Rib dysfunction

Your ribs move with every breath. As you breathe in, the upper ribs lift forward and the lower ribs expand sideways; as you breathe out, they return to their original position. The Costovertebral joints and Costotransverse joints at the back, and the Sternocostal joints at the front, support this movement.

If a rib cannot come down from a raised position or cannot rise from a lowered position, breathing becomes shallower at that level and the surrounding muscles tense up as well. This is common in people who sit in a chair for long periods, work with their shoulders rounded forward, or breathe shallowly.

Integrative Manual Therapy divides rib position problems into two types.

• Elevated rib — A rib that remains raised, as though you were breathing in. The first rib is a typical example. In this case, bending the neck sideways or turning it feels stiff, and breathing into the upper chest is restricted. The tender point is considered to lie beneath the edge of the trapezius at the side of the neck. The first rib is connected to the Scalene muscles, and nerves running to the arm pass nearby, so it is sometimes considered in connection with Thoracic outlet syndrome.
• Depressed rib — A rib that remains lowered, as though you were breathing out. Depression of the second rib is considered closely related to tension in the Pectoralis minor. The explanation is that the pectoralis minor pulls the ribs in this area downward, while its opposite end pulls the shoulder blade forward, creating a rounded-shoulder posture. In this case, the tender point is sought around the midpoint of a line connecting the Sternoclavicular joint and the armpit.

The ribs at the sides and back of the trunk are viewed according to the same principle. Tender points for elevated ribs are said to be found behind the rib angles on the back, while those for depressed ribs are found along the midaxillary line at the side of the trunk.

The basic approach is Strain-counterstrain. The practitioner finds the spot that is most painful when pressed at the level of the affected rib, then moves your body into a position that makes that spot more comfortable. For an elevated first rib, you sit with your chin slightly tucked, your neck tilted very slightly toward the same side, and your head turned toward the opposite side. For a depressed second rib, you lie down with your head bent forward so that your nose points toward the tender point.

Holding that position briefly is thought to reduce the pain at the spot being pressed. Because this does not involve exertion, all you need to do while receiving it is breathe quietly. The technique for a depressed second rib targets the rounded-shoulder component of the combinations of bodily stiffness described in Synergic Pattern Release.

• People who feel tightness in the upper chest when breathing and aching along the side of the neck
• People whose shoulders are rounded forward and who find it difficult to draw them back
• People who feel a catch on one side when bending their trunk sideways or raising an arm

This approach aims to help the breath reach the upper chest, reduce pulling sensations in the neck and shoulders, and make side-bending movements of the trunk feel easier after a session. How it feels varies depending on the person's physical condition.

• Breathing into the sides of the rib cage — Place both hands on the sides of your ribs and breathe slowly, noticing whether your hands move apart sideways as you breathe in. (Breathing)
• Side stretch for the trunk — Raise one hand overhead and lean toward the opposite side, lengthening your trunk. A feeling of the spaces between the ribs opening on the stretching side is enough.
• Opening the front of the chest — Rest your arm against a doorframe and open the front of your chest to give the pectoralis minor a comfortable stretch.
• When to get checked — If you have stabbing pain with every breath, or severe pain when pressing on a rib after an injury, medical evaluation at a hospital comes first. Shortness of breath or squeezing chest pain may not be caused by a rib problem.