Osteopathic Manipulative Treatment: Inhaled Rib Dysfunction

Rib dysfunctions occur in many forms. This article aims to identify, diagnose, and discuss the treatment of inhaled rib dysfunctions with direct and indirect osteopathic treatments. Rib dysfunctions can lead to chest wall pain, musculoskeletal pain, thoracic outlet syndrome, and intercostal neuralgia. Decreased rib motion can lead to excess lymphatic fluid in the subcutaneous tissues as well as the worsening of respiratory pathology. Inhaled rib dysfunctions occur when a set of two or more ribs are displaced (toward the patient's head) with associated physiologic motion dysfunction. The physiologic manifestation of an inhaled rib dysfunction presents when ribs are elevated in inspiration and do not move freely into a neutral position on expiration. When treating inhaled rib dysfunctions, the provider must identify the key rib to release the dysfunctional segment into normal physiologic motion. Osteopathic treatments include direct and indirect treatments to restore physiologic motion. Direct treatments move the dysfunction into its physiologic barrier. Indirect treatments move the dysfunctional segments into their position of ease. Osteopathic manipulative treatment of inhaled rib dysfunctions aims to relieve patient discomfort, improve lymphatic flow, and restore physiologic chest wall motion.