Review Treating Respiratory Rib Somatic dysfunction- Curtis, October

Question 1

General Screening Assessment

Answer 1

Assess the ribs in conjunction with the thoracic vertebral evaluation

• TART changes over the rib angles
• – Tenderness
• – Asymmetry: prominent rib angles
• – Tissue texture changes

When you find motion restriction/somatic dysfunction of vertebral segments, you should automatically look at the ribs as well.

• The ribs attach to the vertebral segments at the same level and above (for example, rib 3 attaches at T2 and T3).
• Restricted motion of one will affect the other

Question 2

ANTERIOR ASSESSMENT

Answer 2

Can be in the seated or supine position

Observe global breathing patterns

• Chest v abdominal breathing
• Rate, rhythm, ease of breathing

Assess motion of the following areas:

• Ribs 1-5 (Pump handle motion)
• Ribs 6-10 (Bucket handle motion)

Assess for the anterior counterstrain points

Question 3

POSTERIOR ASSESSMENT

Answer 3

Best done in the prone position
Assess
- Ribs 11-12 (Caliper motion)
- Posterior counterstrain points

Question 4

Anterior Counterstrain

Answer 4

Found along the mid clavicular line, or along the mid axillary line
Often associated with exhaled S/D

Treated

• Knee contralateral
• Flexion and side bending towards the tender point (more flexion with anterior points and more side bending with lateral points)
• Rotation is usually towards the tender point.
• Hold for 120 seconds!!

Question 5

Posterior Counterstrain

Answer 5

Found along the posterior rib angles
Often associated with inhaled S/D

Treated

• Knee ipsilateral
• Slight extension, side bending away to elevate the posterior part of the rib
• Rotation usually away from the rib tender point
• Hold for 120 seconds!!!!

Question 6

Muscle Energy: Inhaled pump and bucket handle ribs

Answer 6

patient supine
flexing head or head and neck

Pump handle: more flexion
Bucket handle: more side-bending

Question 7

Exhaled ribs- pt hand placement

Answer 7

1& 2- hand on forehead
3-5- arm above head
6-10- arm out to side

Question 8

Muscle Energy: Inhaled caliper ribs

Answer 8

patient prone
Caudad hand over ASIS
Cephalad hand over posterior lateral aspect of ribs 11 or 12
Anterior lateral vector

Question 9

Muscle Energy:Exhaled ribs 11-12

Answer 9

patient prone
Caudad hand over ASIS
Cephalad hand over posterior medial ribs 11 or 12
Anterior vector