Master Counterstrain: Posterior Rib Tender Points with Picmonic for Medicine

Elevated ribs are associated with inhalation dysfunction. This can be caused during hyperventilation, injury, or during certain medical conditions resulting in obstructive lung diseases. All posterior tender points are associated with elevated ribs/inhalation dysfunction.

The posterior tender point of rib 1 can be palpated one centimeter laterally to the costotransverse articulation on the posterior neck. This is also known as the articulation at the manubrium. These points can be palpated bilaterally.

Posterior Tender points for ribs 2-10 can be palpated along the angle of the corresponding rib with the patient sitting or prone. These points can be palpated bilaterally.

Rib 1 has a unique treatment for the posterior tenderpoint. The patient will first be placed into a sitting position, and the tender point palpated. Once identified and the pain quantified, the patient will be placed into the position of ease. This will be accomplished by extending the neck, sidebending away, and rotating toward the tender point. While keeping a finger on the tender point, the position will then be adjusted until the patient reports a decrease in pain of 70% or more. The position will then be held by the provider for a minimum of 90 seconds before being returned to the neutral position and the pain reassessed for improvement.

The posterior tender points for ribs 2-10 are all treated similarly. The tender point will first be identified and quantified by the provider. While keeping a finger on the tender point, the provider will then position the patient into the position of ease by sidebending and rotating away, adjusting positions until the pain has decreased by 70% or more. The provider will then hold the patient in this position for a minimum of 90 seconds before returning to neutral and reassessing for improvement.