Getting A Handle On Our Ribs

We have recently wrote about the respiratory system: from the upper respiratory airway down to the primary respiratory muscle, the diaphragm.  But what about the protective rib cage? Our ribs play a critical role in not only respiration, but in movement, too.

Let's get a better handle on our ribs.

Rib facts:

1. There are 7 sets of true ribs, ribs 1-7
2. There are 5 sets of false ribs, ribs 8-12
3. Rib sets 11-12 are considered floating ribs
4. Ribs move when we breath
5. The true ribs are dominated by a pump handle action
6. The false ribs are dominated by a bucket handle action

Understanding Fact #1

The first 7 sets of ribs directly attach to the sternum anteriorly and to the thoracic spine posteriorly.  This forms a singular unit that is stable and rigid. While this helps to protect the heart and lungs, its' position and motion will dictate the function and orientation of the scapula as well as influence apical lung expansion.

Understanding Fact #2

Rib sets 8-10 are considered false ribs.  These ribs have a posterior attachment to the thoracic spine, but anteriorly they only connect to the sternum through costal cartilage.  This makes them more mobile than the true ribs and allows them to be influenced by our abdominals. Our abdominals help the ribs facilitate the respiratory function of the diaphragm.  This is reflected in the infrasternal angle (ISA). A normal ISA is about 90 degrees, if wider, greater than 100 degrees, it indicates poor abdominal opposition and a diaphragm posturally orientated.  If less than 90 degrees, there is likely an abdominal imbalance driving a similar diaphragm orientation.

Understanding Fact #3

Rib sets 11-12 are also false ribs, but classified as our floating ribs.  These ribs attach posteriorly to the thoracic spine, but do not have an anterior attachment.  These ribs do not serve a significant role in the respiratory process, but are critical for protection of vital organs like the kidneys and the adrenal glands.

Understanding Fact #4-6

Facts 4-6 are all about normal rib mechanics during respiration.  As we breathe the ribs have to move in such a way to optimize thorax expansion.  All ribs upon inhalation will externally rotate and elevate, anteriorly, and internally rotate and depress, posteriorly.  The opposite occurs during exhalation. However this is only part of the story for optimal thorax expansion. The rest of the story is found at the thoracic spine.

The orientation of the costovertebral joints are different for the upper and lower ribs.  As a result the defining motions within these ribs also differs. The movement of true ribs can be best seen from a lateral view and resembles the motion of a pump handle.  Whereas the false ribs have more of a bucket handle motion and can be seen posteriorly. These normal mechanics both work to best increase the thorax dimensions during inhalation and decrease it with exhalation. This in turn creates a pressurized system that will drive bidirectional airflow.

But how does this influence our movement?

Our movement is dependent upon how we manage this pressure system.  You see, as the arms and legs move, they will change the shape of the thorax and alter the airflow as well as the pressure within it.  As the thorax shape changes so does the orientation of our pelvic innominates and scapulae. So if we have poor rib mechanics or don't manage our thorax pressure well we will begin to compensate and restrict our movement patterns.  Thus it becomes increasingly important to be good pressure managers to avoid these compensatory movement strategies.

The ribs have become vastly under appreciated in our movement health.  They can and do influence multiple body parts as well as systems making them an ideal starting point for almost every injury type.  Hopefully you can appreciate this and now have a better handle on why our ribs matter in the restoration of our movement health.

Stay Well, Stay Strong

Keaton

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References:

1. Hartman, Bill, ALL GAIN, NO PAIN: The Over-40 Man's Comeback Guide to Rebuild Your Body After Pain, Injury, or Physical Therapy.  William Hartman. 2017.
2. Lee DG. Biomechanics of the thorax - research evidence and clinical expertise. J Man Manip Ther. 2015;23(3):128-38.
3. Neumann DA. Kinesiology of the Musculoskeletal System, Foundations for Rehabilitation. Mosby; 2010.

The Sportsman: A Journey Together

Sports are the most captivating scenes in America.  We can all identify the iconic sportsmen of our childhood and we all know what it means when we hear, “I wanna be like-Mike”.  However, most of us fall short and recognize these sportsman as the lucky few who were blessed with God-given talent that reached super-stardom, effortlessly.  This is not true though, the journey of a sportsman is anything but effortless.  No journey is effortless.  And no journey occurs in isolation.    

In reflection of the sportsman journey, I see the journey of a patient.  The sportsman is usually part of a team who cohesively works together to achieve a common goal:  winning.  A team struggles as well as finds success as a singular unit.  Similarly a patient is part of the rehabilitation team striving to succeed at restoring functional capacity.  However there are often roadblocks that slow this process.  Identification of how the sports team and rehab team constructs are similar can allow us to begin to see where our roadblocks may be developing and how we can overcome them.

So here’s the breakdown:  coaches = physical therapists, players = patients, opposition = movement/behavioral dysfunction, and the officials = our pain.  Recognizing that not only are we a part of a team, but we carry a specific role is powerful.

Let’s dive into each of these to learn how to overcome our roadblocks.  

Distinguishment between the opposition and the official is essential.  Far too often we hang our hat on “It’s my pain’s fault.”  Why?  It’s always easier to blame someone or something else.  Just like in basketball, it is easier to say “the refs cost us the game.”  However we know this is not the case.  The officials are present to ensure we play be the rules and to alert us if we do anything wrong just like our pain does.  To not get the whistle blown on us again we have to change our behavior.  However, this can be incredibly difficult, but it’s not just you, even elite athletes have ordinary habits they struggle to overcome.  A recent sport psychology article identified three primary drivers of behavioral change in elite athletes:  credibility, reliability, and intimacy.  However the interesting part is that these three primary drivers are not about the elite athlete, but rather their coach.     

This is no different in physical therapy.  A patient and physical therapist must not only trust one another, but they have to trust the process.  This starts with effective communication from the physical therapist.  An explanation of a patient’s condition or procedure allows the credibility of the physical therapist to be highlighted.  Providing knowledge and resources alike ensures a person they are in good hands.  The outcome is often improved compliance in their behavioral modifications.  Knowledge can be the liberator needed by a patient to break them free of a movement dysfunction.

However sometimes more than one explanation is needed to help break a chronic movement/behavioral pattern.  Being a reliable and consistent resource is also critical.  Often a person leaves a session feeling good about their exercise program as well as her behavior changes, but return ill-confident in their performance.  Utilizing repeated exposures and reassuring a person can go along way.  And just because a person struggles doesn’t mean they are doing something wrong and need “more change”.  It is quite the contrary, at the point of struggle is the start of learning, so consistency in their performance becomes essential.  The physical therapist should highlight this notion and coach each person through their exercises as they learn how to regain control of their movement patterns.  

That being said though sometimes frustration sets in and hinders performance.  Early recognition of this by the physical therapist is important.  This reflects the intimacy of the relationship between a patient and physical therapist.  Being able to pick up on differences in mood, verbal language, and/or body language can mitigate the frustration roadblock and allow for a consistent restoration of their movement and resolution of symptoms.  

In the end, a physical therapist is in the coaches seat.  Their influence drives and guides the success of the players.  The role of the coach is to maintain focus on overcoming the opposition and not the officials.  To do so hangs on the three primary drivers of behavioral change:  credibility, reliability, and intimacy.  

Stay Well,

Keaton

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References:  

1. Butler DS, Moseley GL, Sunyata. Explain Pain 2nd Edn. Noigroup Publications; 2013.

2. Halson SL, Lastella M. Amazing Athletes With Ordinary Habits: Why Is Changing Behavior So Difficult?. Int J Sports Physiol Perform. 2017;12(10):1273-1274.