Rib Flare and Improper Rib Cage Position: Manual & Movement Interventions

Being a movement teacher and bodyworker, you begin to notice patterns between your clients. Whether these patterns be in the way they stand, the way they move, or simply the way they present energetically. One of the most significant of those patterns that comes up quite often with those I work with is a posterior tilting of the ribcage, flared ribs, and hyperinflated lungs

From a very general soft tissue perspective, this pattern comes along with sub-optimal pressure in the abdominal balloon, as the lumbar spine is forced into hyperextension, the ribs into external rotation, and a loss of proper coordination/tonicity of the TVA, obliques, and rectus abdominis. This pattern also often spells “deep core compression;” a concept that isn't touched on often in the training/fitness world, yet is strikingly important to the structural bodyworker/movement therapist.

According to “Body 3” by Tom Myers book, this pattern could be due to increased visceral fat pulling the lumbar spine forward and can surely be mended through balancing the tissue around the spine. According to Ida Rolf’s “Reestablishing the natural alignment and structural integration of the human body,” it’s quite common to see those with “love handles” and a small gut in the lower abdominal area complaining that they need to “drop a few pounds.” In reality, they're inner core (musculature surrounding the spine) is so compressed and their abdominal balloon at such sub-optimal pressure that their abdominal tissue is simply being bunched up, and must collect somewhere… The lower abdomen and top of the iliac crests (hip bones) just happen to be those areas.

During my training in structural integration, it was a common theme when speaking about breath and the ribcage to hear “people who are depressed seem to be stuck on the exhale.” Given my instructors' years of combined experience, I surely don't doubt that is the case, as is mirrored in Alexander Lowens Bioenergetics therapy. However, as mentioned previously, from a mechanical perspective It seems to be a much more common ailment, at least in the population I work with, to see one stuck on the inhale, with externally rotated (flared) lower ribs. This particular pattern is often associated with fear (one or continued traumatic events) throughout one's development.

My initial research took me towards one of my most trusted sources in body-mind therapies, Paul Chek. In his course “Scientific Core Training,” Paul makes it clear that faulty posture and poor exercise training techniques often lead to hip flexor facilitation and inhibit the lower abdominals, greatly affecting intra-abdominal pressure. When our abdominal muscles contract against our viscera, the viscera pushes up towards the diaphragm and down towards the pelvic floor. As the diaphragm elevates, it pulls up on L2/L3 via the central tendon, effectively decompressing L4/L5 with every exhale. Heading more superficially, Chek also mentions the importance of the 8 different innervations of the Rectus Abdominis. These multiple innervations make it so that the rectus can act as a stabilizing muscle at one end, while simultaneously acting as a prime mover at the other, depending on the movement. This has major implications for rehabilitation, being that the exact positioning of a client's pelvis and ribcage, coupled with intentional breathwork can play a large part in working to correct the previously discussed pattern.

It's well known that the diaphragm's mechanical action and ability to take in/expel air depends on its relationship with the rib cage itself. This means that the hyperinflation of the lungs (that comes along with external rotation of the ribcage) can be caused by a disconnect between the abdominal musculature and the diaphragm, or in the words of the Postural Restoration Institute “loss of ipsilateral or bilateral abdominal opposition and diaphragm apposition.” Furthermore, according to PRI; lung hyperinflation, accessory respiratory muscle overuse, and chest wall mobility are all influenced by the resting position of the diaphragms “Zone of apposition” at the end of exhalation. This ZOA includes the vertical fibers of the diaphragm running from the costal margin/posterior lower ribs up and over the lobes of the diaphragm.

When this ”Zone of apposition” is functioning properly, the diaphragms remain dome-shaped, and don't require the use of excess accessory musculature for breathing. This function is largely determined by the shape of the ribcage. A ribcage that is externally rotated, or “Open like a condor's wings' ' (Myers, Body 3) is always coupled with lumbar extension. An internally rotated rib cage is coupled with lumbar flexion. This coupling of the ribcage mechanics and spinal position can be further explored through the following concept outlined in Myers Body 3. The fact that with every breath you take, the ribcage is externally/internally rotating, means that with each breath, the discs of the spine are being “pumped” and hydrated. This is not the case with a ribcage that is either stuck on the exhale or on the inhale.

