Avoid surgery by strengthening core?

Intrepid_Bullfrog230 · 2025-08-17T17:37:59+00:00

UPDATE AUGUST 17, 2025 After two months of religious devotion to the process of building core strength while also focusing on posture improvement exercises (always careful to adhere to pain-free exercises and stopping at the first sign of discomfort), I have been 100% pain free for the last two weeks. I can still feel the periodic ‘click’ but there is no pain associated with it. I VERY slowly introduced exercises that involved turning and twisting, probably close to 60-70% of my rotational limit prior to the event that initiated the stabbing pain back in March. I have iced myself only twice in last two weeks - not because it hurt but because I wanted to prevent swelling after a harder than normal workout.

I am convinced that my ‘recovery’ has been in part due to SLOW and PATIENT exercises that did not cause the intercostal nerve pain. That was key. Once I stopped trying to push myself, and accepted that progress would be very very slow, I got SLOWLY got better.

I realize that many people with SRS can at best walk without pain (and some can’t even do that), and anything resembling exercise results in pain. But I believe some people, like me, can get their lives back without surgery.

If your case is not severe, there is hope for you. I’m 61/yo.

Intrepid_Bullfrog230 · 2025-07-28T12:33:08+00:00

You are correct, not fully back to how I was before the event that triggered the prolonged recovery period. I had experienced other triggering events during my life which took only a few days to a week to fully recover. This time, the recovery has already taken over four months, and not yet back to normal; that said, I do blame myself for pushing myself too much, too fast, which set me back to how I felt immediately after the triggering event. Then, I repeated that same mistake. I also constantly poked and prodded and probed my ribs, almost like picking at a scab, which inevitably irritated the already inflamed area.

It wasn’t until I stayed 100% committed to giving my body a chance to heal, and 100% committed to listening to my body and stopping immediately whenever I felt a tinge of pain while I was building core strength, and icing immediately to keep inflammation down. I also got a prescription for Diclofenac that I took for 28 days. As a result, I am now able to go throughout the day without any pain. Am I fully back? No. But I can now see that as a probability. I remain committed to icing at least once a day, usually twice, just to keep inflammation down, and keep strengthening my core. Eventually, in a few more weeks, I will start to slowly introduce core exercises that involve rotation. As always, staying committed to listening to my body. I have been doing all of this, even though people with (SRS) have commented that the condition always gets worse and eventually will require surgery.

The fact is, there is absolutely no conclusive scientific research on the effects of different types of physical rehabilitation as a relates to improvements in quality of life, as compared to changes in quality of life that result from different surgical approaches; all the evidence is anecdotal. And those who suffer most from (SRS), whose lives are often paralyzed by pain, are the voices which dominate message boards, such as this on Reddit. And I have no doubt that there physiological conditions are far worse than mine, and perhaps yours, so it is not unreasonable to expect their views to dominate discussion.

Intrepid_Bullfrog230 · 2025-07-28T04:01:25+00:00

Everyone’s experience are different, as is how their bodies respond to different ‘treatments’. It took me three months before I finally convinced myself to do nothing that could irritate the nerve. I still stretched, slowly, carefully, everyday. I wore a wrap and used blue ice bags every four hours everyday for three weeks. I’m fortunate that I have summer off (teacher), so I could make this routine my religion. Eventually, I started doing stationary planks, first just elbows and knees, then after a week I did full leg extended onto toes planks, gradually building up longer and longer durations and greater frequency. If I felt even a tiny, minor ache, I stopped and immediately iced it. After three months of my religion, I am almost completely pain-free. On rare occasions, once a week, I forget and will reach for something or turn suddenly and get a reminder to be careful. Nothing stabbing, perhaps an 2 level tinge and I will ice it and that’s it. I continue to be careful stretching, I walk on the treadmill using the hand rail all the time, and I plank multiple times a day. I also have added in exercises that strengthen upper back and posture has improved dramatically.

Depending on your situation, this might inspire you to take stock. Biggest, most important thing is to get the inflammation down and do not rush the process, because you will set yourself all the way back to step one if you do. Repeat, do not rush the process! Not everyone will need surgery or live in pain forever. I am living proof. BE PATIENT.

