Overview of Osteopathic Manipulative Treatment: Muscle Energy Procedure – Exhaled Ribs
The process of treating “exhaled ribs” involves a method called muscle energy osteopathic manipulative treatment (OMT). OMT is a set of techniques where a doctor manipulates muscles and joints to address health issues. They involve different methods, such as high velocity/low amplitude (fast pace, low force), muscle energy, strain-counterstrain, and myofascical release (a technique focused on loosening tight muscles).
These techniques are performed in a certain manner. They can be direct, where pressure is applied towards the area causing discomfort, or indirect, where pressure is applied in the opposite direction. Similarly, they can also be passive, where the doctor does all the work while the patient remains relaxed, or active, where the patient participates in the treatment process.
“Muscle energy”, an active and direct technique, involves patient participation and is aimed at the area causing discomfort. This technique has different versions but commonly, the patient’s body is positioned into the discomfort-causing area and they participate by actively moving towards a more comfortable position, while the doctor applies a counter-pressure.
Abnormalities in rib function can lead to several symptoms that include chest pain, difficulty in breathing to full capacity, or aggravation of existing respiratory diseases. An appropriate breathing process requires the diaphragm, ribs, and sternum (chest bone) to move normally; otherwise, it may inhibit effective breathing and oxygen supply to the body. So, when doctors treat rib dysfunctions, they focus on the main rib causing the issue. This rib varies depending on whether one has an inhalation (breathing in) or exhalation (breathing out) dysfunction.
“Exhaled rib dysfunction” is a condition where two or more ribs are displaced or “stuck” downwards meaning that the ribs cannot move upwards during inhalation (breathing in). This prevents the affected ribs from moving when you breathe in and the topmost affected rib is the focal point of the treatment.
Anatomy and Physiology of Osteopathic Manipulative Treatment: Muscle Energy Procedure – Exhaled Ribs
The human body has twelve pairs of ribs. These ribs are at the front and are either linked directly to the breastbone, are connected to the cartilage of the neighboring ribs, or do not have any attachment at all. At the back, the twelve sets of ribs are joined to the spine.
We categorize the ribs into three groups: true, false, and floating ribs. The first 7 ribs are called “true ribs” because they are directly attached to the breastbone. However, ribs 8 to 10 are named “false ribs” as they only connect to the cartilage of the first seven ribs, not directly to the breastbone. The last two ribs, ribs 11 and 12, are known as “floating ribs” because they have no attachment at the front.
The way ribs move also changes slightly based on their attachment. The upper five ribs move forward and backward like a pump handle, moving more when you breathe in and less when you breathe out. Ribs 5 to 10 move sideways like a bucket handle, widening when you breathe in and narrowing when you breathe out. The last two ribs move up and down like a caliper during breathing.
Different muscles control each rib or set of ribs allowing us to inhale and exhale. Certain muscles start from different parts of the neck area and attach to different ribs. For example, the pectoralis minor muscle starts around ribs 3 to 5 and attaches to the shoulder blade. Other muscles, like the serratus anterior, originate from ribs 6 to 8 and insert on the shoulder blade’s inner edge. Some muscles even start from lower down around ribs 9 to 10.
The last two ribs, known as floating ribs, move in a specific fashion when we breathe. It’s important to note the layers of muscles between each rib and the diaphragm’s attachment at the last 6 ribs. Lastly, a thin muscle called transversus thoracis is located on the inner side of the ribs at the front of the chest.
Why do People Need Osteopathic Manipulative Treatment: Muscle Energy Procedure – Exhaled Ribs
Muscle energy techniques used on the ribs can help a wide range of people. These techniques can safely be applied to elderly or very sick patients. They can also help those dealing with long-term health conditions like COPD, asthma, or a disease that affects the tissue and space around the air sacs of the lungs, known as interstitial lung disease.
Studies have shown that this type of manual therapy, known as osteopathic manipulative treatment, can be beneficial for people recovering from surgery or those in intensive care.
