Master Counterstrain: Anterior Rib Tender Points with Picmonic for Medicine

Depression of the ribs can be caused from a myriad of factors, including coughing, forceful exhalation, or an external pressure, like falling and injury to the ribs. These ribs can be palpated as inferior and posterior, and are associated with exhalation dysfunction. All anterior tender points are related to depressed ribs and exhalation dysfunction.

The anterior tender point for rib one can be palpated on the first costochondral junction, inferior to the clavicle. This tender point can be palpated bilaterally.

The anterior tender point of Rib 2 can be palpated on the midclavicular line of rib 2, and can be palpated bilaterally.

The anterior tender point of Ribs 3-10 can be palpated on the anterior axillary line of the corresponding rib. These can be palpated bilaterally.

For anterior rib tender points, identify the tender point and quantify pain with the patient seated or supine. The patient is then positioned into ease by sidebending toward and rotating away from the tender point. Fine-tuning is performed until tenderness improves by at least 70%. Hold the position for 90 seconds minimum, though 120 seconds is often preferred for rib tender points. The patient is then slowly returned to neutral and reassessed.