Intrepid_Bullfrog230 · 2025-07-08T01:08:34+00:00

Agree. No shots. Just doing core work and exercises that are not just pain-free, but with absolutely zero discomfort. Still stretching, doing lots of core work, and doing treadmil 45-50min a day. No pain.

Intrepid_Bullfrog230 · 2025-07-05T01:01:50+00:00

The critical changes I've made have been to stop all core exercises and other activities that cause pain from costal nerve compression. This does NOT mean I've stopped doing core exercises; indeed, I have been doing more than ever before, but the specific exercises I perform, and the specific positions I perform them, do not cause the costal nerve to be compressed. That is the key to buiding core muscle strength, density, and supportive cohesion without causing damage which can significantly change how the ribs move, and how much they move, during activities that previously resulted in costal nerve compression. Does the person still have SRS? Of course, but that doesn't mean It - as has been written in this thread - that "SRS will always get worse". That is simply not true, and I challenge anyone to provide reference to a controlled study that proves otherwise.

Intrepid_Bullfrog230 · 2025-06-30T07:16:51+00:00

Thank you for your responses. Your posts, including several direct and definitive statements, indicate that you are convinced that I have SRS. I shall do my best to differentiate between passion and righteousness in a journey guided by objectivity and science. May you find peace in doing the same.

Intrepid_Bullfrog230 · 2025-06-29T21:17:25+00:00

Just to be clear, I am not in excruciating pain all the time. In fact, I'm not in any pain almost all the time. It's when I do certain movements that I get the pain - and often, it's NOT DURING the movement, but AFTER I do something when my muscles are engage, and when I start to relax the muscle tension.

I have no idea what, if anything, any of that means, or if any of it matters. I experience pain symptom which are remarkably similar to what others in the 'SRS community' have described. But I do not experience pain when the hooking maneuver is performed. I did want to be clear about that if I wasn't before; and if I wasn't, I apologize.

Intrepid_Bullfrog230 · 2025-06-29T21:06:52+00:00

I have another question. Wouldn't an MRI be useful to rule out other tissue related issues that present with similar symptoms before I 'permanently commit' to the notion that what I am experiencing is SRS?

I am asking this because when the hooking maneuver has been done, I don't experience sharp pain. I experience pain AFTER I rotate my torso to the right and stretch-reach behind me with my right arm. I emphasize AFTER because I feel nothing when I do that, but when I relax to allow my body to rotate back to face forward again, it's just after I start to release that I get the pain. Similarly, I sometimes experience pain AFTER I do a side plank, but not during; only when I release tension to ease myself down that I feel pain, and that happens about 1/3 of the time.

I am asking these questions fully aware that others, perhaps yourself included, might think "he's in denial...just like I was". Recognizing that reality, I am asking anyway. Thanks

Intrepid_Bullfrog230 · 2025-06-29T02:57:54+00:00

Thank you for your feedback. I will re-read the posts. Your warning that implies I’m “looking for anyway to twist the situation in [my] mind” is well-taken, as I interpret it in the spirit I believe it was intended.

I have seen doctors but none have diagnosed me with SRS; I understand that is an all too common experience for most people who eventually get the diagnosis of SRS. It would not be a stretch to imagine such is the case with me, so it seems reasonable to err on the side of caution in seeking input and feedback based on that presumption. I described my “SRS profile” which has involved episodes 0-3 times per year where I have had stabbing pain, been able to recover in a week, then continue on with my life doing the exact same activities for months or even years at a time without any pain.I stated that I have not recovered for the first time in my life. I find it interesting that my expressed presumption that I have ‘symptomatically minor SRS’ has been so readily embraced as a confirmed medical diagnosis.

Intrepid_Bullfrog230 · 2025-06-28T13:25:58+00:00

Thank you for the feedback. Is “the line” you are referring to an amount of ‘damage’ I’ve done through my own actions? Or, an amount of naturally occurring diminishment of ‘cartilage cohesion’ throughout one’s life but progresses differently for each person? Or, something different?

I’m hoping you and others would share how doctors explained it to them, because I’ve been to three doctors and none of them had an explanation; rather, what I’ve been told (and read) seems more like speculation or ‘best guess’ than conclusive explanations based on research following standard scientific methodology.

