Hi! Thanks for the comment. You are correct that you would treat rib 3 if your rib group dysfunction was ribs 3-5 exhalation dysfunction. However, my example is a demonstration of treating key rib 5 exhalation dysfunction - as in, any rib group exhalation dysfunction where rib 5 is the key rib. The arm treatment position utilizing the pec minor applies for any dysfunctions for which rib 3, rib 4, or rib 5 is the key rib. Rib dysfunctions can be composed of any combination of ribs. The (arm) treatment position depends on the key rib. For example, for ribs 3-8 exhalation dysfunction, you would treat rib 3 - the key rib. For ribs 5-9 exhalation dysfunction you would treat rib 5 - the key rib. The arm treatment positions would be almost the same for treating key rib 3 vs key rib 5, because you utilize the pec minor to treat any dysfunction where the key rib is rib 3, rib 4, or rib 5. The only difference is the rib you are contacting posteriorly to direct your treatment. For rib 3-8 exhalation dysfunction, you would contact rib 3. For ribs 5-9 exhalation dysfunction, you would contact rib 5. This latter example of treating key rib 5 exhalation dysfunction is what I am demonstrating. Hope that helps to clarify!
Because these are inhalation and exhalation dysfunctions, would you have the patient hold their breath or take a deep breath in during any of these treatments? To encourage inhalation movement during exhalation dysfunction, would you get them to inhale As you move to next barrier? And vice-versa for an inhalation dysfunction? Great video by the way and great explanation...
I did not emphasize it during the video, but yes, for exhalation dysfunctions, you can have the patient take a deep inhale while actively contracting against your isometric resistance. This potentially helps to encourage the rib to move further into inhalation through the restrictive barrier, so you might be able to make a little extra progress with each movement. However, not every patient will be able to effectively coordinate their breathing with their arm or head muscle contractions, and you can be very effective with head and arm muscle contractions alone. Hope that helps! Thanks for watching!
Hello. I have a question. With muscle energy techniques, i believe that we utilize the muscle contraction to our benefit, which in this case, we try to limit the movement of the origin part of the muscle (say, with pectoralis minor muscle, the processus coracoideus) and enhance the movement of the insertion part of the muscle (say, ribs 3-5). With pump-handle movement, when we are applying a force inferiorly we are also helping for the inhalation (as i understand, exhalation dysfunction means that ribs stay in inferior position and can not expand enough). So like a pump-handle, we push the posterior part of the rib inferiorly and then the anterior part moves superiorly. That's clear. But why do we do the same for the bucket-handle movement? Aren't the ribs here supposed to expand laterally and both anterior and posterior sides move superiorly? So by that logic, i'd like to think that, rather than applying a force in direction inferior, i'd help superiorly. It seems that i'm mistaken, but can you explain that in detail (if it's possible)? Thank you very much. Have a nice day!
Hi! The key to this technique is that you are utilizing your posterior hand contact on the superior aspect of the angle of the rib to stabilize the posteromedial aspect of the rib near its attachment to the thoracic spine while the muscle contraction pulls the rest of the rib superior. For the upper ribs, you utilize muscles that attach to the anterior aspect of the rib to emphasize more of the pump handle motion. For the lower ribs, you utilize muscles that have more of a lateral contact to emphasize more of the bucket handle motion. In both cases, the posterior attachments of the rib stay relatively stable. For the upper ribs, the anterior aspect of the rib is pulled anterior superior (pump handle motion) and for the lower ribs, the lateral aspect of the rib is pulled lateral superior (bucket handle motion). Hope that helps to clarify!
Question, My PCP has done this on my 4-8 rib to help my rib joint pain. I am based in california. Any resource on where to find practitioners specialized in OMT?
I have a rib that's been out of place for 8 years. I've gone all over the country looking for help. Is there anywhere you can point me in the right direction? I've tried everything.
i would never survive omm without your videos you are an angel
Thanks so much for creating this channel! Studying for boards as a 4th year and your videos are such a blessing to review material from past years.
Thanks I used all of these in clinic today
Thank you! I’m glad it was helpful!
