Osteopathic Manipulative Treatment: Muscle Energy Procedure - Exhaled Ribs

This activity explains the procedure for treating exhaled ribs using the muscle energy osteopathic manipulative treatment (OMT) method. For example, OMT can be used with various techniques, including high velocity/low amplitude, muscle energy, strain-counterstrain, and myofascial release.   These techniques can be direct or indirect and passive or active. A direct technique is when the restrictive barrier is engaged, while indirect techniques occur when forces are applied away from the restrictive barrier. Passive techniques are ones in which the operator does the work and the patient is in a relaxed position, and an active technique is one in which the patient is helping with the treatment.   Muscle energy is a direct and active technique where the patient is placed into their restrictive barrier and participates in treatment. There are multiple approaches to the muscle energy technique; however, the most commonly used is muscle energy with post-isometric relaxation: the patient is placed into their restrictive barrier, and they participate by actively moving towards the neutral position. At the same time, the clinician holds an isometric counterforce. Rib dysfunctions can cause multiple symptoms, including musculoskeletal or chest pain, thoracic outlet syndrome, difficulty taking a full breath, and worsening respiratory pathology. Diagnosing and managing rib dysfunction may also benefit patients with respiratory disorders such as asthma, chronic obstructive pulmonary disease (COPD), and pneumonia. Adequate respiration requires normal movement of the diaphragm, ribs, and sternum, which increases and decreases the size of the thorax, generating positive and negative pressure needed for proper respiration and oxygen exchange. When treating somatic dysfunctions of the ribs, it is essential to identify the key rib holding up the dysfunction. A rule of thumb is that during an inhalation dysfunction, the key rib is the bottom rib of the rib group; in an exhalation dysfunction, the key rib is the topmost rib. Exhaled rib dysfunctions occur when two or more ribs are displaced or stuck “down” or caudad. This means that the rib is restricted during inhalation and cannot move up, preventing the ribs from moving during inhalation. In this case, the topmost rib within the group of ≥2 adjacent ribs is the key rib, thus targeted for treatment.