Therapy of rib contusion – What to do?

A rib contusion is treated conservatively, i.e. surgical intervention is not necessary in the case of a rib contusion. Cooling (cryotherapy) can help against the swelling and pain. Wet towels, cooling packs and ice spray are suitable for cooling.

The cooling element should be wrapped in a thin towel, as direct contact with the cold can damage the skin.It is advisable to take it easy for a few weeks and not to do any sports. Pain-relieving ointments and medication such as ibuprofen or diclofenac can also be taken to relieve the pain. Ibuprofen is available without prescription in any pharmacy, but the recommended daily dose of 1200 mg should not be exceeded.

If you are taking it over a longer period of time (more than four days), this must be discussed with your doctor, as the wrong self-medication can sometimes cause serious side effects. The pain lasts for 3-5 weeks on average in the case of a rib contusion, but can also last longer or disappear after a short time depending on the degree of injury. If the pain of a rib contusion is severe, especially when breathing in and out, the application of a support bandage can provide relief.

In some cases, physiotherapy may also be useful. Massages and heat applications can also help against the pain. If the rib contusion is so painful that breathing is severely impeded, prophylaxis against pneumonia may be advisable.

Due to the low ventilation of the lungs and the lack of expectoration of mucus, bacteria can multiply very quickly and thus lead to pneumonia. A follow-up with ultrasound and/or X-ray may be necessary if the pain does not subside even after weeks and respiratory distress occurs. The most important remedy against the pain is absolute protection and immobilization of the upper body until the contusion has healed.

Painful movements and coughing, laughing and sneezing should be avoided if possible. The strong pain, especially when breathing in deeply, can cause breathing difficulties; doctors call this dyspnea. In such cases, the patient must remain calm and breathe in and out slowly in a normal way; too deep breaths should be avoided.

Coughing attacks are extremely painful and unpleasant when the ribs are bruised, so the patient can take expectorant and cough-relieving drops. Symptomatic therapy consists mainly of taking painkillers and anti-inflammatory drugs. Ibuprofen, acetylsalicylic acid (ASA) and diclofenac (active ingredient in Voltaren) belong to the group of non-steroidal anti-inflammatory drugs (NSAIDs).

These drugs have an analgesic effect and also have an anti-inflammatory effect. Injured blood vessels can cause a bruise (haematoma) to form over the bruised ribs and cause additional pain. A heparin ointment can be applied locally to the bruise and has a decongestant effect.

If the pain is very severe, the doctor may additionally administer non-opioid painkillers, e.g. procaine, which anaesthetize the nerves between the ribs. In addition, cough-relieving, homeopathic or blood circulation-enhancing ointments can be taken as a supplement. The pain is often strongly dependent on movement and pressure, so that painful movements, sports activities and potential violent effects on the chest should be avoided at all costs.

The pain should be relieved sufficiently to produce an acceptable level of pain and to allow unrestricted breathing and general movement. If these drugs are not sufficient, so-called “opioids” can also be taken. In addition to pain medication, so-called “antitussives” can be taken.

They can block a coughing stimulus and thus relieve the unbearable pain when coughing. To prevent pneumonia, an additional expectorant medication should be added. Part of the symptomatic pain therapy for a rib contusion can be an ointment.

They are very well suited to improve the symptoms of a rib contusion and most of them are available over the counter at any pharmacy. Since the ribs are located superficially under the skin, an ointment on the skin can be used to achieve a relatively high concentration of active ingredients on the bone. Ointments have the advantage that they can achieve a much more targeted effect on superficial injuries without having to burden the entire body with painkillers.

For rib bruises, primarily pain ointments with an additional anti-inflammatory component are used. Common ointments for pain relief include Voltaren Gel (active ingredient Diclofenac), Traumeel Ointment (a homeopathic ointment with various active ingredients from herbs and plants), Dolobene Ibu Gel (active ingredient Ibuprofen) or Dolobene Cool Ointment (a cooling cream with isopropyl alcohol and herbal extracts). The active ingredients come from the NSAID group.More rarely, heparin-containing ointments can also be used in cases of rib contusions with extensive bruising.

