Fine Rib Nine

Now we are at the ninth rib. The ninth rib is a false rib and exhibits essentially the same effects as a lesion of the eighth rib. Marion Clark does very little writing on the ninth rib due to the similarities to the eighth rib (I will do the regular run down of associated structures though!).

The nerves associated with the ninth rib are: the anterior and posterior divisions of the ninth thoracic nerve, the sympathetic chain ganglia, the ninth thoracic sympathetic ganglion, the greater splanchic nerve, and the recurrent meningeal nerve.

The circulatory structures associated with the ninth rib are: the intercostal artery and vein, the mediastinal artery and vein, the azygos and hemiazygos vein, the bronchomediastinal lymphatic duct, and the thoracic lymphatic duct. As with the eighth rib, I will suggest that the connection of the ninth rib to the diaphragm may lead to effects in the phrenic arteries and veins, the descending aorta, the inferior vena cava, as well as much of the celiac trunk.

The muscles that attach to the ninth rib are: serratus anterior (depending on the patient it may end at the eighth rib), iliocostalis thoracis, iliocostalis lumborum, serratus posterior inferior, internal intercostal, external intercostal, internal oblique, external oblique, transverse abdominis, and the diaphragm.

The ninth rib provides an external landmark for the spleen (on the left) and the gallbladder (on the right). The ninth rib has the same visceral associations ( the stomach, liver, gall bladder, spleen, pancreas, and parts of the duodenum) as the eighth rib.

Commonly associated conditions are: herpes zoster, biliary colic, liver congestion (shared with the eighth), pleurisy and other respiratory disorders due to the diaphragm, affections of the small intestines, intercostal neuralgia, and girdle pain (not very common now as very few women regularly wear girdles anymore).

The principal (with principles) of the CAO, Robert Johnston, speaks about long diagonal torsions – essentially a mechanical line of strain from one shoulder to the opposite hip (click to read an excerpt of his current thesis project). It is very likely that many rib lesions can be corrected by dealing with the long diagonal torsion. I say this because short lever (directly on the rib) may not always be called for due to tenderness. With the false ribs the removal of the long diagonal torsion with the long lever may well remove the mechanical strains that perpetuate rib lesions. The principle is: treat from the base down and up, then from the centre out. The base is the pelvis and the centre is the spine. In principle you must balance the spine in all planes before going after the ribs or else the rib lesion will come back. The primary reason I am speaking about any of this is that the muscles available to correct the ninth rib do not seem as viable and do not provide as many movement options on the short lever and, as such, correcting the long diagonal torsion with a full body myo-articular (Body Adjustment) treatment may be more important than going directly to the ninth rib (or any other false rib for that matter). Stick to your principles people!

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One thought on “Fine Rib Nine

  1. Pingback: The Ninth Thoracic Vertebra | Classical Osteopathy in Ontario

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