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rib injury discussion

1/10/2014

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Jerry Hesch

President Hesch Institute - Las Vegas Manual Therapy

Regarding the costocorporal and costotransverse joints one of the most painful rib fixations is a medially compressed rib. It can be released slowly and gently with an anterior glide sustained for 30 seconds and then adding a lateral vector along the angle of the rib. Best is to actually add a slight lateral vector. The rib can of course do the opposite, rather common at upper to upper-mid from posture, habit, work, sitting, etc.

 The next most painful would be inferior fixation, though they can be fixated superiorly, tested just lateral to the transverse process. This is not a bucket handle dysfunction, they are tested laterally and are subtle if tested proximally.

 Lastly, the thoracic segments, if mobilized or manipulated typically correct a side-bending restriction and a rotation can remain, only discovered with medial spring test at spinous process on each side. If restricted stack side bending above and below and gentle rotation. If spinous process rotated to the right and does not spring right to left, thenside bending and rotation is to the right because the front of the vertebrae is rotated left moving spinous process to the right.

 Again, I favor gentle forces and contact the right side of spinous process and the segment above and below and lean in and maintain the force for 2 minutes.

 I do teach courses on very gentle mobilization throughout the body.

 Hope this is helpful, can clarify, shoot video etc.

 Jerry Hesch

 www.HeschInstitute.com

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    Jerry Hesch, MHS, PT, DPT(s) – Las Vegas Physical Therapy

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    Dr. Jerry Hesch, DPT, MHS, PT

    Married with 4 grown kids.  Earned my Doctorate at A.T. Still University in Tempe, AZ, MHS at the University of Indianapolis and my BS PT at University of New Mexico.  I enjoy working with my hands and particularly making glass objet d'art.

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