This can even be useful for people who have an issue with letting air out when they breathe. It can benefit those trying to stretch and open up their chest to improve their body’s natural movement.
When a Person Should Avoid Osteopathic Manipulative Treatment: Muscle Energy Procedure – Exhaled Ribs
Some people shouldn’t have a therapy called muscle energy for various reasons:
Firstly, if a person can’t actively participate in the treatment or doesn’t wish to, this therapy might not be the best approach. Muscle energy involves a significant amount of active participation from the patient, and it wouldn’t be effective if they can’t or don’t want to be involved.
Secondly, people with certain health conditions, such as broken ribs, recent injury to the spine, or abnormally loose ligaments, shouldn’t undergo this treatment as it could possibly cause further harm.
Lastly, if a person has an active skin infection, muscle infection, or cancer that has spread to other body parts (known as metastatic cancer), they should avoid muscle energy therapy. This is because the therapy may possibly spread infections or cancer cells to the ribs.
Equipment used for Osteopathic Manipulative Treatment: Muscle Energy Procedure – Exhaled Ribs
The muscle energy technique is a type of treatment where the patient needs to be either sitting up straight or lying on their back. It’s important for the patient to be able to actively engage in the process. To perform this technique, there are three main things needed: the patient, a professional who is trained in this technique, and a soft table that’s made for this kind of body manipulation.
Who is needed to perform Osteopathic Manipulative Treatment: Muscle Energy Procedure – Exhaled Ribs?
This treatment involves two key people. The first is a skilled healthcare professional who is specifically trained to conduct the treatment. The second is you, the patient, who is prepared and capable of undertaking the treatment.
Preparing for Osteopathic Manipulative Treatment: Muscle Energy Procedure – Exhaled Ribs
Before starting the procedure, the doctor will request for you to give your agreement. This is known as giving ‘consent’. You’ll need to provide consent both verbally and in writing. The doctor will ensure you understand what the procedure involves, including where they’ll be putting their hands. They’ll explain why this particular procedure is being done and if there are any other ways it could be carried out. At the end of it all, you should be comfortable and willing to go through with the procedure.
How is Osteopathic Manipulative Treatment: Muscle Energy Procedure – Exhaled Ribs performed
First, before we start treating the ribs, we have to check that some bones in the middle of your back, called thoracic vertebrae, are okay. If these bones have a problem, known as a somatic dysfunction, the Rib treatments won’t really work.
Here are the steps involved in treating the ribs:
For the first two ribs, you’ll lie flat on your back, and the doctor/handler will stand by your head. The doctor will hold onto the affected rib on your side underneath you, and place the back of your same-side wrist on your forehead. Your head will be turned 40 degrees from the side of the rib problem, to tighten the muscles on the same side of your neck. As you breathe in, the doctor tugs gently on the rib in a downwards and sideways direction. Once your lungs are full, they’ll ask you to hold your breath while lifting your head up, with the doctor giving the same amount of pushback down. After that, you get to relax for 5 seconds. The doctor will push towards the rib again, and these steps are repeated until it ends up treating the rib problem.
When we proceed to ribs 3 to 5, you’ll still lie flat on your back, but the doctor stands on the side opposite of the affected ribs. They’ll then lift your arm on the same side as the rib problem, and as you take a deep breath, the doctor applies the same downward and sideways pull on the rib. When your lungs are full, you’ll be asked to hold your breath, and then bring your elbow towards your opposite hip to tighten your chest muscle, while the doctor pushes against your movement. After that, you’ll get to rest for 5 seconds. The doctor will push against the rib, and these steps are repeated until we get the desired result.
