Rib ME Flashcards
Ribs 1 and 2 exhalation dysfunction treatments
Both uses joint mobilization using reciprocal inhibition
Rib 1:
- engages ANTERIOR & MIDDLE SCALENE
- physician stands on opposite dysfunction
- patient supine, face is forward w/ dorsum of ipsilateral hand on dysfunctional side on the forehead
- physician grasps superior edge of key rib underneath the patient w/ caudad hand. Apply a constant anterior pressure with lateral-caudad traction while pushing down on patients dorsum of the hand with cephalad hand
- patient takes deep breath and holds inhalation while lifting head head against physcians force for 3-5 seconds
- patient exhales and releases as physician increases lateral traction
rib 2 is the exact same except the superior-edge of rib is now rib 2, patients head is rotated 30 degrees, and the POSTERIOR SCALENE is engaged
Ribs 3-5 exhalation dysfunction treatment
All uses joint mobilization using reciprocal inhibition of the PECTORALS MINOR muscle
Ribs 3-5:
- physician stands on opposite dysfunction
- patient supine, face is forward w/ dorsum of ipsilateral hand on dysfunctional side superior to the head in a 45 degree angle
- physician grasps rib angle at level of mid axillary line underneath the patient w/ caudad hand. Apply a constant anterior pressure with lateral-caudad traction while pushing down on patients ipsilateral elbow with cephalad hand
- patient takes deep breath and holds inhalation while lifting elbow towards contralateral ASIS against physcians force for 3-5 seconds
- patient exhales and releases as physician increases lateral traction
Ribs 6-10 exhalation dysfunction treatment
All uses joint mobilization using reciprocal inhibition of the SERRATUS ANTERIOR AND LATS muscle
Ribs 6-10:
- physician stands on the same side of the
dysfunction
- patient supine, face is forward w/ ipsilateral arm abducted to 90 degrees
- physician grasps superior edge of rib angle at level of mid axillary line underneath the patient w/ caudad hand. Apply a constant anterior pressure with lateral-caudad traction.
- the physician also makes contact with the abducted hand to keep it in place
- patient takes deep breath and holds inhalation while addicting their arm against the physcians leg for 3-5 seconds
- patient exhales and releases as physician increases lateral traction
Ribs 11-12 exhalation dysfunction treatment
Ribs 11-12:
- physician stands on the opposite side of the dysfunction
- patient prone, face is rotated towards physician w/ legs sidebent
15-20 degrees away from the side of the dysfunction - patients contralateral arm is at the side to help induce Sidebending away (ipsilateral arm is hanging of table)
- physician hypothenar or thenar eminence of the cephalad hand is along the superior aspect of the rib, exerting a caudal-lateral traction
- physician caudad hand grasps the ipsilateral ASIS lifting it off the table
- patient takes deep breath and holds inhalation while pushing their ASIS towards the table
- patient exhales and releases as physician increases lateral traction
Muscles involved inhalation ME
SCM
Scalenes
Intercostals
Rectus abdominus
External oblique
Internal oblique
Rib 1 inhalation ME treatment
uses respiratory assistance
FSTRA
Physician stands behind the seated patient with the foot and knee propped up on the contralateral side of the somatic dysfunction
Physician places their ipsilateral index MP joint on the upper surface of the dysfunctional rib just lateral to the costotransverse articulation
Physician places their contralateral hand on the patients forehead and side bends the head towards the dysfunction and rotates away
Instruct patient to inhale and exhale completely holding the exhale for 3-5 seconds
Physician resists superior motion of the rib with inhalation and exerts a caudad-forward pressure on rib 1 with each exhalation
Ribs 2-6 inhalation ME treatment
uses respiratory assistance*
FST
Physician stands behind the supine patient with the thumb and index finger of one hand on the superior-anterior surface of the dysfunctional rib and the rest of the hand on the chest
Patients head and neck are flexed and side-bent towards the dysfunction
- with ribs 1-6: more flexed
- with ribs 7-10: more sidebent
Patient inhales completely and exhales completely, holding the exhalation for 3-5 seconds
Physician resists superior/elevated motion of the rib with inhalation and exerts a force in the direction of exhalation on pump handle/bucket handle (depends on rib being treated
Physician increases flexion and sidebending of the patients neck and thorax with each set
Ribs 7-10 inhalation dysfunction
- Uses respiratory assistance *
ST
Physician is at the ipsilateral side of the supine patient to the dysfunction. Physicians thumb and forefinger of their caudad hand is at the lateral-superior aspect of the dysfunctional rib.
Patient is side bent toward dysfunctional rib until tension is taken off the rib (use the neck and shoulders as a lever)
Patient is to inhale deeply and exhale, holding the exhale for 3-5 seconds
- physician resists inhalation movement
- physician exaggerates sidebending during exhalation with the patient trying to reach for their foot at the same time.
Ribs 11-12 inhalation somatic dysfunction
Uses joint mobilization and respiratory assistance
Patient is prone with physician on contralateral side with the patients legs sidebent at 15-20 degrees towards the side of the somatic dysfunction
Patients ipsilateral arm is at the patients side to help side bend towards
Physicians cephalad hand’s hypothenar or thenar eminence is along the inferior aspect of the rib and exerts a cephalad-lateral traction
Physicians caudad hand grasps the ipsilateral ASIS and lifts up.
Patient takes a breath and deeply exhales holding the exhalation will trying to push the ASIS down to the table.
