Rib Techniques - Muscle Energy: Inhalation/Exhalation SD of

Typical
Ribs
2-10
Which
rib to
choose
for Tx?
BITE = Bottom rib for Inhalation dysfunction, Top rib for Exhalation dysfunction
Inhalation Dysfunt = Rib is stuck in inhalation (likes to inhale) & restricted in exhalation
(doesnt like to exhale)
Exhalation Dysfunct = Rib is stuck in exhalation (likes to exhale) & is restricted in inhalation
ME Ribs 2-10 Pump Handle Inhalation Dysfunction
(doesnt like to inhale)
DSD p.377-8 fig.71-4
Dr at the head of the table.
Place pads of fingers on the superior-anterior surface of the
rib being treated, just lateral to the sternum. [***A BOTTOM
rib]
Flex the pts head/trunk until motion is felt at monitoring rib.
Stabilize head with hand or knee.
Dr. pushes down through fingers during exhalation (aka the
restriction).
Dr. resists motion of the rib during inhalation
ME
Passive
stretch
at the
end byInhalation
springingDysfunction
on the rib.
Ribs 2-10
Bucket
Handle
DSD p.377-8 fig.71-5
Dr at the head of the table.
Place pads of fingers on the superior-anterior surface of the rib
being treated, along the mid-axillary line. [***A BOTTOM rib]
Flex the pts head/trunk and then side-bend on the side of the
dysfunction, until motion is felt at monitoring rib. Stabilize
head with hand or knee.
Dr. pushes down through fingers during exhalation (aka the
restriction).
Dr. resists motion of the rib during inhalation
ME
Handle Exhalation
Passive stretch
atRibs
the 2-10
end Pump
by springing
on the rib.Dysfunction
DSD p.375 fig.71-3
Dr. stands at the side of the dysfunction facing the pt
Pt places back of the hand on the forehead.
Dr reaches from behind to place pads of fingers on the
superior-posterior surface of the rib being treated. [***A
TOP rib]
Dr. places their hand on the pts hand.
Pt pushes hand up during inhalation while the Dr resists
this motion. SIMULTANEOUSLY, the Dr pulls caudal on the
rib.
Pt relaxes w/ exhalation and SIMULTANEOUSLY the Dr
resists motion of the rib during exhalation
Passive stretch at the end by springing on the rib
ME Ribs 2-10 Bucket Handle Exhalation Dysfunction
DSD p.375 fig.71-3
Dr. stands at the side of the dysfunction facing the pt
Pt places back of the hand on the forehead.
Dr reaches from behind to place pads of fingers on the
superior-posterior surface of the rib being treated. [***A
TOP rib]
Dr. places their hand on the pts hand.
Pt pushes hand up and laterally at a 45 degree angle
during inhalation while the Dr resists this motion.
SIMULTANEOUSLY, the Dr pulls caudal on the rib.
Pt relaxes w/ exhalation and SIMULTANEOUSLY the Dr
resists motion of the rib during exhalation
Passive stretch at the end by springing on the rib

