3 Important Reasons To Assess Rib Angle—DRA, Posture & More
By: Becky Paulson, PT, DPT
Let’s talk about rib angle.
It all comes back to the diaphragm, which is very important for the health of the pelvic floor. Why? The diaphragm sits in the bottom of the rib cage, similar to a dome. The pelvic floor sits right underneath in the pelvis. Together, when the diaphragm goes through its range of motion, it pushes the pelvic floor to go through its full range of motion.
1. Diastasis Rectus Abdominis
Now, let’s imagine that you’ve just had a baby. You’ve likely experienced rib flaring as a result of your body’s natural instinct to push the ribs up and open to make room for baby. As a result, you may end up with a wider rib angel. When your infrasternal angle (the angel between the two rib cages) is widened above 90 degrees, it’s going to create a lot more tension through the anterior abdominal wall.
After childbirth, if that anterior abdominal wall doesn’t heal properly, is a diastasis recti (or separation of the abdomen, aka DRA). The wider the rib angle, the more prone you are to have that separation of the abdominal wall. Of course, the more separation between through linea alba (between the two muscle bellies), the less ideal the recruitment and the motor control of those abdominal muscles. In summary: after pregnancy, ribs may be flared, which leads to a higher probability of DRA.
2. Posture
The other reason we want to pay attention to rib angle is because it will affect the way that the rib cage stacks on tip of the pelvis. What we want, more or less, is for the rib cage to be right on TOP of the pelvis (so that the diaphragm and pelvic floor can do their thing today), but also for the sake of having a neutral spine.
3. Neutral Spine
In a neutral spinal position, the intervertebral discs that go between each vertebrae in your spine can tolerate 3x the compressive load under neutral than they can out of neutral. In other words: when the spine is stacked ideally, your discs are less prone to mechanical injury.
In summary, we want:
1. Rib cage on top of pelvis
2. Rib angle to be 90 degrees, more or less
3. Neutral spine
You Asked, We Answered:
Place both hands around patient’s most distal and lateral rib cage, feel for mediolateral excursion of rib cage upon inhale, manually compress ribs toward midline on exhale. Have patient repeat on themselves. This will build prop awareness of obliques attaching onto and influencing frontal plane rib positioning. For Sagittal plane rib flare, a great cue is to teach them to exhale on a neutral spine, keeping the rect abd relaxed and feeling for ant rib depression with exhalation. The 90 degree rib angle, however, applies to the frontal plane rib flare.
Not necessarily. For instance, if I release the RA muscles to the point they are able to approximate, but don’t ensure the patient is correctly using their external obliques, I’ve given an incomplete treatment. I’m more likely to try and fix the rib angle first, allowing the patient to coordinate their abdominals more functionally, then do more muscular release of RA to allow for form closure of muscle bellies.
With patient in supine, place both thumbs on the angle of the last non-floating rib as it attaches into the sternum. Tips of both thumbs should be heading towards xiphoid process. Check angle between thumbs.
Depending on the plane of motion in which they are flared your intervention will be different. It comes down to posture, figuring out what is weak, what is tight, and what muscles aren’t being utilized.
Check with your pelvic floor physical therapist to get assessed on these important bodily functions.
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