Muscle Energy Ribs

Front 1

1st Rib Assessment

Back 1

The first region to locate is the tubercle of the 1st rib. It is located inferior to the anterior part of the trapezius muscle, at the root of the neck. You must retract the muscle posteriorly and then you will feel the rib when you palpate inferiorly.

Front 2

Respiratory Motion 1st Rib

Back 2

Assess the active pump- handle inhalation and exhalation movement of the 1st rib from the anterior, medial aspect of the ribs near the manubrium. This is best done in the supine position.

Front 3

Ribs 2-6 Assessment

Back 3

• Patient supine, physician stands at head of table or to the side of the patient.
• Assess pump handle motion in the upper ribs.
– Place fingertips on ribs 2,3,4,5 & 6 at the parasternal region.
– Ask patient to take a deep breath and assess inhalation motion which is anterior and superior. Note if any rib stops during the inhalation phase, this is inhalation restriction or an exhalation rib somatic dysfunction.
– Ask patient to exhale slowly while you assess exhalation motion which is posterior and inferior. Note if any rib stops during the exhalation phase, this is exhalation restriction or an inhalation rib somatic dysfunction.
– Hint: standing up while doing this will help you avoid breast tissue

Front 4

Ribs 7-10 Assessment

Back 4

Patient supine with physician at side of table positioned so that dominate eye is at midline of the patient.
• Assess bucket handle motion in the lower ribs.
– Place fingertips on ribs 7, 8, 9 & 10 at the mid-axillary line. Your little finger is on rib 10 and your index finger is on rib 7.
– Ask patient to take a deep breath and assess inhalation motion which is lateral and superior. Note: if any rib stops during the inhalation phase, this is inhalation restriction or an exhalation rib somatic dysfunction.
– Ask patient to exhale slowly while you assess exhalation motion which is medial and inferior. Note: if any rib stops during the exhalation phase, this is exhalation restriction or an inhalation rib somatic dysfunction.

Front 5

Respiratory Somatic Dysfunction Ribs 11 & 12 Passive Motion Testing

Back 5

Patient is prone with physician standing at the side of the patient so that the physician’s dominate eye is at midline of the patient.
• Assess caliper motion in ribs 11 and 12.
– Place fingertips on the posterior rib shafts
of ribs 11 and 12.
– Ask patient to take a deep breath and assess inhalation motion which is posterior and lateral. Note if any rib stops during the inhalation phase, this is inhalation restriction or an exhalation rib somatic dysfunction.
– Ask patient to exhale slowly while you assess exhalation motion which is anterior and medial. Note if any rib stops during the exhalation phase, this is exhalation restriction or an inhalation rib somatic dysfunction.