Ribs exhalation

As you breathe in, your diaphragm moves down and your rib cage moves out to increase the volume of your lungs. As the volume increases, the air pressure in your lungs decreases. Air from the outside rushes in to fill the expanded volume. This is an application of Boyle s law. In the same way, your lungs decrease in volume when you exhale. The resulting increase in pressure pushes air out of your lungs. 

Palpation of the anterior chest wall may disclose elevated or depressed ribs. In the case of a depressed rib, die space between it and the rib below will be narrowed, while the space between it and the rib above will be widened. These differences are reversed for an elevated rib the space between it and the rib above will be narrowed, while the space between it and the rib below is widened. A single rib or a group of ribs may be elevated or depressed. Motion testing is necessary for diagnosis, as the findings on static palpation may be misleading. Generally, a depressed rib will restrict the motion of the ribs below and when inhalation occurs and an elevated rib will restrict the motion of the ribs above It when exhalation occurs. 

Ribs in a position of inspiration or expiration [inhalation or exhalation dysfunctions]... 

If one rib stops moving before the other rib during exhalation, that rib has an expiratory restriction. 

If a group of ribs stops moving on one side before the other during exhalation, one or more ribs in that group have an exhalation restriction. The restriction may be of pump handle motion or bucket handle motion. 

The individual ribs are tested in the manner just described for each level of ribs, but only one rib on each side is tested and compared. Individual ribs may be tested if one rib is painful or If restriction of motion is found on gross motion testing. If a group inhalation restriction has been found, usually the top rib in the group is responsible for the restriction. If a group exhalation restriction has been found, usually the lowest rib in the group is responsible. 

Muscle energy treatment of the ribs is used to correct inhalation and exhalation restrictions of the ribs. Each treatment entails the following general principles y>ump handle and bucket handle restrictions are treated with slight modifications to the given technique. 

The physician holds the rib down as the patient lakes a shallow breath and exhales again. 

FIG. 71-4 Musde energy technique for treatment of exhalation restriction of the second through fifth ribs (pump handle motion). 

For the purposes of counterstraiu treatment, rib somatic dysfunctions are generally classified as either depressed or elevated. Depressed ribs are held in exhalation and restricted in their movement into inhalation. Elevated ribs art held in inhalation and restricted in their movement into exhalation. 

Still technique for treating rib somatic dysfunctions generally relates to the positional finding, anterior or posterior, of the involved rib. A simple relationship between an anterior rib and an inhalation dysfunction and a posterior rib and an exhalation dysfunction is drawn, which also contributes to the initial placement into the freedom of motion followed by engagement of the barriers. Some modification can also be included for pump or bucket handle components as well. 

UPPER EXHALATION/POSTERIOR RIB (POSTERIOR SECOND RIB ON RIGHT)—SEATED... 

FIG. 74-lA Upper exhalation/posterior Rib (posterior second rib on right), seated. 

POSTERIOR/EXHALATION RIB (POSTERIOR THIRD RIB ON THE RIGHT)-PATIENT SEATED... 

FIG. 74-4 Posterior/exhalation rib (posterior third rib on the right), patient seated (physician anterior to patient). 

Patient lies on left side. The physician stands behind the patient and the patient is asked to reach his right arm behind the physician and grasp her shoulder. By leaning back the physician elevates the patient s ribs. The physician places her hands on the anterior and posterior rib cage as above. The patient inhales fully and as he exhales, the physician bends over and compresses the patient s lateral rib cage with her chest. The patient inhales fully and then at the end of exhalation the physician quickly released the compressive forces. 

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