Ribs thrusting techniques

There are two direct methods used to move the rib articulations rib-raising techniques, which are articulatory, and thrusting techniques, which are generally high-velocity, low-amplitude. Each has its own special applications as described here. 

Note As with high-velocity, low-amplitude thrusting techniques of the thoracic spine, flexion of the spine down to the segment of dysfunction may be necessary for rib dysfunctions lower in the thorax. Flexion is achieved by the physician grasping and cradling the patient behind the shoulders with his nonlocalizing hand and then flexing the patient to create localization down to the necessary point. 

FIG. 76-4 Patient position for HVLA thrusting technique for a posterior rib head somatic dysfunctloh. 

R.T. was treated with osteopathic manipulation. He received soft tissue myofascial techniques to the neck and upper back. The somatic dysfunctions were treated with facilitated positional release techniques, as was the first rib. The T3-4 somatic dysfunction was also treated with high-velocity, low-amplitude thrusting technique. 

It is best not to use thrusting techniques on these patients. Many COPD patients have been on heavy doses of corticosteroids, which predisposes them to having osteoporosis. Caution should be observed in performing the thoracic pump and in directing pressure onto the Sternum rather than the ribs. 

Abdominal compressions should not be used for 1 to 1.5 hours following a meal, however, chest compressions can be used to augment PCF. Chest thrusting techniques must be performed with caution in the case of an osteoporotic rib cage. Unfortunately, since it is not widely taught to health care professionals, manually assisted coughing is underutilized (67). 

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