Rib Dysfunctions

Normal rib motions

• 1-5 = Pump handle
• 6-10 = Bucket handle
• 11-12 = Caliper motion

Rib dysfunctions are named according to their preferred respiratory motion - position in which the ribs become restricted.

Exhaled Rib Dysfunction

When a patient's ribs are stuck in the exhaled position (downward), they demonstrate a preference for exhalation. This creates an exhaled rib dysfunction, where:

• The ribs prefer the exhaled position
• Inhalation movement is restricted
• The ribs appear "stuck down"

Inhaled Rib Dysfunction

Conversely, when ribs are stuck in the inhaled position (upward), they show a preference for inhalation. This creates an inhaled rib dysfunction, where:

• The ribs prefer the inhaled position
• Exhalation movement is restricted
• The ribs appear "stuck up"

Identifying the Key Rib for Treatment

The success of rib dysfunction treatment depends on identifying and treating the correct "key" rib. The key rib varies depending on whether you're dealing with an exhaled or inhaled dysfunction.

Treatment Approach by Dysfunction Type

Exhaled Dysfunction: When ribs are stuck in exhalation (downward position), the top rib in the dysfunctional group becomes the key rib. Treating this top rib allows the entire group to regain upward mobility.

Inhaled Dysfunction: When ribs are stuck in inhalation (upward position), the bottom rib in the dysfunctional group becomes the key rib. Treating this bottom rib allows the entire group to regain downward mobility.

The BITE Mnemonic

Remember which rib to treat using the BITE mnemonic:

• Bottom = Inhaled dysfunction
• Top = Exhaled dysfunction

Rib Muscles

Once you've identified the key rib, you'll need to know which muscle to target for effective treatment:

• 1 - 2 muscles - Anterior and middle scalene
• 2 - 1 muscle - Posterior scalene
• 3 - Pec
• 6 - Serratus (both start with S)
• 10 - 10 letters in latissimus
• 12 - Quad