Segmental Drop Adjusting: Rotated Rib

By: Wayne Henry Zemelka, DC

Analysis

Figure 1. Checking for sternal pain due to rotated rib.

Figure 1. Checking for sternal pain due to rotated rib.

With the patient in a sitting position palpate along the vertebrae. You will find the rib head very tender without posteriority or laterality of the vertebra. The involved rib head and rib are inferior in relationship to the rib heads above and below. Additionally you will feel the inferior edge of the rib raised to some degree. The pain found on palpation will also follow the rib around to the sternum, and pain will also be evident on the sternal connection of the same rib (Fig. 1).

 

Procedure

With the patient standing on the table or sitting up, place the thenar pad on the involved rib (Fig. 2). Lay the arm parallel to the angle of the ribs, and lay the patient back, (Fig. 3), making sure to raise the head piece for the comfort of the patient.

With the patient in the supine position and the head piece raised for patient comfort, locate the rib at the sternal junction. Place the thenar at that location.

Figure 2. Demonstrator pointing to thenar pad.

Figure 2. Demonstrator pointing to thenar pad.

Bring the doctor’s elbows in line with each other, cock the table and give 3 or 4 quick, light thrusts, pulling with the inferior hand toward you and thrusting with the anterior hand away from you.

Discussion

The rib cage, an integral part of the human frame, is the scene for a number of conditions that can create problems of their own.

Breathing is directly affected when the rib cage does not move as it should under normal conditions. This immobilization may create an oxygen deficiency, respiratory problems and unexplained pain syndromes.

Stress, which we all deal with, shows up in the body in any number of symptoms, such as upset stomach, colitis, high blood pressure, headaches, nausea, and the list goes on, ad infinitum.

Figure 4. Placing patient in horizontal position.

Figure 3. Placing patient in horizontal position.

The rib cage encompassing the heart and lungs, when restricted, can pose a challenge to the Chiropractor. Many of these problems mentioned may be due to a rib or series of ribs that are subluxated, creating a neuronal disturbance that affects the homeostatic balance of the body. With the use of good examination skills and a drop table to adjust on, you can remove these subluxations and mobilize the rib cage to function more normally; thereby increasing lung capacity and removing stress that may be placed on the heart and lungs.

Ribs may subluxate on the posterior and reflect this distortion around the course of the rib to the sternum. This can be verified by palpation of the involved rib along its course to the sternum. Likewise, the same is true of a malposition at the sternum being reflected to the posterior. The inferior portion of the rib tends to protrude, giving a palpatory impression similar to a partially opened venetian blind. In most cases not only is this condition found by palpation, it may be observable to the examiner.

In your examination process consideration should be given to clavicle, sternum, scapula, and the shoulder joint. A problem in one area can, and will, influence the area in question, or for that matter may affect the entire rib cage.

The rib adjustments shown on the Thompson Technique video and in this article by no means cover every aspect of rib problems you may encounter in your day-to-day patient care.

It may be necessary to adapt this technique to the unique needs of the patient, especially when the patient presents with advanced osteoporosis, DJD, or has had surgery involving the rib cage. You may need to modify or even refrain from adjusting specific areas such as the rib cage with those conditions.

In the Chiropractic model we look at the structural relationships of the rib cage and the muscular contractions that create this problem. Also, consideration must be given to what the patient may be doing to exacerbate the problem. Carrying a shoulder bag or backpack over one side or the other can aggravate this problem. If this is the case they must cease such activities in order to restore muscle integrity and be given an exercise program such as the THERA-CISER® and BACKSYS® systems from Foot Levelers, Inc. Exercise instructions come with each system.

About the Author

Dr. Wayne Henry Zemelka was a 1975 graduate of Palmer College of Chiropractic. He is certified in Thompson Technique. Dr. Zemelka was Faculty President for six years in the 1980’s, during which time he built and operated the Media Production Department for Television and Video and was instrumental in production of classroom instruction videos and operation of the Printing Department. “Dr. Z” also taught in the Technique Department, Business Management and Continuing Education. In 1997 he was elected once more as Faculty President. He retired from Palmer in 1998.