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 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.