Can a broken nose cause back pain? Yes, it can.
Just before I had to close my clinic due to COVID-19 restrictions, I worked on a client that really emphasized for me the deep interrelationship between the breathing passage, rib positioning, and back pain. This new client came in with a host of different issues, including a big twist through his torso, shoulder, and back pain. He told me that his pain was worse in the morning and got better through the day as he worked long shifts as a server. I also noticed his runny nose, which he told me was a chronic issue he thought was mostly due to allergies—a week before the pandemic became serious here in Canada, I just noted this down as relevant clinical information rather than breaking into a panic and asking him to leave.
Postural Evaluation Showed Rib Flare
Often, the cause of back pain can be narrowed down with postural evaluation. A glaring issue with his posture was a huge rib flare on both sides. This issue is often caused by an upregulation of the muscles of the diaphragm, low back, or the hip flexors and a downregulation of the muscles that hold the costal margin down (the abdominal muscles), importantly, including the transverse abdominis and the internal obliques. These two muscles are especially important because they are both connected to the deep lamellar layers of the thoracolumbar fascia and thus are partially responsible for the maintenance of intra-abdominal pressure and core stability. But after testing with Neurokinetic Therapy, we found these muscles to be all relatively strong. This wasn’t a cookie-cutter case at all. His core stability loss wasn’t coming from his core.
Reflexive Stability Testing Helps Pinpoint the Issue
Luckily, I am also able to use reflexive stability testing to help narrow down the area that might be the most important. This client didn’t lose stability around his pelvis or ribcage, which is what you might expect with a big rib flare and low back pain. Instead, we found that he lost most stability in the area of his face. What did this mean? Thank goodness I take a detailed history! While the client’s nose was straight, he had broken his nose twice in middle school, once on either side. I did some nerve testing and found decreased sensation in the V3 area of the facial nerve on the right side. This meant that the scar tissue from the nose break was potentially entrapping a nerve. Since nerves don’t like to be stretched, his jaw, neck, and everything down from there was compensating.
Scar Tissue Was Blocking His Air Passage
Maybe more importantly, the scar tissue had partially closed off his air passage. This meant his diaphragm was having to work extra hard to create a vacuum in his lungs for air to pour into. This overworked diaphragm was causing his rib flare. How do we know? His ribs dropped after 10 minutes of release of the scar tissue around his nose and a cranial adjustment of the nasion (the bridge between the nasal bones and forehead). Of course, this drop in his ribs also reduced the strain on his back significantly, returning core stability and reducing back pain. So why did my client’s symptoms get better through the day? Simple—sinus drainage. His horizontal sleeping position made breathing even more difficult. It took hours upright during the day for his diaphragm to relax from the marathon of strained breathing during the night and for his ribs to drop partially.
Scar Rehab Takes Time
While scar release often takes quite a bit of time to do, many of my clients are able to do it on their own. His homework was to continue the release around his nose and focus on exhalation when doing conscious breathing exercises. I heard from him six days after his appointment, happy to report that his left nostril had cleared up significantly—a big shift from what felt like a lifetime of stuffiness. I am looking forward to what we find when we finally get to work together again—hopefully soon.
Pain Assessment Means Looking Beyond the Obvious
If you have back pain, it could be related to core stability loss. However, it might also be connected to something less obvious. Chronic stuffiness, a previous broken nose, fascial scarring, or the time of day that the pain gets worse or better—these are all hints that help lead me to the real causal agent of chronic issues. This work brings out the detective in me—I follow the body of evidence in front of me and then test using NeuroKinetic Therapy to verify my hypothesis. If you have an issue that you’ve been having trouble getting good treatment for, book an appointment, and we will investigate together.
Image credit: StrongFirst.com. They have an excellent article on breathing, strength, and posture that explains the more common causes of rib flare and how to correct them – I highly recommend checking it out!
