When I tell a patient that Hip Rib Impingement is the cause of their ongoing back pain, the most common reaction is disbelief. One of the reasons for this disbelief is that they have not heard of it before. The other common reason is that they have no idea where their lower ribs are in relation to the top of the iliac crest. Common illustrations of the human skeleton show a relatively large gap between the 2 structures but in my clinic, I rarely see anyone with a gap greater than 5 cm. By examining the patient in the standing position and demonstrating to them how much of a gap they have between the lower edge of the 11th rib and the top if their hip by placing your fingers in the gap you can easily convince themof how easily they can collide and damage the lateral abdominal muscles. They will be even more convinced if while moving your fingers up and down between their ribs and their hips you can find some tender spots. The evidence that Hip Rib Impingement occurs is there on everybody’s hips. The search for a cause of mechanical back pain has been going on for many years and I believe that Hip Rib Impingement is the simple explanation for this massive problem. This solution to the problem is classic lateral thinking and thinking outside the square. The theory does not contradict any evidence that we have on back pain at present.
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