COMLEX Osteopathic Manipulative Medicine (OMM) Practice Exam

Rib motion during breathing has two classic patterns. The pump handle group uses the upper ribs, which have a more vertical orientation; when these ribs elevate, their anterior portions move forward and upward, increasing the front-to-back (anteroposterior) diameter of the chest. That’s why the statement that pump handle ribs are the first through fifth ribs and move anterior-superior is true.

In contrast, the bucket handle group involves ribs six through ten, whose movement mainly increases the width of the chest by lifting the lateral aspect of the ribs, expanding the transverse diameter. They move outward (laterally), not medially, and not posteriorly-inferiorly.

So the accurate pairing is that pump handle ribs are the first five and move anterior-superior, while bucket handle ribs are the lower ribs (often cited as six to ten) and move laterally/outward.