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Chiropractic Research Review

Chiropractic Evaluation & Management of Rib Dysfunction

Injury and dysfunction of the costovertebral joint complex (the costotransverse and costovertebral joints) can be attributed to several different mechanisms, including direct blows, forceful compression of the rib cage, and trunk flexion injuries.

Chest pain emanating from musculoskeletal origins accounts for an estimated 10-30% of patients presenting with chest discomfort, necessitating that clinicians rule out potential nonmusculoskeletal conditions such as angina, myocardial infarction, aneurysm and tumor.

This article reviews selected manual procedures utilized in the clinical detection and management of costovertebral dysfunctions and other rib and functional lesions. Included is a comprehensive discussion of visceral vs. musculoskeletal causes of thoracic pain and evaluation of the ribs and related structures. The authors present numerous photographs and tables which illustrate a variety of potential chiropractic adjustive techniques, along with detailed descriptions (indications, patient and doctor positioning, contact points, procedures) of nearly a dozen such techniques.

The authors summarize their protocol for managing rib dysfunction by providing a sequence of treatment that clinicians can utilize in their practice:

1) manipulative procedures to resolve joint dysfunctions;

2) stretching and relaxation of shortened agonist muscles of the thoracic cage;

3) strengthening of inhibited thoracic cage musculature; and

4) progressive scapular stabilization and upper-quadrant strengthening.

Scaringe JG, Ketner C. Manual methods for the treatment of rib dysfunctions and associated functional lesions. Topics in Clinical Chiropractic, Sept. 1999:6(3), pp20-38.
Reprints: (800) 638-8437

Chiropractic Research Review

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