Ribs Techniques Muscle Energy: Atypical Rib 1

ME Rib 1 Pump Handle Exhalation Dysfunction (Restricted in Inhalation
DSD p.374-5 fig.71-1
Dr. stands at the side of the dysfunction facing the pt
Pt places back of the hand on the forehead.
Dr. places their hand on the pts hand.
Dr reaches from behind to place pads of fingers on the superiorposterior surface of Rib 1
Pt pushes head up during inhalation while the Dr resists this
motion. SIMULTANEOUSLY, the Dr pulls caudal on the rib.
Pt relaxes w/ exhalation and SIMULTANEOUSLY the Dr resists motion
of the rib during exhalation
Passive stretch at the end by springing on the rib
ME Rib 1 Bucket Handle Exhalation Dysfunction (Restricted in
Inhalation)
DSD p.374-5 fig.71-2
Dr. stands at the side of the dysfunction facing the pt
Pt turns head 40 degrees toward the dysfunctional rib and
places back of the hand on the forehead.
Dr reaches from behind to place pads of fingers on the
superior-posterior surface of Rib 1
Dr. places their hand on the pts hand.
Pt pushes head in direction their facing during inhalation
while the Dr resists this motion. SIMULTANEOUSLY, the Dr pulls
caudal on the rib.
Pt relaxes w/ exhalation and SIMULTANEOUSLY the Dr resists
motion of the rib during exhalation
Passive stretch at the end by springing on the rib.
ME Rib 1 Pump Handle Inhalation Dysfunction (Restrict. in
Exhalation)
DSD p.
Dr at the head of the table.
Place pads of fingers on the superior-anterior surface of the
rib, between the 2 heads of the SCM
Flex the pts head until motion is felt at monitoring rib.
Stabilize head.
Dr. pushes down through fingers during exhalation (aka the
restriction).
Dr. resists motion of the rib during inhalation
Passive stretch at the end by springing on the rib.
ME Rib 1 Bucket Handle Inhalation Dysfunction (Restrict. in
Exhalation)
DSD p.
Dr at the head of the table.
Place pads of fingers on the superior-anterior surface of
the rib, lateral to the clavicular attachment of the SCM.
Flex the pts head and side-bend towards the
dysfunctional rib until motion is felt at monitoring rib.
Stabilize head.
Dr. pushes down through fingers during exhalation (aka
the restriction).
Dr. resists motion of the rib during inhalation
Passive stretch at the end by springing on the rib

Ribs Techniques Muscle Energy: Atypical Rib 11 and 12

ME Rib 11 or 12 Inhalation Dysfunction
(Exhalation Restriction)
DSD p. Fig 71-6
Pt lies prone with arms to the side.
Dr stands at the side opposite the
dysfunction.
Use the caudad hand to grasp the ASIS
in order to pull the pelvis posterior.
Place the cephalad hand of the thenar
eminence on the rib being treated.
During exhalation, push anterior on the
rib while SIMULTANEOUSLY pulling
posterior on the pelvis.
Resist motion during inhalation.
Passive stretch at the end.

ME Rib 11 or 12 Exhalation Dysfunction

(Inhlation Restriction)
Pt lies prone with arms up/out.
Dr stands at the side opposite the
dysfunction.
Use the caudad hand to grasp the ASIS
in order to pull the pelvis posterior.
Place the cephalad hand of the thenar
eminence on the rib being treated.
During inhalation, push anterior on the
rib while SIMULTANEOUSLY pulling
posterior on the pelvis.
Resist motion during exhalation.
Passive stretch at the end.

Arms
up

Rib Techniques HVLA

HVLA seated Ribs 1
Drs leg up on table opposite the side of dysfunction
and drape pts arm over the leg. DO NOT put knee in
axilla.
Place the MCP of the thrusting hand on the posterior
aspect of rib 1. Move the trapezius out of the way.
Take the other arm and rest elbow on pts shoulder,
and use that hand on the pts head to Side-Bend
towards and rotate away.
Ensure elbow of thrusting arm is up with a thrusting
vector towards opposite axilla.
Can be begin with some articulation. At the end,
thrust down the created vector while
SIMULTANEOUSLY moving the leg out.l
HVLA Upper Ribs (1-4) Prone
DSD Fig. 76.6
Pt cups chin w/ hand from the same side of the
dysfunction, keeping the head midline.
Dr. places thenar or hypothenar eminence of cephalad
hand on the rib to be treated at the costrotransverse
joint.
Move the pts elbow, of the arm cupping the chin,
cephalad until motion is felt.
Place other hand on pts head and rotate away.
Apply a downward thrust with the vector pointing
towards the axilla.

HVLA Typical Ribs Supine

(Similar as HVLA to Thoracic Spine Supine)
Dr stands on side opposite the dysfunction.
Pt crosses arm over chest, with the arm on the
side of the posterior rib on top of the other arm.
Ensure Alligator movement of the arms.
Lift the patient and place thenar eminence on
the rib angle of the posterior rib.
With the other arm, cradle and flex the pt until
motion is felt.
Add Side-Bending and Rotation towards the
dysfunction to lock .
Have the pt take a deep breath, and thrust
down at the end of exhalation.