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Letters to the Editor  |   October 2010
Effects of Rib Raising on the Autonomic Nervous System: A Pilot Study Using Noninvasive Biomarkers
Author Affiliations
  • Harold I. Magoun, Jr, DO, FAAO, FCA
    Englewood, Colorado
Article Information
Osteopathic Manipulative Treatment
Letters to the Editor   |   October 2010
Effects of Rib Raising on the Autonomic Nervous System: A Pilot Study Using Noninvasive Biomarkers
The Journal of the American Osteopathic Association, October 2010, Vol. 110, 608. doi:10.7556/jaoa.2010.110.10.608
The Journal of the American Osteopathic Association, October 2010, Vol. 110, 608. doi:10.7556/jaoa.2010.110.10.608
To the Editor:  
It is discouraging to see the traditional osteopathic concept of rib raising diluted in the original contribution by Kristie Grove Bridges, PhD, and coauthors1 published in the June issue—especially in light of the American Osteopathic Association's march away from traditional concepts of osteopathy. 
There is no question that rib raising affects the sympathetic nervous system. However, the well-established rib raising technique has historically been done not to modulate the sympathetic nervous system, but to relieve pulmonary congestion in patients with pneumonia or influenza. The most outstanding example of this use of rib raising—as well as of the thoracic lymphatic pump—occurred during the influenza epidemic of 1917-1918. According to statistics in Georgia W. Walter's The First School of Osteopathic Medicine: A Chronicle,2 the estimated nationwide mortality rate for patients who received conventional medical care during this 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%. The beneficial results from rib raising in cases of respiratory congestion are not mentioned in the article by Dr Bridges and her colleagues.1 
Furthermore, the photograph on the cover of the June JAOA does not show the proper application of rib raising. To properly apply this technique, the operator stands beside the supine patient, takes the patient's arm on that side, holds it in his or her cephalad axilla, and places the fingers of both hands under the rib angles. Then, as the operator raises the ribs, he or she leans toward the patient's head, using the pectoralis major and the serratus anterior to elevate the rib cage, enhancing the action of his or her fingers. 
The late Walter Mill, DO, and I interned together at Rocky Mountain Osteopathic Hospital in Denver, Colorado, in 1950-1951. During our internship, we treated each surgical patient with rib raising every day—and we did not have a single case of postoperative pneumonia. With conventional medical care, postoperative pneumonia still occurs. 
Henderson AT, Fisher JF, Blair J, Shea C, Li TS, Bridges KG. Effects of rib raising on the autonomic nervous system: a pilot study using noninvasive biomarkers. J Am Osteopath Assoc. 2010;110(6): 324-330. http://www.jaoa.org/cgi/reprint/110/6/324. Accessed August 12, 2010.
Walter GW. The First School of Osteopathic Medicine: A Chronicle. Philadelphia, PA: The Thomas Jefferson University Press; 1992: 96.