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Ep 482 – Rib Out? Where Did It Go?: “The Rebel MT” with Allison Denney

01/21/2025
Image of a person holding their right rib in pain.

What exactly happens when a rib goes out? While it's not exactly hitting the club scene in Vegas, what happens is not so different from if it did. In this episode of The ABMP Podcast, host Allison Denney of Rebel Massage explains what is going on when a rib goes out, how to think about costovertebral joints, and the importance of the health history. 

Author Images
Image of Allison Denney.
Author Bio

 

Contact Allison Denney: rebelmt@abmp.com     

      

Allison’s website: www.rebelmassage.com          

          

Allison Denney is a certified massage therapist and certified YouTuber. You can find her massage tutorials at YouTube.com/RebelMassage. She is also passionate about creating products that are kind, simple, and productive for therapists to use in their practices. Her products, along with access to her blog and CE opportunities, can be found at rebelmassage.com.        

 

Sponsors

 

Anatomy Trains: www.anatomytrains.com

 

Rebel Massage Therapist: http://www.rebelmassage.com

 

Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.    

                

Website: anatomytrains.com    

                  

Email: info@anatomytrains.com          

 

Facebook: facebook.com/AnatomyTrains

                    

Instagram: www.instagram.com/anatomytrainsofficial

 

YouTube: https://www.youtube.com/channel/UC2g6TOEFrX4b-CigknssKHA  

 

 

Rebel Massage Therapist

My name is Allison. And I am not your typical massage therapist. After 20 years of experience and thousands of clients, I have learned that massage therapy is SO MUCH more than a relaxing experience at a spa. I see soft tissue as more than merely a physical element but a deeply complex, neurologically driven part of who you are. I use this knowledge to work WITH you—not ON you—to create change that works. This is the basis of my approach. As a massage therapist, I have worked in almost every capacity, including massage clinics, physical therapy clinics, chiropractor offices, spas, private practice, and teaching. I have learned incredible techniques and strategies from each of my experiences. In my 20 years as a massage therapist, I have never stopped growing. I currently have a private practice based out of Long Beach, California, where I also teach continuing education classes and occasionally work on my kids. If they’re good.

 

website: www.rebelmassage.com

 

 

FB: facebook.com/RebelMassage

 

 

IG: instagram.com/rebelmassagetherapist

 

Full Transcript

0:00:00.3 Speaker 1: When a rib is out, what exactly does that mean? Is it traveling for the weekend? Is it out clubbing? Or is it like passed out on the couch from exhaustion? Spoiler alert. It is none of these. But one thing is for certain about what happens to a rib when it goes out. It is not a comfortable situation. If this has happened to you, you know that it can feel like anything from an annoying poker in your side to to the inability to breathe. Neither of which are fun. I mean, it might be more fun to think about what it means to go out. Let's just say our rib did get away for the weekend. And while it was there, it decided to explore the club scene and then stayed out too late and then collapsed on the couch for the entire Sunday. It took going out to the nth degree. It went out in every way that it could, and coming back ain't going to be easy. In the planning stages, going out may seem like a lot of fun. Maybe the rib even brought a disposable camera that made its rounds, a la the hangover. And it has a super funny story to tell.

 

0:01:07.1 S1: But no matter how you slice it, that rib has deviated away from its normal routine and it's going to be a bit cattywampus until it feels normal again. What is actually happening when a rib goes out is not that different from when one heads to Vegas for a weekend. The skeleton, or really any one of our awesome anatomical parts, doesn't very much like being askew. New and exciting adventures can be enticing, but unless we are specifically pushing these parts to do better or be better, getting off track is the imbalance that doesn't always end well. A rib going out is its own version of deviation. How a rib articulates with a vertebra, well, two vertebrae technically, is situated in such a way that a turn away or out in any direction can feel all sorts of uncomfortable. The good news is that a costovertebral joint is very similar to many other joints in the body. And once we see this, understanding how to help a rib find its way back is a lot less overwhelming.

 

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0:02:11.8 S1: The body has this incredible ability to show us patterns. And if we can understand some of those bigger patterns, we can get better at figuring out some of the more complex ones. Like for example, our legs and our arms are very similar. One long bone at the top, a joint that mainly only flexes and extends, two thinner long bones side by side, sitting atop a collection of rock-like bones that create a cool amount of mobility. And then five little long bones extending from there to eventually give us what we know as our fingers and toes. So tarsal tunnel syndrome might be easier to digest because of what we already understand about carpal tunnel syndrome, where two or more bones meet and create joints also present similarities that we can follow. If you remember, the big picture in the joint world is that there are three overarching categories: Synarthrosis or joints that don't move; amphiarthrosis or joints that offer a little movement, and diarthroses or freely moving joints. Costovertebral joints, or where a rib articulates with a vertebrae falls in this last category, it is considered diarthrotic, which we also call freely moving, which we also call synovial. This is a handy-dandy piece of information, because what this means is that a costovertebral joint has all the trademarks of a synovial joint, a fibrous joint capsule creating a synovial cavity that holds the articulating surfaces of the bones of said joint and synovial fluid inside.

 

0:03:41.1 S1: So thinking about any of the costovertebral joints up and down the spine can be like how you might think of any of the freely moving joints we have in our body. Well, kind of. Synovial joints also have a handful of subcategories. Throwback to my last episode, if you want to hear me wax philosophical about the category of categories. These are pretty cool, though. Basically, freely moving joints move in about six different ways and are named according to how they move. For example, your shoulder and your hip are synovial joints that are considered ball and socket joints. Like a trailer hitch on a truck, or like the sphere in Vegas appears to spin sometimes, if we want to stick with that theme. Costovertebral joints are classified as gliding or plane, P-L-A-N-E, not P-L-A-I-N joints, depending on who you're talking to. Gliding because they glide, or plane because their movement only happens in one plane. The surfaces of these bones that are involved are flat or mostly flat, so that when they move, they glide against each other in the same way the teacup ride at an amusement park does.

