In Asthma, Asthma (Chronic), Dysautonomia, General Lung Health, Influenza (flu), Manual Medicine, Nervous System, Pneumonia


Osteopathic treatments can be extremely helpful to patients and the Rib Raising Technique is a great example of an effective one. This technique has been used for years to assist patients with lung or rib issues or to prevent pulmonary issues in higher risk patients. This technique can help decrease soft tissue and muscle tone of the thoracic spine. Restoring normal rib cage motion may improve blood flow and lymphatic drainage.

The Rib Raising Technique is a useful osteopathic treatment method that utilizes the ribs and surrounding muscles to open up access to the lungs. It is indicated for patient’s experiencing breathing issues. Osteopathic literature suggests this may include asthma, influenza (flu), and pneumonia. This treatment is used to relieve pulmonary congestion in patients as well as to relax the sympathetic nervous system. It is not indicated for acute issues like an asthma attack.

Relevant Anatomy

The rib cage serves to protect the soft tissues of the heart and lungs. The muscles around the rib cage are responsible for breathing. Sometimes breathing issues can be related to insufficient motion in the rib cage or thoracic spine. The rib angles, near where the ribs meet the spine, also cover the sympathetic chain ganglia; this is the part of the nervous system that regulates our fight or flight signals including rapid breathing and rapid heart rate.


The Rib Raising Technique serves as a simple osteopathic treatment that anyone can learn to help with relaxation or breathing issues. The purpose of the treatment is to facilitate rib head movement which in turn facilitates full rib movement. The process increases lymphatic outflow and helps modulate the sympathetic nervous system. This allows for more blood flow to the area and more air flow into the lungs. Additionally, the Rib Raising Technique will increase rib motion, may decrease pain in the area, normalize sympathetic tone, improve lymphatic drainage, and can improve antibiotic access to the lungs.

Step-by-Step Instructions

  1. The patient lies in a supine position (on his or her back) with the practitioner positioned at the patient’s side.
  2. The practitioner’s hands are positioned so that the finger pads are placed at the position of the rib angles. To find the rib angles, look for the spinous process or the middle bump on the spine; go just a bit toward the patient’s side where the ribs start to rise like a small hill. The finger placement at the rib angles is important as the rib heads approximate the thoracic sympathetic chain ganglia. The thoracic chain ganglia are responsible for the impact of this treatment on the sympathetic nervous system.
  3. The practitioner’s fingers are placed at the rib angles and wrists are placed onto the table so that gentle pressure and traction can be applied through the shoulders and elbows into the wrist.
  4. Traction the fingers a small amount in the lateral position or toward the patient’s side. Gently lift the ribs about ½ inch up off the table towards the ceiling, gently stretching the fascia (soft tissue) connecting the ribs to the vertebrae.
  5. Hold this position was waiting for the soft tissues to release. Release is different depending on the patient. Some release in 15 seconds others in 1-2 minutes.
  6. Once the soft tissue release occurs, the practitioner’s hands are repositioned to subsequent ribs. I like to start at the top of the rib cage and work my way down.

Practitioners are typically able to treat 5-6 ribs at one time, about one per finger.

Risks or Contraindications

Effects of rib raising on the autonomic nervous system: a pilot study using noninvasive biomarkers suggests that the Rib Raising Technique may over stimulate the autonomic nervous system which can result in an overactive sympathetic nervous system. As you’re practicing this technique, see if your patient appears more calm or more activated; the goal is for him or her to be more calm and relaxed.

Evidence Basis or Studies Supporting It

Many articles and studies suggest that the Rib Raising Technique is indeed beneficial in treating patients with asthma, influenza, and pneumonia.

Harold Magoun, Jr, DO states “According to statistics in Georgia W. Walter’s The First School of Osteopathic Medicine: A Chronicle, the estimated nationwide mortality rate for patients who received conventional medical care during a flu epidemic was 30% to 40%. By contrast, for 110,120 patients who received osteopathic care during this epidemic, the mortality rate from influenza was 0.25%”. Furthermore Dr. Magoun states that he has personally used the rib raising technique in post-operative patients and believes that it prevented the development of postoperative pneumonia.

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