These inhibit blood clotting under the skin and accelerate the healing process in the case of hematomas. To treat rib bruising, the affected area can be creamed with Voltaren Emulgel. This is a cooling gel containing the active ingredient diclofenac.

Diclofenac is an analgesic and anti-inflammatory agent from the group of non-steroidal analgesics (NSAIDs), which is suitable for the treatment of acute contusions and injuries caused by blunt trauma. The gel is applied to bruised ribs twice a day. The most important therapeutic step in the treatment of rib bruising must be taken within the first 48 hours after the injury.

During this period, swelling may occur and bruising may develop. Household remedies should be used to ensure adequate cooling in the first two days. Initially, cool packs can be used for this purpose, but curd wraps or moist compresses can also be used.

During the healing phase, which can last several weeks, the healing process can only be slightly accelerated with home remedies. Primarily, sufficient protection and immobilization should be observed. In cases of coughing or slimy colds, symptomatic support can be provided with household remedies.

Tea and inhalation should be used to relieve cough stimuli, in order to reduce the strain on the ribs and also to reduce pain. Homeopathic medicines are based on the assumption that highly diluted active ingredients sensitize the body to a disease and use the body’s self-healing powers to cure the disease. Homeopathic remedies can also be taken to help relieve the symptoms of rib contusions.

In the pharmacy you can buy over-the-counter Traumeel ointment with active ingredients from belladonna, wolfsbane, marigold, arnica and other plants. This ointment is applied to the bruise several times a day. Beads with the active ingredient of daisy (Bellis perennis) is a common remedy used for the homeopathic treatment of blunt injuries.

However, pain-relieving medication should never be avoided under any circumstances, as a rib contusion can otherwise lead to serious complications, e.g. pneumonia. If breathing is restricted and the rib contusion leads to secondary diseases, homeopathy may only be taken as a supplement to the doctor’s drug therapy, but should not be the only method of treatment. The exact effect of homeopathic remedies on contusions and injuries is controversial.

In order to be able to reduce the symptoms of a rib contusion somewhat, a kinesio-tape bandage is often used in addition to drug therapy. Although this does not accelerate the healing of the bruised rib(s), it can sometimes make the healing phase more pleasant. Especially the respiratory pain, which is usually the main cause of rib bruising, can be reduced by applying a tape bandage.

Usually several strips of the elastic cotton tape are needed to treat a rib contusion. Here one or more strips are applied along the ribs. Sometimes tape is also applied from top to bottom.

The tape should not disturb during normal everyday life and should cause an improvement of the symptoms caused by the rib contusion. It acts like a second skin and the taped area is fixed without restricting the freedom of movement. Through the tape, muscles are taped, massaged and the blood flow is stimulated.

If this is not the case, the tape can be removed and reapplied. The tapes can be applied either by a physiotherapist, occupational therapist or by yourself. Taping a rib contusion is to be understood as an additional therapeutic measure and should not be used as the sole therapy, especially if there are severe symptoms (see: Pain with rib contusion).

This bandage remains on for a week and should show the main effect in the first three days. Normally such a bandage holds and works very well, but if there is no improvement or the tapes come off, the tape can be removed and reapplied. A contusion of the ribs can be extremely painful.

Especially bruises of the ribs caused by coughing usually lead to very strong pain when the cough is stopped.For this reason, taking painkillers (analgesics) is very important in the treatment of rib bruising. One tablet can be administered approximately every 6 hours as needed. In addition, rib contusion can be treated mainly by sparing the rib cage.

The affected patient should take absolute rest during the healing period. Any further excessive strain on the ribcage may worsen the rib contusion. If the pain is severe, the use of ice packs or cold compresses positioned on the affected area may be helpful.

