Massage & Bodywork

January/February 2012

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Use the flat portion of your forearm to gently release the erectors, including the iliocostalis (orange), the most lateral of the erector spinae. Image 1 courtesy Primal Pictures; used by permission. Image 2 courtesy Advanced-Trainings.com. ribs and vertebrae together into an immobile mass. Free costovertebral joints allow the ribs to change their angle in relation to the spine, lifting with inhalation, and dropping with exhalation. Since the costovertebral joints are obliquely arranged, with the rib lying anterolateral to the transverse processes of the vertebra (Image 3, page 114), these joints also allow a small amount of anterior rib movement as well; this anterior movement is an indicator of freedom at this joint. Assess this anterior mobility after you've addressed the erectors with the previous technique. With your client prone, use what manual therapy teacher Art Riggs calls the "piano key" method: using either your fingers, thumbs, palm, or forearm (as in the Erector Technique, Image 2), check each rib's anterior mobility in turn. Each rib can be palpated just lateral to the muscle mass of the erectors, or on the upper ribs, just medial to the scapula. A variation is to reach under your supine client, and with your fingertips, lift each rib from underneath. Whichever position or assessment method you choose, be sure you're feeling for the boney hardness of the rib itself, and not getting distracted by any remaining tightness in the soft tissues over the ribs or in the laminar groove. Each rib should give slightly when you put anterior pressure on it. An unyielding rib or particular tenderness with the test reveals an issue with that rib's costovertebral joints. Test all ribs, using caution and using very little pressure on the lowest two pairs of floating ribs. Once you've identified which costovertebral joints are restricted, position your client on his side, with the restricted joint on the upper side (e.g., for right- side restrictions, your client would lie on his left side). Curl your client into a tight fetal position, with hips and spine in flexion, knees to the chest, and chin tucked. This position will give you a head start by creating a bit more space between adjacent vertebral transverse processes, opening them away from the neck of the restricted rib. Using the flat section of your ulna just distal to your elbow, apply pressure (in an anterior and slightly medial direction) to the back (posterior angle) of the restricted ribs (Image 3, page 114). Usually it is most effective to approach at a low angle, almost parallel to the table. Tune the direction of your pressure until you feel the rib itself, then lean on it, check with your client about their comfort, and wait for a release. You can invite your client to breathe into his back, which will fill the area you're working with and encourage the spine to move slightly posteriorly. You can monitor this slight posterior motion of the spine with your nonworking hand. The key here is patience; stay comfortable in your own body so that you can sustain the pressure for several breaths, giving the ligaments around the joints time to respond. You'll feel the rib become subtly but tangibly mobile, if you wait long enough. When you've released the restrictions on one side, turn your client over and work the restrictions on his or her other side, so that you're again working the upper side. Or, before your client turns over, check another dimension of that side's rib mobility with the Intercostal Space Technique. Watch Til Luchau's technique videos and read his past Myofascial Techniques articles in Massage & Bodywork's digital edition. The links are available at www.massageandbodywork.com, www.abmp.com, and on Advanced- Trainings.com's Facebook page. Watch the free archived webinar related to this article at www.abmp.com. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 113

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