Master Counterstrain: Anterior Rib Tender Points with Picmonic for Medicine

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Counterstrain: Anterior Rib Tender Points

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Counterstrain: Anterior Rib Tender Points

Counter-strainer with Anteater Ribs and Tenderizer Point
Picmonic
Rib tender points are located both anteriorly and posteriorly. Anterior tender points are associated with depressed ribs, or exhalation dysfunction. The Anterior tender point of rib 1 can be found just inferior to the clavicle, at the first costochondral junction. The anterior tender point of rib 2 is located at the midclavicular line of rib 2. The anterior tender points for ribs 3-10 are located at the axillary line of the corresponding rib. Treatment for the anterior tender points is the same, with the patient sidebends toward and rotated toward the side of dysfunction. Posterior rib tender points are associated with elevated ribs, or inhalation dysfunction. The tender point for rib 1 is located 1 centimeter lateral to the costotransverse junction, and the tender point for ribs 2-10 is located along the angle of the corresponding rib. Treatment for the posterior tender point of rib 1 is extension of the neck, sidebending away and rotating toward the side of dysfunction. Treatment for the tender points of ribs 2-10 is sidebending and rotating away from the side of the dysfunction. Remember, all counterstrain positions should be held for a minimum of 90 seconds, though 120 seconds is preferred for rib tender points.
5 KEY FACTS
ANTERIOR TENDERPOINTS
Depressed Ribs / Exhalation Dysfunction
Deflated Ribs

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.

Rib 1: First Costochondral Junction Inferior to the Clavicle
Rib (1) Wand: Costo-condiments In-fur to Clavicle

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.

Rib 2: Midclavicular Line of Rib 2
Rib (2): Middle-ages-clavical Line

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

Rib 3 - 10: Anterior Axillary Line of the Corresponding Rib
Rib (3) Tree to Rib (10): Anteater Axe Line of the Corresponding Rib

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.

ANTERIOR TREATMENT
Sidebend, and Rotate Towards (STRT)
STARTing Line

For all anterior tender points, the point should first be identified and the pain quantified with the patient in a sitting position. The patient will then be placed into the position of ease by sidebending toward and rotating away from the tender point. You can remember this position by the acronym ‘START’. While keeping your finger on the tender point, the position should be adjusted until the pain is improved by 70% or more. The provider will then hold the patient in this position for a minimum of 90 seconds, though 120 seconds is preferred for rib tender points. Once the treatment is complete, the patient will be returned to neutral and the tender point reassessed for improvement.

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