For ribs 6 to 8, you’ll still lie flat on your back, but the doctor stands on the side opposite the affected rib. They’ll then lift your arm on the same side as the rib problem, and your elbow to a right angle with your palm facing up. Again, as you breathe in, the doctor will give a pull on the rib in a downward and sideways direction. With your lungs full, you’ll hold your breath, and then push your arm forwards while the doctor provides resistance to your push. You’ll then get a rest period for 5 seconds before these steps are repeated until we get the desired result.
For ribs 9 and 10, once again, you’ll lie flat on your back and the doctor handling the case stands on the side opposite the affected ribs. They’ll then lift your arm on the same side as the rib problem until it’s straight up. While you’re breathing in, the doctor will then give the rib a downward/sideways pull. While your lungs are full, you’re asked to hold your breath, then move your elbow towards your body as the doctor resists the movement. After that, you get to relax for 5 seconds before we start the steps again until we get the desired result.
Finally, for the last two ribs, 11 and 12, you’ll be laying on your stomach and the doctor stands on the side opposite the affected ribs. They’ll then lift your arm on the same side as the rib problem straight up. The doctor’s lower hand holds your ASIS (the bony bump on your hip bone), and the other hand will be placed on the lower part of the rib that’s being treated. As you breathe in, the doctor will encourage the upper motion of the ribs. While you’re breathing out, they’ll prevent the downward movement of the ribs. These steps will be done at least three times.
Possible Complications of Osteopathic Manipulative Treatment: Muscle Energy Procedure – Exhaled Ribs
It’s important to tell patients that they might feel some soreness in their muscles and joints after the manipulation procedure. This discomfort doesn’t happen to everyone, but it can occur. If someone often has muscle soreness after this procedure, they can take a commonly available pain reliever before it begins to ease the discomfort. Though it’s uncommon, there can be serious side effects to these procedures as well.
What Else Should I Know About Osteopathic Manipulative Treatment: Muscle Energy Procedure – Exhaled Ribs?
Despite the research being limited, some studies have looked into the effectiveness of physical manipulations for muscle improvement, notably for individuals with Chronic Obstructive Pulmonary Disease (COPD). But the results were not definitive. However, in the context of managing back pain (whether it’s acute or chronic), the American College of Physicians strongly advises trying manipulative therapies first, including muscle energy techniques.
A particularly popular method in osteopathic medicine is the Muscle Energy Technique (MET). This method, developed by Fred Mitchell Sr. about 50 years ago, strives to enhance muscle functioning, restore regular length to parts of the muscle that have shortened, increase joint movement, and reduce inflammation.
The effectiveness of MET relies on various factors. These include the appropriate positioning of the joint, the correct muscle tension, a precise diagnosis, enough pressure applied by the practitioner to change muscle behavior in the specific area, and appropriate repositioning of the joint after the manual treatment. The technique is also beneficial for managing muscle stiffness, as we may often see post-thoracic surgery, and combatting trigger points.
As of now, the scientific understanding of why this method often brings positive results is incomplete. Some theories suggest that MET could stimulate mechanoreceptors, which are sensory receptors responsive to mechanical pressure or distortion, and thus interfere with painful sensations. Further, it could also help relax contracted muscles, improve fluid drainage, and reduce overall inflammation in the treated area.
But when should doctors opt for this particular method? Well, the favorable aspect of MET is that it causes no side effects and is tracked based on the patient’s comfort, i.e., it doesn’t cause pain or discomfort. Also, you can use it as preparation for other more intense techniques or stretches for effective work on the muscles of your rib cage, like after undergoing sternotomy, a surgical procedure in which a vertical inline incision is made along the sternum, to provide access to the heart and lungs.
Also, scars resulting from past injuries or surgeries can limit the movement of the rib and neighboring muscles. In such cases, MET can enhance the rib’s movement, albeit temporarily, because of the presence of the scar. Therefore, regular follow-up appointments might be necessary for patients to ensure long-lasting improvement concerning muscle and joint movement.
In conclusion, this technique could be used just by itself if it fully restores joint and muscle function, or as a preparatory step for more demanding procedures for the patient.