Chronic dyspnea is commonly seen in patients with Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (CHF). It is also associated with back pain.  Since back pain is such a common co-morbidity in patients with chronic lung and heart disease we don’t usually see the importance of the relationship. Lately I have been seeing a few relatively younger patients with back pain and shortness of breath who have no cardiac or respiratory pathology to explain their dyspnea. Eventually they have discovered that the source of their breathing difficulties was from an exercise machine that they have just started using. These machines were designed to tone their abdominal muscles, but vigorous use of the machines have caused Hip Rib Impingement from repetitive side flexing movements. The repeated impingement would cause injury not only to the lateral abdominal and gluteal muscles, but would also cause injury to the lower intercostal muscles and the insertion of the diaphragm along the lower rib margins. This would explain the development of back pain as well as dyspnea.

As there are variations of the size of the Hip Rib Gap (HRG) between individuals, and the amount of muscles in the gap, these exercise machines would cause more problems with people with the smaller gaps and the least amount of lateral abdominal muscles. Getting back to the patients with chronic cardiac or respiratory problems; these patients would be more sedentary, but if they had poor sitting posture especially if they had to sleep propped up in bed, then Hip Rib Impingement would occur and contribute to their dyspnea. I have treated patients with dyspnea and medically managed COPD and CHF in the past, relieving them of dyspnea despite their ongoing cardiac or respiratory pathology. I wonder what percentage of patients with COPD or CHF with some degree of dyspnea who will benefit from treatment. The treatment would also be useful for patients with dyspnea where no medical cause ould be found.

Hip Rib Impingement postoperatively may also play a significant part in the aetiology of post operative pneumonia due to injury to the diaphragm when patients are propped up in hospital beds.