Issue link: https://www.massageandbodyworkdigital.com/i/72121
MYOFASCIAL TECHNIQUES INTERCOSTAL SPACE TECHNIQUE Once you've addressed restrictions at the costovertebral joints, you can proceed around the rib's shaft to check for the ribs' cranial/caudal motion. Since the ribs articulate at their posterior and anterior ends, rib cage expansion causes their most lateral part to rise on inhalation, much like a bucket handle pivots on its fastened ends when lifted. This motion depends on the mobility not only of the costovertebral joints, but on the ability of the intercostal structures to lengthen and allow separation between the ribs. To check the ribs' ability to separate, Applying gentle, steady pressure encourages a restricted rib in the release phase of the Costovertebral Joint Technique. Image 3 courtesy Advanced-Trainings.com. Stabilizing a rib against the lift of active inhalation allows the intercostal spaces to open like an accordion. Image 4 courtesy Advanced- Trainings.com. position yourself behind your side-lying client, facing the foot of the table. Your client should no longer be in the tight fetal position of the Costovertebral Joint Technique, but instead, lying with the spine straight, that is, neither flexed nor extended. Use a broad, open hand to check for expansion between the ribs as you direct your client to take a full breath (Image 4). When the ribs are free, you'll feel each intercostal space expand on inhalation, much like the pleats of an accordion expand (Image 5). Note any rib spaces that expand less than others. Most of us have restrictions here; for example, on women, the spaces at the level of a bra strap can become bound together by restricted fascia, and move all together, instead of as individual bones. To address any restricted intercostal spaces you find, use the base of your forefinger at the edge of your hand to apply gentle caudal (inferior) pressure to the upper edge of the rib, below the restricted intercostal space (Image 6). For example, if the intercostal space between ribs four and five is restricted, apply inferior pressure to the upper edge of rib five, thus encouraging the restricted space to open with direct but gentle pressure. Actually, your pressure itself will not open the space as much as your client's breath will. Once your hands are in position, ask your client to "inhale above this place," as you resist the tendency of the lower rib to lift with inspiration. It may take your client a few attempts to discover how to lift the ribs above your stabilizing hands. Patiently coach your client to be specific with their in- breath: "inhaling from here up." This motion will actively separate the ribs and open restricted intercostal spaces. 114 massage & bodywork january/february 2012