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  • Using SMRT on the Rib Cage

    The 2017 student experience was a few weeks ago and the learning was intense. The work we gave and received was amazing. A good time was had by all!

    During our Saturday discussion, one of the students asked me how to assess the rib cage as a whole. In our basic series we typically work the rib cage one rib or one section at a time, mostly so we can get used to feeling ribs and what ribs are doing.


    I put someone on a table and explained that the rib cage as a unit could have a divergent point. I shifted the lower rib cage from right to left and found it moved easier and much more to the right. I jumped up a couple of levels and found that the level I was at hardly moved in either direction. A couple of levels higher than that and the rib cage moved easiest to the left. Finally, I moved to the top of the table, placed my fingers in the axillas and moved the upper rib cage right and left. At first, it looked as if this area of the rib cage moved easiest to the right, but I explained to the class that this was a false read.

    “What do you mean by a false read?” One student asked. It is the term I use for when something feels or looks one way on the surface. I told them that I could feel that in order to accomplish the movement to the right, the upper rib cage had to pull in the middle and lower rib cage. I reached down with my right hand and stabilized the middle of the rib cage on the right side. With my left fingers in the left axilla I moved the upper rib cage toward the right side. It did not move right. Reversing my hands and moving the upper rib cage to the left showed more mobility moving to the left than the right.


    Using SMRT to work with the divergent patterns in the rib cage as a whole, I shifted the lower rib cage to the right and upper rib cage to the left. I held that position for about 30 seconds. When I reassessed, there was more equal movement in the rib cage as a whole. But there was still one level, at about the 7th and 8th ribs that was not moving well. We did this again, but on a micro level, moving the 7th and 8th ribs into their respective patterns and holding. Upon releasing this hold, the restriction was gone.

    What does all of this truly do? Well, if the rib cage is restricted, there is limited glide/motion/expansion in the connective tissue attached to the rib cage. So, for example, the endothoracic fascia which lines the interior of the rib cage and eventually blends with the diaphragmatic pleura is unable to freely move with the parietal pleura. The pleura separates to create pleural sacs that house the lungs. Between these pleural sacs is the mediastinum, which is a continuation of the parietal pleura and the middle aspect of which helps create the pericardial sac that houses the heart.

    In addition to all of this, the endothoracic fascia is continuous with the prevertebral fascia of the cervical spine. The prevertebral fascia attaches to the length of the c-spine. When the rib cage has diminished mobility, all of the connective tissues described are unable to move optimally. This may show up as pain in the neck, a headache, shoulder pain, shallow breathing, etc.

    There are many things we can do through SMRT to mobilize the ribs and work directly with the fascia of the thoracic cage. Take your knowledge of SMRT for the shoulder, axilla, ribcage, & upper back to the next level by registering for a class here.

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