 

0:04:46.3 S1: You know, like, it slides out and around, but stays on a flat surface like that, but on a much smaller scale. This brings us to what a rib looks like and why. As bones go in our humble human anatomy, they are a bit odd. They curve all the way around the torso from the spine to the sternum. Well, with the exception of ribs 11 and 12, which have stopped short and just float there. So the ribs act as a cage and do a pretty great job at protecting the heart and the lungs. Good thing, too, those organs are just slightly important. But also our ribs and the muscles that move them are integral to breathing. Shocking, I know. But think about it. As the diaphragm and the intercostals and the other accessory muscles that pull air into our lungs contract, the ribs move in a way that is very similar to a bucket handle. So imagine 12 bucket handles on either side of your torso. Take a deep breath in and envision how they might rise up and down like handles on buckets, with the anterior and posterior connections having to stay in place. Only we are just a bit more complicated than a bucket.

 

0:05:54.6 S1: The costal cartilage that joins the anterior ribs to the sternum at the front is fascinating, but I want to focus on the costovertebral junctions in the back, because it's even more fascinating. And, well, that's typically where a rib goes out. Let's take a look at the thoracic vertebrae. It's got all the basic components, a vertebral body at the anterior aspect, a vertebral foramen where the spinal cord passes through, two transverse processes extending out laterally, and a spinous process projecting posteriorly. As always, there is a whole lot more to it than that, but let's stay focused. If you look at a vertebra from the side, there are three facets or relatively flat surfaces. This is where a rib makes itself at home. One on the more anterior aspect of the transverse process, called the costal facet, and two smaller ones on the posterior area of the vertebral body. One more superior and one more inferior, known as the demifacets. There are also superior and inferior articulating processes, which are where one vertebra sits atop another, but those are not the focus of this episode. A rib is going to join a vertebra at those costal and demifacets.

 

0:07:10.0 S1: But here's the cool part. Each rib has a head. This is the end of the rib at the back that joins with the vertebrae. It also, then, about an inch lateral from the head and on the inferior aspect, has a tubercle or a small bump. The head of the rib has two articulating surfaces and the tubercle has one. But in a twist of events, because anatomy likes to do that, the ribs and vertebrae are just slightly out of step. Let's put them together. Take, for example, the fourth rib. The tubercle of the fourth rib will join the articular surface of the transverse process of the fourth thoracic vertebra. The head of the fourth rib, though, hangs out between the bodies of the third and the fourth vertebrae. So the inferior facet of the head of the rib sits neatly on the superior demifacet of the fourth vertebral body, but the superior facet of the head of the rib fits nicely with the inferior demifacet of the third vertebral body. So the fourth rib has two connections to the fourth vertebra and one with the third vertebra. And as you know, all of these vertebrae are stacked one on top of the other, and all of these ribs are laying parallel to each other, shaping our thoracic cavities.

 

0:08:25.4 S1: And all of these joints are synovial joints, so they move. Individually, they may not move a lot, but together we've got the capability to do all sorts of things. The engineering of the ribs and the spine is spectacular. This trait of combining a lot of small movements to offer the potential of incredible flexibility is a very cool feature. Think Cirque du Soleil. And like I mentioned earlier, each of these joints is a synovial joint, so they are held densely together with many ligaments and fibrous capsules that are strong and offer a lot of support. But anytime you've got a high number of moving parts, the probability that something can go wrong is also high. We do a lot with our backs. We push them to crazy limits with anything from doing dishes to kettlebells, from sitting at a computer to bowling, from picking daisies to hauling furniture. We ask a lot of these intermingling parts. And so every once in a while, where a rib articulates with the vertebrae is going to deviate away from its intended space, or it goes out. The technical term for this is subluxation, and it can happen for a handful of reasons beyond heading to Vegas for a weekend.

 

0:09:37.7 S1: A rib can find itself a little sideways from a weakening or deterioration of the cartilage in the joint, similar to how a meniscus in the knee can wear down, an injury or surgery or more chronic issues like kyphosis, lordosis, or scoliosis. Needless to say, as always, a thorough health history is vital to treatment. When you see a client in this predicament, the key thing to keep in mind is that all the elements of a gliding synovial joint are there, similar to the carpals in the wrist or the acromioclavicular joint in the shoulder. It will indeed slip out of place if pushed too hard. It will get inflamed, it will create scar tissue to some degree, and it will cause a domino effect of pain responses if not taken care of properly. The less common elements to understand are that each rib has a neurovascular bundle associated with it. Nerve pain, it follows, is common and no fun. And most ribs, as we know, wrap around to the front of the body, making a slight displacement trigger muscle spasms along the tiny and layered intercostal muscles and or the other muscles of respiration and elicit that trademark pain response with each breath.

 

0:10:49.0 S1: As for hands-on approaches, these can vary depending on your client. I know I say that a lot, but I say it because it's true. Take health history evaluations seriously, ask detailed questions and gather as much information as you can. A rib out for one person may mean a team of experts, yourself included, to help manage the issue. Or it may mean releasing a couple of trigger points in the serratus posterior inferior, and they're good to go. I will say this a lot, too. Thank you for listening to my podcast. It is a little labor of love that sits in the corner of the social media universe that I happen to thoroughly enjoy. And without sounding too corny, the work you do is an extension of that love. Your passion for anatomy, soft tissue manipulation and helping people feel better is the foundation of this corner that is my whole world. I wish you incredible success in 2025, whatever that means to you.

 

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