader's question about healing conditions, aside from time, some oral and topical analgesics and anti-inflammatory medications can help alleviate discomfort.
However, if the pain persists for several weeks, or if you wake up at night due to pain, or if there are any unusual changes in the local skin, it is advisable to visit a hospital for an examination.

Reply Date: 2004/08/01

More Info

Periostitis, or inflammation of the periosteum (the connective tissue that surrounds bones), can indeed be a painful condition. Your experience of localized pain in the area of your rib, especially when bending or twisting, aligns with the symptoms of periostitis. The treatment approach suggested by your family doctor, which involves the use of a massage ointment and gentle massage to promote warmth in the affected area, is not uncommon. However, it's essential to understand the rationale behind this treatment and whether it is the most appropriate approach for your specific situation.

Understanding Periostitis
Periostitis can occur due to various reasons, including repetitive stress, poor posture, or even minor trauma that may not be immediately apparent. In your case, your doctor suggested that improper sitting posture could be a contributing factor. While it may seem surprising that poor posture could lead to such inflammation, it is indeed possible. Prolonged periods of sitting in an awkward position can place undue stress on certain areas of the body, leading to inflammation over time.

Treatment Options
1. Massage and Heat Application: The use of massage ointments and gentle massage can help increase blood flow to the area, which may promote healing. The warmth can also provide temporary relief from pain and discomfort. However, it is crucial to ensure that the massage is gentle and does not exacerbate the pain. If the pain worsens with massage, it may be a sign that this approach is not suitable for your condition.

2. Rest and Activity Modification: Avoiding activities that aggravate the pain is essential. If your pain is indeed related to posture, making ergonomic adjustments to your workspace or daily activities can be beneficial.
3. Physical Therapy: Engaging in physical therapy can provide targeted exercises to strengthen the muscles around the affected area, improve posture, and alleviate stress on the periosteum. A physical therapist can also guide you on proper body mechanics to prevent recurrence.

4. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and relieve pain. If your pain is persistent, discussing medication options with your healthcare provider may be beneficial.

5. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture or chiropractic care. However, it is essential to consult with a qualified practitioner and ensure that these approaches are appropriate for your condition.

When to Seek Further Evaluation
If your symptoms do not improve with conservative treatment, or if you experience increased pain, swelling, or other concerning symptoms, it may be necessary to seek further evaluation. Imaging studies, such as X-rays or MRIs, can help rule out other conditions, such as fractures or tumors, that may mimic periostitis.

Conclusion
In summary, while massage and heat application can be part of the treatment for periostitis, it is essential to approach this method with caution. If you find that the treatment is not effective or if you have concerns about your doctor's recommendations, seeking a second opinion from a specialist, such as an orthopedic doctor or a physical therapist, may provide additional insights and treatment options. Remember, your comfort and understanding of your treatment plan are vital in managing your health effectively.

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