For ribs 3-5 exhalation dysfunction, you would target the top rib (rib 3) not rib 5 like you mentioned in the video.
Hi! Thanks for the comment. You are correct that you would treat rib 3 if your rib group dysfunction was ribs 3-5 exhalation dysfunction. However, my example is a demonstration of treating key rib 5 exhalation dysfunction - as in, any rib group exhalation dysfunction where rib 5 is the key rib. The arm treatment position utilizing the pec minor applies for any dysfunctions for which rib 3, rib 4, or rib 5 is the key rib. Rib dysfunctions can be composed of any combination of ribs. The (arm) treatment position depends on the key rib. For example, for ribs 3-8 exhalation dysfunction, you would treat rib 3 - the key rib. For ribs 5-9 exhalation dysfunction you would treat rib 5 - the key rib. The arm treatment positions would be almost the same for treating key rib 3 vs key rib 5, because you utilize the pec minor to treat any dysfunction where the key rib is rib 3, rib 4, or rib 5. The only difference is the rib you are contacting posteriorly to direct your treatment. For rib 3-8 exhalation dysfunction, you would contact rib 3. For ribs 5-9 exhalation dysfunction, you would contact rib 5. This latter example of treating key rib 5 exhalation dysfunction is what I am demonstrating. Hope that helps to clarify!
Because these are inhalation and exhalation dysfunctions, would you have the patient hold their breath or take a deep breath in during any of these treatments? To encourage inhalation movement during exhalation dysfunction, would you get them to inhale As you move to next barrier? And vice-versa for an inhalation dysfunction? Great video by the way and great explanation...
I did not emphasize it during the video, but yes, for exhalation dysfunctions, you can have the patient take a deep inhale while actively contracting against your isometric resistance. This potentially helps to encourage the rib to move further into inhalation through the restrictive barrier, so you might be able to make a little extra progress with each movement. However, not every patient will be able to effectively coordinate their breathing with their arm or head muscle contractions, and you can be very effective with head and arm muscle contractions alone. Hope that helps! Thanks for watching!
Hello. I have a question.
With muscle energy techniques, i believe that we utilize the muscle contraction to our benefit, which in this case, we try to limit the movement of the origin part of the muscle (say, with pectoralis minor muscle, the processus coracoideus) and enhance the movement of the insertion part of the muscle (say, ribs 3-5).
With pump-handle movement, when we are applying a force inferiorly we are also helping for the inhalation (as i understand, exhalation dysfunction means that ribs stay in inferior position and can not expand enough). So like a pump-handle, we push the posterior part of the rib inferiorly and then the anterior part moves superiorly. That's clear.
But why do we do the same for the bucket-handle movement? Aren't the ribs here supposed to expand laterally and both anterior and posterior sides move superiorly? So by that logic, i'd like to think that, rather than applying a force in direction inferior, i'd help superiorly. It seems that i'm mistaken, but can you explain that in detail (if it's possible)?
Thank you very much. Have a nice day!
Hi! The key to this technique is that you are utilizing your posterior hand contact on the superior aspect of the angle of the rib to stabilize the posteromedial aspect of the rib near its attachment to the thoracic spine while the muscle contraction pulls the rest of the rib superior. For the upper ribs, you utilize muscles that attach to the anterior aspect of the rib to emphasize more of the pump handle motion. For the lower ribs, you utilize muscles that have more of a lateral contact to emphasize more of the bucket handle motion. In both cases, the posterior attachments of the rib stay relatively stable. For the upper ribs, the anterior aspect of the rib is pulled anterior superior (pump handle motion) and for the lower ribs, the lateral aspect of the rib is pulled lateral superior (bucket handle motion). Hope that helps to clarify!
@@OsteopathicClinicalSkills now i understand perfectly! Thank you very much for the clarification. Have a nice day.
Question, I've done post isometric stretching work and it seems to be effective. How long do the effects last or how long should they last? Thanks
Question,
My PCP has done this on my 4-8 rib to help my rib joint pain. I am based in california. Any resource on where to find practitioners specialized in OMT?
I have a rib that's been out of place for 8 years. I've gone all over the country looking for help. Is there anywhere you can point me in the right direction? I've tried everything.
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