Quick Case: First Rib Pain with SOAP and Odd Self Testing | Modern Manual Therapy Blog

Quick Case: First Rib Pain with SOAP and Odd Self Testing


Here is a quick case from the recent Pitt-Marquette Challenge Eclectic Approach to Spinal Manipulation (or High Speed Mobilization in Pennsylvania - Boo!)

Will is a young therapist who had "first rib" pain and wanted me to take a look at it. Instead of looking at his first fib, I asked him what bothered him. His limitations were
  • doing SOAP notes (a complaint I heard several times that weekend)
  • and this weird self testing movement
    • someone did ask me if this was a first rib test movement, and perhaps it is, but not one that I've learned

rot R, SB L... painful and limited or DP
Ummm... why do you do this Will? A simple answer like any patient, because it hurts and doing it the other way does not. Ok... good enough, so we have a semi functional baseline pre and post test. Quick MDT screening of the cervical spine revealed unilateral loading loss to the ipsilateral painful side. Remember for this movement assessment, passively retract the patient, and maintain the retraction, this loading often brings out asymmetry which as a pattern, is limited to the painful side.

oooo, that's a nice cervical retraction and SB right!

would be "normal" if not for the asymmetry compared to the uninvolved/right side
Treatment was, light IASTM to left cervical and upper trap patterns for about 30-40 seconds each. Then repeated cervical retraction with passive overpressure to the left for about 40 repetitions. It started out as a yellow light, mild discomfort during motion, which progressed to end range, then not at all for the last several reps.

Upon retest, the cervical retraction with SB left and OP was symmetrical, pain free, and that weird head movement was also now pain free and symmetrical. Homework was naturally repeated cervical retraction with SB left to be performed hourly. The next day he was still pain free, and his "first rib" felt much better!

Another bonus! This particular PT emailed me and stated on Monday, he used techniques I presented at the weekend course on 3 patients who he had stalled with previously and all 3 were completely pain free by the end of their visit!

A full vid of this Quick Case can be found on the OMPT Channel, Eclectics Channel.

Staying Eclectic and Easy all at once...

Post a Comment

Post a Comment