9.8 Ribs R4–10
Patient sitting
Assume somatic dysfunction (S-T-A-R-T) is identified and you wish to produce cavitation at the costotransverse joint of the right sixth rib (Fig. 9.50).
4 Operator stance
Stand behind and slightly to the left of the patient with your feet spread. Pass your left arm across the front of the patient’s chest to lightly grip over the patient’s right shoulder region (Fig. 9.51).
5 Positioning for thrust
Translate the patient’s trunk to the right and away from you. This opens up the intercostal space between the sixth and seventh ribs (Fig. 9.52) and allows better access to the inferior aspect of the sixth rib. Place your right hypothenar eminence on the inferior surface of the angle of the sixth rib. The thorax is now rotated to the left (Fig. 9.53). Sidebending to the right is introduced to localise tension at the costotransverse joint of the sixth rib. The operator maintains as erect a posture as possible. Keep your right hypothenar eminence firmly applied to the sixth rib with your right elbow held close to your body (Fig. 9.54).
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