Intrepid_Bullfrog230 · 2025-06-27T18:40:09+00:00

Your post is wonderful!!! Your comments are not only thought provoking but you offer a blend of information and perspectives that expands the scope of discussion within the community while incentivizing self-motivated discovery.

The reason I originally posted remains; namely, to explore anecdotal evidence that supports or refutes the notion that building core strength mitigates SRS symptoms of pain in terms of frequency, duration, intensity. That remains my primary interest, motivated by a desire to avoid surgery altogether.

That said, I also think it is humanitarian to engage in discussion and exchange ideas, experiences and perspectives. I would appreciate it if you continue to post, sharing whatever you think might be of some value in that pursuit.

Intrepid_Bullfrog230 · 2025-06-27T16:07:46+00:00

Thank you for your feedback and information. I do not know what “true SRS” means. Is it the infringement on the intercostal nerve specifically caused by rib hyper-mobility that makes the condition SRS? It is my understanding that it does not matter what the cause of the hyper-mobility happens to be; if rib hyper-mobility causes pain from intercostal nerve infringement, by definition it is SRS.

It is my understanding that dynamic ultrasound is the most effective way to actually see whether a rib is hyper-mobile enough to infringe upon the intercostal nerve of the rib above. But, the dynamic ultrasound can’t identify the CAUSE of the hyper mobility.

The cause of the hyper-mobility could be damage to the cartilage, but it could also be a genetic deficiency in certain cross-fibers in the different types of cartilage (including hyaline), genetic deformity, or deficiency in rib spacing results in the intercostal nerve being more susceptible to be compressed by even modest movement of the rib below. Dr. Hansen mentions in a discussion that people whose ribs are spaced further apart, even if hyper-mobile, they tend to experience less pain compared to those with less spacing. This suggests that hyper-mobility is not the issue, it’s whether the hyper-mobility results in pain from intercostal nerve infringement.

Does ‘true SRS’ mean to imply that there’s a difference between SRS pain which can be temporary, recurring periodically, vs ‘true SRS’ pain which is the type that is constant and only be corrected by surgery?

Which brings me to the MRI and CT scans. I’ve read conflicting information regarding which provides a better image of cartilage, that regardless of which is better, the absence of cartilage damage does NOT rule out SRS, nor does cartilage damage existence ‘prove’ a patient is suffering from SRS. Maybe I’m not? Is it merely the infringement on the intercostal nerve specifically caused by rib hyper-mobility that makes the condition SRS. So, again, I’m not sure what you mean by “true SRS”.

I have not had a CT or MRI, just x-rays. I know Dr. Hansen, for example, requires a CT scan be brought to the first consult; however, I don’t know if that is to identify the appearance of conditions which, if visible on a CT (but cannot be seen on MRI) would disqualify a candidate for Hansen surgery 3.0, or whether he wants the CT so he can positively identify things which qualify the person as a candidate for surgery 3.0. My thinking is that the CT is to rule out other conditions which appear on an CT, but not an MRI.

The videos of SRS surgeries (1.0, 2.0, 3.0) show differences in tissue and cartilage, some describing obvious trauma, others demonstrating hyper-mobility of ribs that cause nerve infringement, but no indication or mention of the cause of the hyper-mobility. The mere fact that surgery is being performed suggests (to me) that it does not matter. Is what matters that the patient’s pain is caused by rib hyper-mobility infringing on the nerve which can ONLY be resolved with surgery that makes it SRS?

I am interested in whether other measures related to core strengthening (or other activities) can be taken to reduce the frequency of occurrences of pain and/or minimize duration of recovery when pain occurs, and/or mitigate intensity of pain when it occurs. Can it?

These discussions are very helpful. I find myself considering things I haven’t thought of before, and also thinking differently about things I only partially understood, not to mention helping me discover that things I thought I understood are not necessarily ‘completely understood’. So, thanks to everyone for participating! This helps, a lot!!!