This all to say that, proper shape and function of the domes of the diaphragm (ie being able to achieve full inhale/exhale and the accompanying internal rotation/external rotation of the ribcage) can only occur when the body is actually able to achieve thoracolumbar flexion. An anteriorly tilted pelvis and/or hyperextended lumbar spine will inhibit this movement, in turn inhibiting proper function of breathing, which has a massive cascade of ill health effects. The myofascial chain outlined by the Postural Restoration Institute is known as the “Anterior Inferior Chain,” while the same myofascial track in the language of Tom Myers anatomy trains is known as the “Deep Front Line.”

So the question remains, what does one do about hyperinflated lungs/externally rotated ribcage? Well obviously entire schools, courses and books have been dedicated to the topic, so I will leave it to a few simple bodywork techniques and movement therapy exercise strategies.

Helping a client achieve proper balance of tissue around the abdomen (superficially) and achieve balance of the inner core musculature is key. More specifically, goals of manual interventions might be to improve psoas/erector balance (the 4 pillars surrounding the spine), release held tensions in the psoas specifically (to ease hyperextended lumbars) and move “piled up” tissue on the front of the abdomen and tops of iliacus’ to create more space for proper abdominal muscle functioning. Through a more global structural lens, it's clear that an anterior shifted pelvis (compared to the feet) could create a similar issue, and would take a global approach via helping the client find their heels, ease hyperextension in the knee, help settle the anterior tilt of the pelvis and more.

Through a corrective exercise lens, it is clear through the work of the Postural Restoration Institute that exercises involving intentional breathing paired with specific positioning of body segments can be quite successful, especially paired with manual intervention (Postural Restoration). Positioning of the client's body during these movements can differ given different patterns, but for most with hyperinflation/external rotation of the ribcage, lying on the back with the legs at 90 degrees and feet on a wall will help achieve thoracolumbar flexion, while still maintaining slight lumbar lordosis. Throughout the breathing exercises, the client must maintain this spinal position. If they fall back into lumbar-hyperextension, external rotation of the ribcage is sure to follow. Ensuring this position is held can be facilitated by having the client hold a yoga block between their knees and/or putting a hand under their Thoracolumbar junction (“Don't lift off my hand!”).

The next step would be long exhalations, focused on getting as much air as possible out of the lungs. This can be done by either telling the client to “Blow out the candles” through pursed lips, “Fog up the window” with an open mouth or even by exhaling into a balloon for maximal proprioceptive feedback. These elongated exhalations, aside from making the ribcage “smaller” are actively recruiting the external obliques to help pull the ribs down. Once full exhalation is achieved, the following inhalations are to be done while maintaining intraabdominal pressure. This effectively holds down the ribcage, via the internal obliques and TVA, and allows the ribcage to EXPAND upon inhalation rather than ELEVATE (or externally rotate). (Postural Restoration)

In my clinical experience, this ribcage/diaphragmatic pattern also tends to present with anterior tilted and medial tilted scapula and accompanying rhomboid trigger points/pain. This is likely due to the fact that if the ribcage is stuck “open like bird wings” and tilted posteriorly, then the tissue along the spine (namely the erectors) will inevitably be pulled towards the spine, and the scapula forced to be pulled superior and lateral. In my own personal experience teaching these movements with clients and doing them myself, I’ve found immense value in internally rotating the shoulders and reaching for the ceiling, at the same time as completing the long slow exhalations. Theoretically, this would be activating the serratus anterior, effectively “suctioning” the scapula back to the rib cage while simultaneously activating the latissimus to “pull” the top of the rib cage forward, taking the entire rib cage out of its posterior tilt, while achieving internal rotation through the breathing/leg positioning.

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