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Depending on your client's tendency toward exhalation- or inhalation-fi xation, sometimes it is more effective to reverse the technique, stabilizing a rib superiorly while the client actively exhales below that level (Image 6 inset). In this version, the contraction of the abdomen and internal intercostals in forcible exhalation pulls the ribs downward. When combined with your gentle upward pressure on the rib just above the restricted space, you can use the exhalation (instead of an inhalation) to open a restricted intercostal space. If one variation does not seem particularly effective with your client's intercostal restrictions, try the opposite approach. The release will be clear to both your client and to you when you get it right. RIB PAIN CONSIDERATIONS The techniques described here are effective in reducing many kinds of rib pain, including mild rib displacements or fi xations. These techniques are a good start—you'll also want to assess how the diaphragm, chest, shoulders, and abdomen might be inhibiting rib cage mobility. It is important to keep in mind that in addition to soft-tissue or articular restrictions, rib pain can accompany other issues, including: • Bruised, cracked, or fractured ribs; or costochondritis (infl ammation of the sternal cartilage, usually painful but benign). These often respond best to rest and the passage of time. Once healed, these can leave behind tissue and movement restrictions that these techniques can help relieve. • Pleurisy (infl amed linings of the lung cavity) should be considered when breathing is painful. Referral to a physician is indicated when pleurisy is suspected. • Cardiac issues can also cause chest pain. In the most cautious approach, unexplained chest pain should be considered an emergency until cardiac issues can be ruled out. • Osteoporosis (a bone disease that increases the risk of fracture) initially has few signs or symptoms unless a fracture has already occurred, and is diffi cult to detect without screening. Both men and women can be affected. Bone density screening is recommended when three or more of these risk factors are present: being over age 65, Caucasian or Asian, female, low body weight, or having a family history of osteoporosis. Play it safe and avoid excessive pressure on the ribs or spine when you suspect any risk of osteoporosis. Stabilizing a rib against the downward pull of exhalation in the reversed Intercostal Space Technique. Image 6 courtesy Advanced-Trainings. com; Image 6 inset courtesy Primal Pictures, used by permission. Boney movement, like the ribs' movement in breathing, is often not the main focus in a soft-tissue practice. By assessing and releasing the ribs' articulations and tissues, we broaden our effectiveness and increase the contribution we make toward our clients' overall well-being. The techniques described here are a good start—you'll also want to assess how the diaphragm, chest, shoulders, and abdomen might be inhibiting rib cage mobility,2 body is a web of connections and interrelationships. since the Notes 1. One study of the link between breathing and depression: R.P. Brown et al., "Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part I—Neurophysiologic Model," Journal of Alternative and Complementary Medicine 11, no. 1 (February 2005): 189–201. 2. An expanded version of this article and a photo gallery are available at www.tinyurl.com/mb-rib-e xt. Til Luchau is a member of the Advanced-Trainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. He is also a Certifi ed Advanced Rolfer and teaches for the Rolf Institute of Structural Integration. Contact him via info@advanced-trainings.com and Advanced-Trainings.com's Facebook page. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 115