The purpose of this case report was to describe the observation of the manipulation of the fourth rib followed by the reproducible, rapid return of heart rate to normal in a patient with paroxysmal supraventricular tachycardia.


A male patient had paroxysmal supraventricular tachycardia. He was evaluated using standard methods of palpation. He was followed over a 6-year period.


The patient was treated during episodes of supraventricular tachycardia (SVT) with instrument-assisted manipulation of the fourth rib without treatment of any other segments. Tachycardia was eliminated after rib manipulation within less than 2 minutes. Over a 6-year period, effective control of episodes of SVT was consistently achieved associated with manipulation of the fourth rib.


This case study is suggestive of a relationship between SVT and misalignment of the fourth rib. Controlled studies are necessary to validate this observation.

J Manipulative Physiol Ther. 2008 Jun;31(5):389-91. [PMID:18558281]

Author information: Julian MR. Private practice, Reston, VA 20191, USA.

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