Muscle energy for rib somatic dysfunction

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Notes

Ribs

Rib muscle energy

Author: Arman Israelyan, OMS-III

Editor: Matt Lipinski, DO

Illustrator: Abbey Richard

Illustrator: Ursula Florjanczyk, MScBMC

Editor: Robyn Hughes, MScBMC

Promoting inhalation means that you exert a caudad and lateral traction to the posterior angle of the dysfunctional rib during inhalation.

MUSCLE ENERGY FOR EXHALATION DYSFUNCTION
DYSFUNCTIONAL RIB	MUSCLE(S)	TREATMENT POSITION
1	Anterior and middle scalenes	Instruct patient to: place dorsal wrist on forehead with face forward gently lift head toward ceiling against resistance, while you are promoting inhalation
2	Posterior scalene	Instruct patient to: place dorsal wrist on forehead with head rotated away 30 degrees lift head toward ceiling against resistance, while you are promoting inhalation
3–5	Pectoralis minor	Instruct patient to: place dorsal wrist superior to head lift elbow toward opposite ASIS against resistance, while you are promoting inhalation
6–10	Serratus anterior and latissimus dorsi	Instruct patient to: abduct shoulder to 90 degrees pull arm towards ipsilateral hip against resistance, while you are promoting inhalation
11–12	Latissimus dorsi and quadratus lumborum	Patient prone, with torso and lower extremities side bent toward you and ipsilateral arm above head Lift at ipsilateral ASIS while pushing between ribs 11–12 during inhalation

Figure 1. Anterior view of the neck depicting the locations of the anterior, middle, and posterior scalene muscles.

Figure 2. Anterior view of the chest showing the pectoralis minor muscle, which is deep to the (faded) pectoralis major muscle.

MUSCLE ENERGY FOR INHALATION DYSFUNCTION
DYSFUNCTIONAL RIB	PHYSICIAN	PATIENT POSITIONING
1	Resist superior motion of rib with each inhalation, exert caudad and anterior pressure with each exhalation	Seated Head flexed, side bent toward, rotated away (F STRA)
2–6	Resist rib elevation with each inhalation, use hand to exaggerate exhalation motion of dysfunctional rib, increase flexion and side bending towards new barrier after each cycle	Supine Head and neck flexed and side bent toward dysfunctional side
7–10	Resist anterior and lateral motion of ribs with each inhalation, exaggerate side bending with exhalation	Supine Torso side bent toward dysfunctional side
11–12	Stand opposite the dysfunctional side, push caudad (at rib 11) or cephalad (at rib 12) and lateral during exhalation, lift ipsilateral ASIS with each push and exhalation	Prone Torso and lower extremities side bent away from you (making dysfunctional rib the concave side)

Summary

Muscle energy techniques are manual therapies used for the treatment of musculoskeletal dysfunctions. In the case of rib somatic dysfunction, muscle energy techniques can help improve the mobility and strength of the rib cage, as well as reduce pain associated with the dysfunction.