Rib fractures occur fairly commonly in ice hockey. Luckily, most of them are minimally to non-displaced fractures, which means that the structures which the ribs are supposed to protect (the liver, spleen, kidneys, and lungs) generally do not get injured. They usually occur when a player is checked against the boards or runs into the goal posts. The most common location when they occur is outside the area of the protective padding from the shoulder pads.

While rib fractures themselves are not themselves serious long-term problems, it is important to make sure that there are no other injuries present which could be serious. If a player has a check against the boards or hits the goal posts and there is an area over the ribcage which hurts when it is pressed on, or if the player feels like some of the bones are crunching, then they should have x-rays taken to assess the amount of fracture displacement. It is especially important to follow up with a physician if there is any abdominal pain or difficulty with breathing.

A very small percentage of patients can have damage to the internal organs. Therefore, it is important to have appropriate follow up. A rib fracture could cause a tear in the lining of the lung, which could cause it to collapse. A rib fracture could also cause injury to the liver, spleen, or kidneys, which needs to be evaluated also.

In your case, where you have a rib fracture and you do not have injuries to these other structures, the first thing you should do is make sure that you have enough pain relief such that you can skate. These injuries can be painful because of the motion of the chest wall when you breathe. Since we typically breathe approximately 15 times per minute, which increases with heavier activities, this can cause the broken ends of the ribs to move frequently and it can be quite painful. It may be necessary soon after the fracture occurs to have pain medications prescribed, or you may take acetaminophen as necessary.

We commonly like to provide a rib strap to help "splint" the broken rib. The purpose of the rib strap is to help prevent your chest wall from moving as much when you are taking a breath, which in turn will cause the rib fracture to be less painful. This method, however, does not prevent subsequent additional injury because it does not provide extra padding to the rib.

You may return to play as soon as you can tolerate the pain. When there are not other injuries present, we commonly let our players go back with the use of a flack jacket to protect the area of the fracture so that they can skate with minimal pain while minimizing the chance of taking another blow to the area of the fracture. They may need to wear the flack jacket from anywhere up to a few days to three weeks depending on the location of the fracture and the severity of the initial check that they had.

You should not be on any medication stronger than acetaminophen when you return back to play. We generally do not use anti-inflammatory medications, such as ibuprofen and naprosyn, in the initial period after this type of injury because it tends to increase the bleeding and it may slow down the healing.

Rib fractures do tend to heal quickly. In most cases, they are pain-free by three to four weeks after the fracture. It is important that they be assessed by a physician to make sure that there are no underlying injuries and be monitored closely by your athletic trainer to determine when you should return back to play.