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First Rib: Exhalation Somatic Dysfunction Muscle Energy
Treatment Notes:
- First Rib Exhalation Dysfunction- Rib 1 uses 50% Pump and 50% Bucket
- Treating the fist rib requires treating both the pump handle (Anterior Scalene) and bucket handle (Middle Scalene) aspects of rib 1 motions to completely treat the rib.
- For treating an exhalation dysfunction, you want to move the ribs UP!
Steps for Treatment:
Pump Handle
- Patient lies supine, with you on side of dysfunction facing patient’s head
- Patient places hand, palm side up (same side of dysfunction) on forehead; you place your cephalad hand on top
- Place your caudad hand under patient’s back and grasp posterior/superior angle of the first rib with the pads of fingers
- Patient inhales deeply while raising HEAD off table as you resist and pull posterior rib in caudad direction (so you are helping the anterior handle move up by engaging the anterior scalene, and assisting with the restriction of inhalation)
- Isometric contraction held for 3-5 seconds (while patient holds breath)
- Then have patient relax and breathe out, while you maintain pressure on rib so it doesn’t move
- Repeat 2-3 times
- Passive stretch
- Reassess
Bucket Handle
- Same as Pump Handle Motion except have patient turn head 40 degrees away from midline away from the side of dysfunction to engage middle scalene and raise head in that direction during muscle energy
