Two most common types of rib somatic dysfunctions: Inhalation and Exhalation SD

Before diagnosing it is important to perform static motion testing

Static motion testing

For static motion testing, you are comparing static symmetry. You can palpate the ribs and can spring the cage to feel for any general restrictions. This Gives an idea for where you would expect to find Somatic Dysfunction

Inhalation Somatic Dysfunction

• Elevates with inspiration (ease) restricted in exhalation (barrier)
  • “Stuck in” inhalation so we name it for the ease of motion (inhalation)
    • AKA Exhalation restriction
  • Won’t move inferiorly with expiration
  • Key rib –bottom rib (Bottom rib, Inspirations)

Exhalation Somatic Dysfunction

• Moves inferiorly with expiration (ease) restricted in inhalation (barrier)
  • “Stuck in” exhalation so we name it for the ease of motion (exhalation)
    • AKA Inhalation restriction
  • Won’t move superior with inspiration
  • Key rib -top rib (Top rib, Expiration)

A good Mnemonic for Finding the Key Rib… BITE!

BITE: fix the Bottom rib for Inhalation SD and Top rib for Exhalation SD (inhalation SD of ribs 2-5, you would treat rib 5; exhalation SD of ribs 2-5 you treat rib 2) *usually a follow up question 

Overview of Axis of motion for Ribs:

• Pump Handle is around the costovertebral-costotransverse (horizontal) axis in the sagittal plane
• Bucket Handle is around the costovertebral-costosternal (AP) axis in the coronal plane
• Caliper is around a vertical axis in the horizontal plane

Remember that ribs 2-10 exhibit BOTH pump and bucket handle motion, but each set has a predominant movement, which is what the focus will be on

Muscle Attachments to Ribs

Be sure to know what muscles attach to which ribs and their direction of motion!

• 1^st rib: anterior scalene (pump) and middle scalene (bucket) 
• 2^nd rib: posterior scalene (pump)
• Ribs 3-5: pectoralis minor (pump)
• Ribs 6-10: serratus anterior (bucket)
• Rib 11: latissimus dorsi (upward caliper motion)
• Rib 12: quadratus lumborum (downward caliper motion)