Note: Set up the same exact way as 1^st rib!

1. Patient lies supine, with you on side of dysfunction facing the patient’s head
2. Patient places hand, palm side up (same side of dysfunction) on forehead; you place your cephalad hand on top
3. Place your caudad hand under patient’s back and grasp posterior/superior angle of key rib (superior rib of group dysfunction)
4. Instruct patient to lift their ARM (not their head this time) toward the ceiling while inhaling deeply (pump handle) – adjust the arm until you feel motion under your hand
   • For bucket handle – Have patient lift their hand and arm up and laterally 45° from midline (mostly using serratus anterior to help lift bucket handle motion). Instruct patient to press their hand against yours while inhaling deeply

4. You maintain isometric resistance for 3-5 seconds while simultaneously pulling down on posterior aspect of rib
5. Repeats 2-3 times
6. Passive stretch
7. Reassess

Video Tutorial: