Most of you know that I do not think palpation is necessary to assist in your clinical decision making. However, once in a while a case pops up where you may actually need to direct a treatment at a rib.
Functional Rib Mobilization in Sitting
Indications
- painful and/or limited unilateral trunk rotation
- pain with deep breath/cough
- thoracic mobilization/manipulation and/or thoracic whips to the involved side DO NOT effect the complaints or function
The last indication is important, at least in my experience, I have not "directed" a treatment at a rib more than once or twice in the past 10 years.
Technique
- pt is sitting, measure seated trunk mobility actively and then passively overpressure, both should be equal in quality and quantity
- PT places treatment hand webspace or ulnar border on the painful rib area
- if rib "feels" more posterior, patient rotates lightly actively into PT hand
- i.e. right sided rib pain, limited/painful trunk rotation to right
- if it is painful/limited to rotate to the opposite direction, PT assists rib moving anteriorly, superiorly, and laterally on the involved side, and other hand assists same level rib inferiorly, medially, and posteriorly
- i.e. right sided rib pain, limited/painful trunk rotation to the left
- repeat both 2-3 sets with 10-15 reps, add hold relax at end ranges to re-educate the movement, or use agonist reversals to get past any sticking points
This technique, as always should be pain free, or if the patient has constant pain, should in the minimum, not increase pain or cause increased pain for more than 2-3 minutes after it is performed. IASTM to the intercostal spaces may mitigate threat and make the above technique easier. HEP should be thoracic whips after pain free mobility is restored.
Keeping it Eclectic...
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