Rib counterstrain
Rib counterstrain
Chronic Week 1
Chronic Week 1
Down syndrome (Trisomy 21)
Galactosemia
Tay-Sachs disease (NORD)
Mucopolysaccharide storage disease type 1 (Hurler syndrome) (NORD)
Phenylketonuria (NORD)
Phenylketonuria (NORD): Year of the Zebra
Classical homocystinuria (NORD)
Homocystinuria
Glycogen storage disease type II (NORD)
Hypertrophic cardiomyopathy
Abnormal heart sounds
Normal heart sounds
Development of the cardiovascular system
Fetal circulation
Aortic valve disease
Mitral valve disease
Pulmonary valve disease
Tricuspid valve disease
Valvular heart disease: Pathology review
Cyanotic congenital heart defects: Pathology review
Acyanotic congenital heart defects: Pathology review
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta
Cardiomyopathies: Pathology review
Approach to cyanosis (newborn): Clinical sciences
Aortic dissections and aneurysms: Pathology review
Peripheral artery disease
Peripheral artery disease: Pathology review
Vasculitis
Vasculitis: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Raynaud phenomenon
Fryette laws
Diagnosing cervical somatic dysfunction
Spurling test
Cervical spine counterstrain
Cervical spine facilitated positional release
Cervical spine HVLA
Cervical muscle energy treatment
Cervical spine myofascial release
Other cervical spine treatments
Diagnosing lower limb somatic dysfunction
Special tests for the lower limb
Lower limb counterstrain
Lower limb HVLA
Lower limb muscle energy treatment
Lower limb myofascial release
Other lower limb treatments
Diagnosing lumbar spine somatic dysfunction
Lumbar muscle energy treatment
Lumbar spine counterstrain
Lumbar spine facilitated positional release
Lumbar spine HVLA
Lumbar spine myofascial release
Other lumbar spine treatments
Cranial osteopathy: Cranial nerves
Primary respiratory mechanism
Diagnosing cranial somatic dysfunction
Cranial treatments
Diagnosing pelvis somatic dysfunction
Pelvis counterstrain
Pelvis muscle energy treatment
Other pelvis treatments
Diagnosing rib somatic dysfunction
Rib counterstrain
Rib HVLA
Muscle energy for rib somatic dysfunction
Other rib treatments
Diagnosing sacral somatic dysfunction
Sacrum counterstrain
Sacrum muscle energy treatment
Sacrum myofascial release
Diagnosing thoracic spine somatic dysfunction
Thoracic spine counterstrain
Thoracic spine facilitated positional release
Thoracic spine HVLA
Thoracic muscle energy treatment
Thoracic spine myofascial release
Other thoracic spine treatments
Diagnosing upper limb somatic dysfunction
Special tests for the upper limb
Upper limb counterstrain
Upper limb HVLA
Upper limb muscle energy treatment
Upper limb myofascial release
Other upper limb treatments
Angina pectoris
Stable angina
Coronary artery disease: Clinical sciences
Coronary artery disease: Pathology review
Heart failure
Heart failure: Pathology review
Congestive heart failure: Clinical sciences
Dilated cardiomyopathy
Restrictive cardiomyopathy
ACE inhibitors, ARBs and direct renin inhibitors
Adrenergic antagonists: Beta blockers
Calcium channel blockers
Thiazide and thiazide-like diuretics
Loop diuretics
Potassium sparing diuretics
cGMP mediated smooth muscle vasodilators
Lipid-lowering medications: Statins
Cardiac conduction velocity
Cardiac conduction system
ECG basics
ECG normal sinus rhythm
ECG intervals
ECG QRS transition
ECG axis
ECG rate and rhythm
ECG cardiac infarction and ischemia
ECG cardiac hypertrophy and enlargement
Notes
Ribs
Rib counterstrain
ANTERIOR RIBS (AR) | ||||
| TENDER POINT | ANATOMICAL POSITION | TREATMENT POSITION | ||
| AR1 | Inferior to clavicle on 1st chondrosternal articulation | Supine Flex, side bend toward, rotate toward (F STRT) | ||
| AR2 | Superior aspect of 2nd rib in mid-clavicular line | Supine Flex, side bend toward, rotate toward (F STRT) | ||
| AR3–AR10 | Anterior axillary line on corresponding rib | Seated Flex, side bend toward, rotate toward (F STRT) | ||
Figure 1. Locations of the anterior ribs' counterstrain tender points.
POSTERIOR RIBS (PR) | ||||
| TENDER POINT | ANATOMICAL POSITION | TREATMENT POSITION | ||
| PR1 | Superior aspect of 1st rib lateral to costotransverse articulation | Seated Extend, side bend away, rotate toward (E SART) | ||
| PR2–PR10 | Superior aspect of corresponding rib angle | Seated Flex, side bend away, rotate away (F SARA) | ||
Figure 2. Locations of the posterior ribs' counterstrain tender points.
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Illustrator: Aileen Lin, MScBMC
Editor: Robyn Hughes, MScBMC
Key Takeaways
Rib counterstrain is a technique used in osteopathic medicine to relieve pain and discomfort in the rib cage area. It is based on the principle of positional release therapy, which involves finding a position that relieves pain by releasing muscle tension or strain. It is considered a safe and effective treatment for rib-related pain, but it should be performed by a trained practitioner.