[Applause] [Music] [Applause] In this video, we're going to be discussing one of the special tests used in the assessment of rib hypomobility, and that is rib spring testing. We're eventually going to look at an actual

patient demonstration here, but before we do that, I'm going to demonstrate this on my skeleton model. So, right here we have Steve the skeleton, and Steve is lying in the prone position. And just for reference, up here is superior and down here is inferior on

the thoracic spine. Now, right now his arms are by his sides. This poses a problem if we are rib spring testing or mobilizing, depending on the context, and that's because when the arms are by the side like this on the table, the scapulae are retracted, meaning

they're closer to the midline, and that's a problem because when we spring test or mobilize the ribs, our contact points are medial—okay, right where the ribs come off of the corresponding vertebrae—and that means that the scapulae more or

less are going to block those positions. So the first thing we actually need to do is we need to actually dangle the arms off of the side of the table like this. Now, obviously, this is a fixed skeleton; the scapulae are nailed tight, but in a

real person, they would actually protract; they'd move away from the midline, and that would more expose the contact points for these upper ribs, particularly 2, 3, 4, 5, 6, and to some extent 7. All right. Now I'm standing on Steve's left side

Which means I'm going to be testing or mobilizing ribs on his right. The rule of thumb here is that you always stand on the side opposite of the ribs that you're moving, and today I'm going to be focusing here on rib number eight.

That being said, where am I supposed to contact rib eight if I'm expecting to move it? Am I out here laterally, or in here medially? Well, if we follow this rib, rib eight on the right, from lateral to medial, we come to a point approximately right

there, where my index finger is. And this is the posterior-most protrusion of the rib. Meaning, if you actually had a live person right here with skin, soft tissue, everything, this would be where you'd feel it most prominently; it sticks out the farthest posteriorly; it's the most

superficial in other words. But then if we imagine a vertical line right here going just medial to that, we have all the erector spinae muscles. Okay? And so if we continue to go medially here, the rib is actually going to course underneath or deep

to the erector spinae muscle group as it goes towards the transverse process here; that is the right transverse process of T8. Okay, so bottom line, my contact point for the rib is going to be just lateral to the transverse process here where the rib courses deep to the

erector spinae muscles. Now, if I come in here and start trying to mobilize this rib or test its mobility, notice here I'm just getting rotation of the whole spine; the ribs are kind of just going with the spine. So how do I know if

That's actual rib movement, meaning normal mobility; or if it's movement of this whole complex, you don't know, right? So that means I'm going to have to stabilize on this other side, okay? And it turns out that I'm actually going to stabilize the transverse

process on the other side at the same level. So rib 8 right here articulates with the right transverse process of T8. That means I need to stabilize the left transverse process of T8, and I'm going to do that with hypothenar contact

so right on the pisiform. Okay, so I'm going to come in here, and notice my hand is actually going parallel with the spine. This is my stabilizing hand. I need to have this anytime I rib spring or mobilize. Okay? My testing or mobilizing hand is going

to be perpendicular to my stabilizing hand, and I'm going to use hypothenar contact right in this area of the rib, lateral to the transverse process where it goes underneath the paraspinals. So just like that. Okay? And my fingers point in the direction

that I'm going to try and move the rib anteriorly and laterally. Okay? Notice that I really have to apply a stabilizing force here because if I'm kind of just resting my hand there, doing this haphazardly, again I get that whole

rotation there. I need to stabilize at that left transverse process of whatever level I'm dealing with. That way, if I'm getting mobilization here or if I'm getting movement, I know that it's movement of the rib at the costotransverse joint and not this whole

Okay, I can also go to different levels. Let's go to rib nine. Here, now I need to move down to the transverse process on the left for T9 and stabilize there. Now I can mobilize rib nine, and so on.

All right, now back to the patient demonstration. The patient will be in prone with their arms hanging over the sides of the table. You can't really see the arms hanging too much here, but again, the reason we put them in that position is it draws the scapulae away from the

midline. If her arms are by her sides on the table, then the scapulae would be in a retracted, or we would say adducted, position; they'd be close to the midline, and we wouldn't be able to spring test the upper ribs—so ribs two

through five, let's say—because the scapula would be in the way. We put the arms over the side to move the scapula out of the way, to put them into protraction or abduction, and that allows us access to the medial portions

of the upper ribs so that we can spring test those. The arm position really doesn't affect the lower ribs as much, but we do have to test the upper ribs if we suspect there's hypomobility or other dysfunction. Now, the patient will stand on the opposite

side of the rib being mobilized or tested. So, for example, if I'm testing the mobility of the right seventh rib, I'm going to stand on the patient's left side. Now, important note here: I don't just want to randomly test ribs; I want to be

Accurate with my hand placement, so the first thing I'm going to do is actually find her midline by finding her spinous processes. Note that for a patient wearing a sports bra, you can't necessarily trust the midline of the sports bra because the

bra may have shifted when the patient got on the table. So you want to make sure you accurately find the midline by finding the spinous processes. And then, once you know where the midline is, you can find the painful and potentially hypomobile rib.

Now, once you locate the rib to be assessed, you have to remember that as you go laterally out here to medially, there's going to come a point—right where my finger is, right there—where the rib becomes most prominent. It sticks out the most posteriorly; it's the most

superficial part of it. But then, as you go more medially, the rib is going to dive down deeper underneath the erector spinae muscles. And then, right around the point where it goes underneath those erector spinae muscles, that's where it's going to

articulate with the transverse process of the thoracic vertebra. Okay, right around where it dives underneath the erector spinae muscles, that's where you want to sink down and contact the rib. We will see that in more detail in just a minute. So I'm assessing mobility of the right

seventh rib, which articulates with the right transverse process of T7. If I just simply push on the right seventh rib without stabilizing anywhere else, I'm going to get movement, most likely. But is it movement of the rib relative to the transverse process here?

Or is it just overall rotation of T7? It's probably overall rotation of T7, but I don't want T7 to move at all, so I need to stabilize T7 from the other side, on its left transverse process. So it's going to look something like this, okay.

So I'm going to have pisiform contact or hypothenar contact right here on the left transverse process of T7. That way, when I eventually push on rib 7, if there's movement there, I can be sure that it's movement of the rib relative

to the transverse process, and that would be normal mobility. And then I'm going to take my other hand, which is the testing hand, and position it perpendicular to the stabilizing hand. So point it out here to the right, with pisiform contact on the hypomobile rib, which is the right

seventh rib. Now remember, my finger right here was pointed at the most prominent aspect of that rib; it came most superficially right. And then as I went more medially, it dipped back underneath the erector spinae muscle group. The contact point with my pisiform

is right where it goes underneath the erector spinae muscles, okay? Because that is just lateral to the right transverse process. Let's take a look at that. And then finally, once you have this positioning, you're going to allow the testing hand to sink through the soft

tissue, so through the erector spinae muscles to contact that rib. And then you're going to assess the rib movement by trying to move it in the anterior and lateral direction. That will look like this: so sink through the soft tissue there.

And then move anterior and lateral; fingers point in the direction of the test. We can then move up a level and test rib six. In any case, a positive rib spring test is going to be hypomobility compared to the unaffected side and compared to

adjacent, non-affected levels and familiar pain provocation, which will typically occur in a unilateral parasagittal pattern. Thank you for all your support. Be sure to check out my Instagram for cool science and not-science stuff.

Rib Spring Testing for Rib Hypomobility [Ribs 2-10 (12)]

Rib Spring Testing for Rib Hypomobility [Ribs 2-10 (12)]

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