6
Chapter
The basic exercises
- Basic exercises for the thoracic cage and ribs 2. Basic exercises for the thoracic cage and ribs
- Basic exercises for the thoracic cage and ribs 2. Basic exercises for the thoracic cage and ribs
- Basic exercises for the thoracic
cage and ribs
There are 12 pairs of ribs: the upper seven ribs are
the true ribs, whereas the eighth, ninth, and tenth
rib are the false ribs, and the 11th and 12th ribs are
the floating ribs. All ribs articulate with the thoracic
vertebrae. The cartilage parts of the true ribs artic-
ulate with the sternum. The cartilage parts of the
false ribs are connected together and to the cartilage
part of the seventh rib, therefore they are indirectly
connected to the sternum. There is no connection
with the floating ribs. The cartilage parts of the ribs
are important for elasticity of the thorax, and so it
is important to stretch the transverse thoracic mus-
cle connecting the sternum and the ribs.
The ribs move specifically with the breath. With
inhalation the upper two ribs move forward and
up, whereas the lower ribs flare outwards, and the
middle ribs combine these movements. The upper
sternum moves upwards and forwards, and the
lower sternum mainly upwards. During exhalation
these movements are passively reversed.
The basic exercises have been selected to mobi-
lize all these structures. The supported bend-
ing exercises forwards, backwards, and to the
sides in particular stretch the intercostal muscles
and improve the mobility of the joints with the
ribs. Stretching of the front of the upper tho-
rax is also important, as it is too short in many
patients (Roth 2009). To target the movements
specifically at the ribs it is essential to maintain
a neutral lumbopelvic position. The elasticity of
the thorax and the quality of breathing can be
maintained or even improved with age. When the
thorax is expanded more alveoli in the lungs can
also expand. This increases the surface for the
exchange of oxygen and carbon dioxide, with the
result that all the bodily systems receive a better
oxygen supply.
Rib restrictions may be a cause of shoulder prob-
lems. To make the rib exercises more effective, it is
important to maintain a neutral lumbopelvic posi-
tion, so that the movements do not dissipate into
the lumbar spine. Many rib exercises can be slightly
modified to work on the thoracic spine. The rib
exercises also work on the diaphragm, particularly
if combined with breathing well. One of the best
diaphragmatic exercises is laughing. Positive effects
of laughing include:
• releasing muscle tension
• stimulating brain activity
• improving blood circulation
• long-term decrease in heart rate, after a short-
term increase
• deeper breathing with an associated
improvement in oxygen exchange (Titze &
Eschenröder 2003).
If the patient has chest pains, think of heart
problems; if the pain is in the costovertebral joints,
think of lung problems. The thorax is particu-
larly vulnerable to emotional stress. If the exer-
cise therapy is generating an emotional reaction,
the patient should be referred to a counselor for
psychotherapeutic investigation and treatment if
necessary.
Exercise 2.1: Communicating with
your breath
Aims: training awareness of the breathing move-
ment; mobilizing the costovertebral and costosternal
joints.
- Lie on your back in a comfortable position.
- Use support for your legs if necessary, so that
your abdomen and lumbar area are relaxed; use
support for your head so that the throat and
neck are relaxed.
- Place your hands on the costal arches
(Figure 6.36).
- Breathing should be very subtle and fine,
with no resistance; feel the movement with
inhalation and exhalation for 3–5 breaths;
the hands are only feeling, not guiding, the
movements.
Figure 6.36
