Steps for Treatment:

1. Patient lies supine and the patient is flexed to the level of the dysfunction (you can either use your knee or raise the table if you have an adjustable table)
   • Suggestion to use your knee that is opposite the side of the dysfunction.
2. The patient’s upper body is then side-bent to the side of the dysfunction until tension is taken off the dysfunctional rib, supporting it with your hand and arm (sidebend towards)
3. Place fingers or hypothenar eminence on the superior surface of the dysfunctional rib (bottom rib), lateral to the sternum for pump handle and at mid-axillary line for bucket handle component
4. Instruct patient to inhale and exhale deeply. Follow the inferior motion of rib pushing it further into exhalation
5. Hold the rib down as the patient inhales, then push the rib further into exhalation as the patient exhales forcefully again
6. Repeat 3-5 times
7. Passive stretch
8. Reassess

Video Tutorial: