Rib HVLA
Notes
Ribs
Rib HVLA
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Editor: Robyn Hughes, MScBMC
See “Thoracic spine HVLA” for more information on how to deliver a successful thrust.
TREATMENT GOALS
- Improve rib motion
- improves respiration and diaphragm motion
- normalizes intrathoracic pressure and improves lymphatic and venous return to the heart
- Modulate sympathetic function and improve spinal mobility
- decreases pain
RIB HVLA | ||||
| RIB 1 | RIBS 2–10 | |||
| DIAGNOSIS | Dysfunctional rib may be tender to palpation, superior rib dysfunction may lack spring | Dysfunctional rib may be tender to palpation, respiratory movement is restricted on side of dysfunction, rib angle is more prominent posteriorly (“speed bump”) | ||
| HAND PLACEMENT | Place 1st MCP joint on the medial 1st rib | Place thenar eminence of caudad hand at the posterior rib angle | ||
| POSITIONING | Stand at the head of the table Supine: flex the head and neck, side bend toward and rotate away (F STRA) Prone: extend the head and neck, side bend away and rotate toward (E SART) | Supine: stand at the side opposite the dysfunction, cross patient’s arms over the dysfunctional rib, side bend away from the dysfunction | ||
| THRUST | Thrust at the end of exhalation Supine: inferiorly and medially Prone: inferiorly and laterally | Place your torso over the patient’s elbows, thrust by directing force and weight to the fulcrum at the end of exhalation | ||
Summary
High-velocity, low-amplitude (HVLA) manipulation is a type of manual therapy often used in osteopathic medicine to treat various musculoskeletal conditions, including those of the ribcage. Rib HVLA is a specific technique used to manipulate the ribs and to restore normal movement and alignment to the affected rib. It is usually used to treat conditions such as rib subluxation or fixation, which can cause pain, difficulty breathing, and restricted movement in the chest area.