Ribs pump handle motion

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

Ribs individual ribs have rotary elevating or depressing motions. The entire thorax, how ever, expands in the anteroposterior plane (pump handle motion) and in the frontal plane (bucket handle motion). 

The term pump handle motion is derived from the similarity between the rib motion and that of an old-fashioned water pump. One end is fixed, and the free end describes an arc. The costovertebral-costotransverse axis of the upper ribs lies close to the coronal plane. As the ribs move about this axis, they increase the anteroposterior diameter of that portion of the rib cage. 

FIG. 70-2 Pump handle motion testing of the upper ribs. 

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. 

Patient position same as for treating pump handle motion, except that the upper trunk is side-bent toward the affected rib as well as forward bent (Fig. 71-5). 

FIG. 69-4 Rib motions (A) Bucket handle motion (B) Pump handle mot on. (C) Caliper motion. 

In a female patient, it may be preferable to evaluate pump handle and bucket handle motions individually by placing the fingers along the sternal border first and then along the ribs at the mid-axillary area. 

FIG. 71-3 Muscle energy technique for treatment of inhalation restriction of the second through tenth ribs (pump and bucket handle motions). 

The costovertebral-costotransverse axis for the middle ribs lies at an approximately 45-degree angle to the sagittal and coronal planes. The motion of these ribs is of a mixed pump and bucket handle type with an increase in both the transverse and anteroposterior dimensions. 

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. 

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