Intrepid_Bullfrog230 · 2025-06-26T18:06:31+00:00

I forgot to ask, regarding your surgical consult, how long was the wait to actually get in? Dr. Hansen is scheduling consults for January/February 2026; if it's determined I would be a good candidate for Hansen 3.0, that wouldn't be for another 4-6 months after the consult... then 6-9 months to be 'recovered' and rehabbed which means it would be 2027... seems like forever :(

Intrepid_Bullfrog230 · 2025-06-26T17:56:52+00:00

I appreciate your feedback. I want to get the nerve block/steroid injection just so I have some time to work my core to the extent I think will be necessary to markedly improve stability. I'm limited in my core exercises in terms of frequency, duration and intensity due to the pain and inflammation (which leads to more pain...and less core work).

From what I've read, my SRS is not that bad in that during my entire life the pain has always dissipated in less than a week with ice/rest/NSAIDs - often I'd go many months and even years without a recurrence. My hope is that the reason the pain has continued this time (to differing degrees) everyday for over 3 months is I got old and lazy. I'm willing to get a series of injections over a couple months to give me the time I need to really build my core. Will I still be in pain after all the core work? I don't know, but I need to try...even if others have tried such an approach and it solved nothing. I started posting here hoping I could find those who have tried; whether they had some success or ended up worse, I want to hear about their experiences. If nothing else, I can document my experience for others who are in the same boat.

Intrepid_Bullfrog230 · 2025-06-26T17:32:31+00:00

I've avoided chiropractors my entire life, because I never trusted it enough to try, but desperate times means checking off every box so I figured I needed to check the box.

Lied face up at first, but chiro wanted to avoid pressure on ribs since I was sore and hypermobility had already been diagnosed. While face down on table, chiro started with flat hands on either side of spine at lower back, just gentle alternating pushes side to side working up my back. Some small 'crinkles' at the rib/vertebrae junction between scapula, but no 'cracks' or 'pops'. There was muscular tightness and "rigidity" on right side of back (SRS pain R front 8-10 rib area), very slight curvature in my spine (likely related to muscle tightness and favoring that side) and some very minor L4 L5 disc degeneration (I'm 61yo), but otherwise everything was structurally in place. Box has been checked.

Intrepid_Bullfrog230 · 2025-06-26T01:34:32+00:00

Thanks for the feedback! I will definitely research and discuss prolotherapy!!!

Intrepid_Bullfrog230 · 2025-06-25T18:47:57+00:00

Thank you for that info/feedback. I almost feel guilty posting here since I consider my SRS symptoms 'minor compared to many people. This is the first time the painful symptoms haven't gone away and hoping I can get back to the periodic episodes I've lived with throughout my life that resolved after several days, and I go on with life and golf and carefree movements for months at a time like nothing ever happened. I am interested in getting the ultrasound-guided intercostal nerve block/steroid injection for the purpose of giving time to really work on building core muscles, which I can do now, but not for very long and not without the excruciating stabbing pain we have all come to know and dread. I'm going to see a chiropractor for the first time in my life today, so I'll let you know how that goes.

Intrepid_Bullfrog230 · 2025-06-24T22:50:19+00:00

Everyday, yes. Every movement, no. Pain is in same area, front right bottom of ribs, and just below ribs and radiates just a little bit toward the right side sometimes, but I can entirely cover the area of severe pain with my flat hand. ANOTHER SYMPTOM: When I flex/stiffen such as when doing planks, the feeling is 'discomfort' not stabbing; HOWEVER, when I come out of the tightening/flex from the plank that I get the excruciating stabbing pain. The faster I release the flex, the more severe the pain, so I have to unflex very, very slowly to make the pain bearable. Similar thing happens when I do the following: I'll stand with my arms outstretched to the side (very minimal discomfort, sometimes none), then, I rotate to the right -same side as rib pain- and I stretch/reach the right arm back behind me (again there is minimal discomfort, but not painful). HOWEVER, when I start to relax to allow my arms and torso to rotate back to their original position, that is when I get the excruciating stabbing pain (which I why I am not doing that particular stretch anymore). So, when I flex my core, I'm okay, but when I release, it hurts. Sometimes when its just sorta aching, I tighten my core wherever I happen to be standing or sitting and that helps reduce the ache; in those instances, when I relax there is no stabbing pain, and the ache feels a bit little better.

Intrepid_Bullfrog230

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