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Postural dysfunction/ Rib flare

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  • Postural dysfunction/ Rib flare

    Hey all, I’m curious if any of you have had to retrain your core so that your ribs don’t flare ? I’ve been on a new course of PT and was diagnosed with Rib flares associated with weak/dysfunctional rectus muscle. Truth be told, I have had this weakness for a long time, just no label. In essence, based on my glib understanding I took in as PT poked and prodded my stomach, that the rib cage is supposed to fit nicely on top of pelvic girdle. When the spine over extends backwards in effort to hold torso upright, the rib cage tilts upward, inactivating the core, weakening the spine, shortening the breath. It also can throw all hipflexor and other girdle muscles off, causing spasticity and pain. The solution is retraining the body to not over extend spine, engage core, put spine in neutral and THEN strengthen exercises. Have any of you gone through this? I’m struggling and it’s frustrating. At least now I intellectually understand my weakness but the cure seems out of reach. I’m sore and not doing much exercise wise.

  • #2
    Core weakness and low endurance has been my nemesis since I was diagnosed with MS. My frustration is that while my health care providers have overall been top notch, I am not confident my drs and PTs really understand the physiology behind my MS poor endurance, or understand the dramatic nature of it until they witness me walk on Gumby legs after limited activity. Although I am mobile, I recently struggled to do very simple strength building exercises 2x week at PT. Although PT is experienced MS PT, she seemed surprised by my sudden lack of endurance (Gumby legs) during session and the very low limits of my strength. We were both disappointed in my body.

    Curious about core strength in MSers I found a 2017 study , which stated that core weakness in MSers had not been previously compared to healthy controls before that 2017 study!. The study found (not surprisingly) that “ambulatory patients with MS with low EDSS scores had appreciably lower performance on endurance and strength tests of core muscles compared with a matched control group.” In particular, the lateral flexor group, the external and internal obliques, and the rectus abdominis during walking were examined. The findings “suggested that patients with MS use compensatory mechanisms during walking to maintain balance and posture. These strategies were likely to result in increased muscle energy cost and early fatigability.” Interestingly, the study notes Core stabilization “involves coordinated stabilization of the lumbo-pelvic-hip complex via active (muscles) and passive (inert ligaments and capsules) components.” And this kinetic core action, which gives “stability and strength are important components to maximize balance”. Thus, a balance disturbance may due to poor core stabilization. Lower Endurance and Strength of Core Muscles in Patients with Multiple Sclerosis, Int J MS Care. 2017 Mar-Apr; 19(2): 100–104,

    Anyone out there have suggestions or tips on ways that you were able to improve your core strength? I’m currently too weak per PT to stabilize core sufficiently to properly perform exercises that are unilateral for legs (bike, stairs, marching).


    • #3
      I don't know what your limitations look like and I am certainly not trained in PT or anything close, but wonder if doing seated, simple balance exercises would help activate your core muscles. At the MS Achievement Center we do a seated exercise with both arms out to the side, bending forward, backward and side to side. Then change the arm position to hanging down at your sides and repeat the same movement. Finally change the arm position to being extended directly in front of you, parallel to the floor. Nothing dramatic. Kind of looks like gentle rocking but with intention, returning to an upright posture with proper mechanics.


      My Two Numb Feet - An MS Diary


      • #4
        Thanks Livwell, your advice is very similar to what my PT did to modify my workout.....essentially core bracing lying flat on floor and moving arms separately or legs together. It’s Really modified crunches with optional arm movement. I am mobile without a cane. It’s my core that is weakest. So frustrating. Moving my legs separately causes my pelvis/ girdle to be unstable and fatigue and lack of endurance to sack me. I think the focus of my exercises are the same as your gentle rocking, focusing on posture and mechanics. Let’s hope this does the trick.