During the past few weeks, we have seen and treated many different rib dysfunctions in the office. So, it seemed like the perfect time to discuss how rib dysfunctions occur and how we treat them in the office.
Rib dysfunctions can result from many different situations. Patients with chronic asthma, COPD or interstitial lung disease develop chronic rib dysfunctions due to their underlying visceral pathology. However, those without lung disease also develop rib dysfunctions. One common cause is Upper Cross syndrome, also known as proximal or shoulder girdle crossed syndrome. This develops as a result of tight trapezius, levator scapulae, and pectoral muscles coupled with weak cervical flexors and rhomboids (in English, tight upper back, weak front of the neck and between the scapula). These often develop from poor ergonomics in workspace environments due to the hunched forward, neck flexed posture.
Treatment of rib dysfunctions and upper cross syndrome go hand in hand. Osteopathic manipulative therapy (OMT) can address the specific rib dysfunctions, but must be coupled with biomechanical changes in order to address the behaviors that created the dysfunction in the first place. Regular yoga and stretching can emphasize these positive changes and help prevent their reoccurrence.
One of the most common types of OMT is a technique called rib raising. The technique involves the patient laying down face up, while the physician stands or sits to one side. The physician will place both of their hands under the patient’s back, perpendicular to the spine and then will oppose the hands and hold. The duration of holding this technique depends on how long it takes for the soft tissues in the affected area to soften, between 30 seconds and two minutes. Other OMT techniques include where the physician applies pressure to the rib and, though deep breaths, loosens tension on the rib allowing for freer movement.
Rib raising was originally developed during the era of the Spanish Flu to attempt to improve outcomes better than just medical therapy. It did, and the field of osteopathy gained traction and recognition. Rib raising decreases our “fight or flight” response (1), and is one of the most common osteopathic techniques performed, particularly in the elderly. Additionally, it improves outcomes by shortening hospitalization time and decreasing antibiotic duration (2)
For more information on stretches, take a look here:
For more information on OMT, feel free to call the office.
Henderson AT, Fisher JF, Blair J, Shea C, Li TS, Bridges KG. Effects of Rib Raising on the Autonomic Nervous System: A Pilot Study Using Noninvasive Biomarkers. J Am Osteopath Assoc 2010;110(6):324–330.
King Channell M, Wang Y, McLaughlin MH, Ciesielski J, Pomerantz SC. Osteopathic Manipulative Treatment for Older Patients: A National Survey of Osteopathic Physicians. J Am Osteopath Assoc 2016;116(3):136–143. doi: 10.7556/jaoa.2016.030.
Noll D, Shores J, Gamber R, Herron K, Swift J. Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia. J Am Osteopath Assoc 2000;100(12):776–782.