In this context, however, care should be taken to ensure that the application of an ice pack can cause severe skin reactions. For this reason, cooling should not be applied directly on the skin surface. If possible, the ice pack should be wrapped in a towel and only then placed on the chest.

If the symptoms persist for a long time, the rib contusion can be treated more extensively. In particular, special breathing therapies and/or breathing exercises can help to shorten the healing time of the rib contusion. Periodic, deep breaths should help to stretch the intercostal muscles and effectively treat the rib contusion.

Some specialist books recommend the use of rib belts and/or compression bandages in the event of rib contusions. In the meantime, however, it is now assumed that these aids lead to pneumonia in many cases. Patients who regularly practice contact sports should wear special protective clothing for a longer period of time even after the rib bruise has healed.

This is the only way to protect the ribs and chest from massive violence and to prevent a renewed rib contusion. As an immediate measure in case of a rib contusion, cooling of the rib cage is recommended, since the cold reduces the pain conduction in the nerve tracts and less pain is felt. In addition, cooling causes the blood vessels to contract, so that the swelling after the injury is less severe.

It is important to perform the cooling for about 20 minutes, so that the effect reaches the depth of the tissue and not only the surface is cooled. There are various options for cooling, depending on availability. If no other option is available, cooling can be done with wet cloths.

Otherwise, cooling pads, cooling ointments or ice can be used. The use of an ice spray is possible, but does not help satisfactorily in case of a rib bruise. The ice spray cools only as long as it is sprayed on and preferably on the body surface.

With all types of cooling, a break should be taken after about 20-30 minutes to avoid skin damage caused by the permanent cooling. In addition, with cooling pads and ice, a towel should be placed between the skin and the coolant to prevent frostbite at this point. The cooling is still completely sufficient.

After the acute phase, it is different whether further cooling or treatment with heat is felt more pleasant. Heat treatment is not recommended in the first 48 hours after the rib contusion, as it causes the blood vessels to dilate and thus promotes swelling after the injury. If the rib contusion is not caused by sports but by a pronounced cough, many people find it pleasant to treat with warm compresses or heat pads.

The warmth can weaken the coughing stimulus and supports for example the healing of a pneumonia. After the acute phase, a heat treatment can lead to relaxation of the muscles that have become cramped due to the pain and thus provide relief. Heat therapy also helps by increasing the blood circulation, as a higher blood flow ensures a higher metabolism.

An increased metabolism means a better supply of nutrients and oxygen to the tissue, which has a positive effect on the healing process of rib bruising. Whether a heat therapy is felt however as pleasant or not, is very individual. Many concerning place themselves the question, which works better with a rib bruise – warmth or cold weather?

Generally it can be said that both measures help with a contusion, but at different times. As an immediate measure immediately after the injury, the contusion must be cooled. The cold ensures that the vessels contract and no major bruising can occur.In addition, the cold reduces the transmission speed of the nerves, which means that pain stimuli are less strongly transmitted to the central nervous system and processed.

Anything that is cold can be used for cooling, preferably cooling pads, ice or special ointments with a cooling effect. During the first two days, the bruised ribs should be treated with cold for at least 15 minutes three to five times. Care must be taken to ensure that the cooling pads or ice do not come into direct contact with the skin, otherwise skin damage due to frostbite may occur.

It is best to wrap the cooling element in a tea towel or thin cloth. On the third day after the accident, the heat treatment of the rib bruise begins. At this point the first healing phase is complete and the inflammation has already been reduced.

Heat leads to a better blood supply to the tissue around the bruise and provides it with nutrients and oxygen. The blood circulation accelerates the healing process and the heat additionally relaxes the muscles that are cramped by the severe pain. For a heat therapy, warm compresses, a hot-water bottle or a hot cherry stone cushion can be used. There are also special preparations that contain the natural active ingredient capsaicin (the hot substance from cayenne pepper) and are applied to the bruise in the form of a cream.