This week’s post is about the all too common issue of rib flaring. Rib flaring is an issue because it shows that there is typically a motor control problem in the individual stemming from both a mobility limitation and a lack of core stability.
Someone presenting with a rib flare is likely to have a thoracic spine extension limitation as well as anterior rib cage tissue restriction. Due to these limitations, an individual would appear to have very rounded shoulders and to be slouching over if they were to walk around like this. To avoid looking like this, the individual will flare their ribs forward/upward and go into a more upright posture (extension) by moving through their lower Tspine/Lspine and most commonly TL junction.
This is often combined with an anterior pelvic tilt, which can be known as “Open scissor syndrome”. When this occurs the it can cause an array of problems, but the most important one being the inability for the diaphragm to descend properly during inhalation. As we know, diaphragmatic breathing is always a major topic of discussion in the rehab world, so it is important we address potential issues that may be contributing to the diaphragm not functioning properly. It is a little bit of a chicken or the egg scenario. Did a dysfunctional diaphragm lead to an open scissored postural/movement pattern? Or did dysfunctional movement patterning lead to a dysfunctional diaphragm? Either way both need to be addressed in order to fully help the problem, but this post will focus on the postural/movement issue side of the coin.
As discussed earlier, this movement issue could very likely lead to lower back discomfort/pain/injury, but is also commonly present in shoulder/thoracic/cervical complaints and a contributor to lower body dysfunctions as well. So when people talk about treating proximal to distally, this is what they mean.
The areas that need to be addressed with a rib flare are:
- Thoracic spine extension
- Pectoral/lat/tricep length (overall shoulder mobility though really)
- Motor control exercises
- Anterior core strength
- Diaphragmatic breathing (future post)
Thoracic Spine extension:
- As discussed a few weeks ago. This exercise is great for regaining some level of Tspine extension or using a double tennis ball for more specific restrictions. Notice the focus on not flaring the ribs, this exercise can’t just be done by going through the motions. A little rib flare is okay as we are retraining a very stiff area to move and it will take time to be perfect. Also note that it just isn’t rolling up and down like many people do, but focussed extensions with a little bit of rolling.
2. Here is an exercise that can also be beneficial in mobilizing the thoracic spine into extension.
The key here is to perform mobility exercises of these 3 like you normally would, but with a specific focus on not letting the ribs flare upwards. A lot of times while working on these tissues people will just flare their ribs or shred open their anterior shoulder capsules. Couldn’t find a great video to demo exactly what I like, but this is an overall good shoulder mobility circuit, but need to keep the rib position in mind!
Motor control exercises:
These are important to incorporate as it re-educates the individual as to where they should be moving from. Now that we have opened up some areas of restriction the body can take a new path of least resistance, which before was the TL junction and now is the chest/thorax as desired. The drill I like to start people with is foam roller snow angels as demoed below. They can also do this exercise with a dowel and do over head raises like a snatch while maintaining good rib position.
Anterior core strength:
Like the other categories there are many different ways to address the above issues more so than what is posted. Here are three anterior core strength exercises (in order of progression) that can be incorporated into a program.
Again, many different ways to skin the cat, but thought it was a good topic to bring up as it is very important in the grand scheme of movement health. Looking forward to hearing everyones thoughts and feel free to share any tips and tricks you use to address the issue!