muscle energy of the ribs muscle energy of the ribs "muscle energy of the ribs" is an osteopathic manipulative medicine technique used to treat dysfunctional ribs. when treating each rib with muscle energy, assistance with local muscles is elicited as follows: ribmusclevisual referencemethod of activation 1anterior and middle scaleneslook straight ahead and lift head anterior 2posterior scalenesturn head 30 degrees away and lift anterior 3-5pectoralis minorpush ipsilateral elbow towards opposite asis. 6-8serratus anteriorpush arm anteriorly 9-11latissimus dorsipatient pushes the ipsilateral arm into adduction against resistance. 12quadratus lumborumpatient pushes the ipsilateral arm into adduction against resistance.