Of the PT Persuasion: Broken Ribs
Have you ever wished for a resource that helped writers cut back on hours and hours of researching how to accurately portray injuries and medical conditions? Look no further. In this blog series, I’ll be discussing just that. What makes me qualified to do so? Well, I’m a Physical Therapist! Or, rather, I’m a writer…Of the PT Persuasion.
Alina Starkov may have captured our hearts in Leigh Bardugo’s mega-hit Shadow and Bone, but our adored Sun Summoner isn’t as beloved by everyone when she reaches the Little Palace. Jealous of Alina’s burgeoning power and a bit of a sore loser, Zoya has no problem breaking the rules of engagement during their fistfight and manifesting her bitterness—and Squaller powers—to throw Alina back against the training room wall, breaking her ribs. It’s safe to say there’s no love loss between Alina and Zoya.
Being as smart and angry as she is, I’m sure Zora realized what she was doing. Broken ribs might be a simple little injury, but the truth is that they are immensely painful. Here’s why…
Let’s start with our relevant anatomy. We have 24 ribs forming our ribcage, 12 on each side. All of our ribs attach on our thoracic spine (mid- and upper-back), and curve around our sides to the front. The first six ribs on either side attach directly to the breastbone (sternum and manubrium) via cartilage. The seventh through tenth ribs attach to the sixth rib’s cartilage like a keychain, so they’re indirectly attached to the breastbone. The eleventh and twelfth ribs don’t actually attach to the breastbone; we call them “floating ribs” since their only attachment is to the spine.
Now, you’re probably noticing a lot of “cartilage” mentioned in there. Cartilage is a lot more flexible than bone, but still provides structural support; think of your ears and the tip of your nose—flexible but still retains shape. The purpose of the ribcage is the protection of some of our most vital organs (heart, lungs, major blood vessels, and part of the liver and spleen), but it also needs to have enough mobility that we’re not just carrying around a solid vault in our chests.
The ribcage needs this flexibility in order to expand and allow inspiration and expiration (a.k.a. breathing). If you’ve ever unfolded a circular paper lantern, that’s roughly how the ribcage moves and expands, where the wire framing is the ribs and the paper is like the muscles between the ribs that help them move so our lungs can take in air.
So let’s think about this: Alina gets blown against the wall with enough force to crack her ribs. Well, she still needs to breathe, right? So every time her breathing muscles pull on those ribs to move them…ouch. If you’ve ever had a broken bone, you know that just sitting still hurts. Now, imagine having to move that bone repeatedly just to fulfill a basic life requirement like, I dunno, breathing. That’s why rib injuries are so painful; there’s no way to not use your ribs.
Okay then, if your character has been unlucky enough to break a few ribs, they’ll have pain while breathing, right? Of course. But also pain with pretty much everything else, too.
Because our ribs are attached to our spine, the ribs have to move whenever the spine moves. And if you’ve ever had back pain, you’ve noticed that we have to move our spines a lot. Any twisting, bending, or even arm movement involves our thoracic spine, so when the servants come to help Alina onto a stretcher, it’s no wonder she passes out from the pain!
Then what are some things to keep in mind for this character injury?
Your character will get ‘the wind knocked out of them’ when the impact happens, which is a spasm of the diaphragm that inhibits breathing momentarily. Rib pain is sharp and severe during breathing and movement (especially reaching with the arms, twisting, leaning, and bending over), though it can be dull and deeply achy with shallow breathing. The problem with shallow breathing, like if a character is trying to prevent pain by not taking full breaths, is that it can lead to lung infection.
Well, this opens up an entirely new can of worms. What internal problems can broken ribs cause? Oof, well, remember that time we talked about all the vital organs under our ribcage? If those organs are an inflated balloon and if a rib is broken badly enough, you now have a balloon protected by a cage of knives. Yes, yes, sounds super safe. Bone fragments and splinters are very sharp, my friends, and that’s the reason punctured lungs are the scariest problem associated with broken ribs. (The heart is a bitbetter protected than the lungs based on positioning, so you can worry a little less about a speared heart.)
Okay, then how do you get these problematic broken ribs to heal? Well, if you’re Alina Starkov, you’re lucky enough to have Healers to tend to your wounds. If you’re not lucky enough to have a Grisha nearby, then your options come down to this: because the ribcage can’t be splinted, a mild to moderate rib fracture is allowed to heal by 1) not moving in ways that aggravate it, and 2) not putting pressure on the ribs. To avoid lung infection while breathing shallowly, someone with fractured ribs should try to occasionally and gently breathe deeper and/or cough to dispel any fluids building up in the bottom of the lungs. Other than that, it’s “good luck” and “be smart!”
Broken ribs will take about six to eight weeks to heal. In the meantime, your character will likely be wincing with every breath and complaining about how annoying this injury is!
And there we have it! Broken ribs are no joke, and I’m sure Alina would agree, though she’d never let Zoya have the satisfaction of knowing that!
Thank you for reading! I hope you enjoyed this installment to Of the PT Persuasion.
Disclaimer:
If you’re seeking medical advice for yourself or someone you know, you should speak to a medical professional. This blog is not intended for diagnosing or treating real-life medical conditions, only fictional ones.
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