What are the main types of chest wall injuries. How is costochondritis diagnosed and treated. What are the symptoms of manubriosternal junction injuries. Can costal arch shape affect chest pain conditions. How do costosternal and costochondral junctions differ anatomically.

Understanding the Anatomy of the Chest Wall

The chest wall is a intricate structure composed of various elements working together to protect vital organs and facilitate breathing. Its complexity stems from the interconnection of bones, cartilage, muscles, and ligaments. To fully grasp chest wall injuries and conditions, it’s crucial to understand its anatomical components:

• Bony skeleton (ribs, sternum, and vertebrae)
• Multiple joints (between sternum and vertebrae, ribs and costal cartilage)
• Ligamentous and tendinous attachments
• Muscular structures

These various “junctional” areas are often susceptible to injury, inflammation, and damage. Let’s explore some key anatomical regions and their associated conditions.

Manubriosternal Junction: A Crucial Connection

The manubriosternal junction is where the manubrium sterni (top of the sternum) connects with the body of the sternum and the second rib. This fibrocartilaginous joint is easily palpable and often appears as a slightly raised prominence due to the angle at which the manubrium meets the sternum (known as the sternal angle).

Symptoms of Manubriosternal Junction Injuries

Injuries to the manubriosternal junction can occur through direct impact or indirectly through acceleration-deceleration forces. Common symptoms include:

• Severe pain
• Tenderness
• Swelling
• A noticeable “step” in the area

Is a chest CT scan necessary for manubriosternal junction injuries? In cases where such an injury is suspected, a chest CT scan is indeed required for accurate diagnosis and to assess for other potential chest injuries.

It’s worth noting that inflammation in this area can also develop more gradually, leading to increasing pain, discomfort, and occasionally local heat or swelling. In these cases, a high clinical suspicion and radiological investigations such as an MRI may be necessary for proper diagnosis.

Costosternal and Costochondral Junctions: Where Ribs Meet Cartilage

Understanding the differences between costosternal and costochondral junctions is crucial for diagnosing and treating chest wall injuries.

Costosternal Junction

The classification of ribs is based on their costosternal attachments:

• True ribs (1-7): Costal cartilage attaches directly to the sternum
• False ribs (8-10): Costal cartilage attaches to the cartilage of the next superior rib
• Floating ribs (11-12): No costal cartilage connection

Costochondral Junction

This refers to the joint between the ribs and the costal cartilage at the front of the chest, typically lateral to the sternum. The upper 8 costochondral junctions form hyaline cartilaginous joints, similar to the first rib-sternum connection (synchondrosis). The 9th and 10th rib costochondral junctions are fibrous.

What are the main types of pain associated with costosternal and costochondral junctions? The primary causes of pain in these areas are:

1. Acute trauma from direct or indirect injury
2. Inflammation

Costochondritis and Tietze Syndrome: Inflammatory Chest Wall Conditions

Costochondritis and Tietze syndrome are two inflammatory conditions affecting the chest wall that can cause significant discomfort and concern for patients.

Costochondritis

Costochondritis is characterized by inflammation of the cartilage junctions of the sternum or ribs. It can cause localized chest pain that may mimic more serious conditions.

Tietze Syndrome

Tietze syndrome presents with sudden chest pain and localized swelling at the junction of the sternum and ribs. While similar to costochondritis, the presence of swelling distinguishes this condition.

How can healthcare providers differentiate between costochondritis and more serious cardiac conditions? A thorough physical examination, patient history, and sometimes imaging studies are crucial in making this distinction. The reproducibility of pain with palpation is often a key indicator of costochondritis.

The Costal Arch: Structure and Variations

The costal arch, also known as the costal margin, forms the lower edge of the chest. It’s created by the costal cartilages of ribs 7 through 10. Understanding the anatomy and variations of the costal arch is important for diagnosing certain chest wall conditions.

Anatomical Variations

The shape of the costal arch can vary significantly between individuals. Factors influencing its shape include:

• Age
• Gender
• Obesity (particularly truncal abdominal obesity)

Does the shape of the costal arch affect the likelihood of developing certain chest wall conditions? While research is ongoing, there is evidence to suggest that variations in costal arch shape may influence the development of conditions such as slipped rib syndrome, particularly when the lower costal cartilages are not fully attached to the costal arch.

Diagnostic Imaging for Chest Wall Injuries

Accurate diagnosis of chest wall injuries often requires advanced imaging techniques. The choice of imaging modality depends on the suspected injury and the specific anatomical region involved.

CT Scans

Computed tomography (CT) scans are invaluable for diagnosing acute injuries, such as manubriosternal dislocations or costochondral fractures. They provide detailed 3D reconstructions of the chest wall, allowing for precise visualization of bony and cartilaginous structures.

MRI

Magnetic resonance imaging (MRI) is particularly useful for assessing soft tissue injuries and inflammatory conditions. It can reveal subtle changes in the cartilage and surrounding tissues that may not be visible on other imaging modalities.

Challenges in Imaging the Costal Arch

Why is the costal arch difficult to image? The costal arch, being primarily composed of cartilage, presents unique challenges for imaging. Traditional X-rays and even CT scans may not provide optimal visualization of this structure. Advanced MRI techniques or ultrasound may be necessary for a comprehensive evaluation of the costal arch.

Treatment Approaches for Chest Wall Injuries

The management of chest wall injuries varies depending on the specific condition, severity, and individual patient factors. Here are some general approaches to treatment:

Conservative Management

Many chest wall injuries, including mild cases of costochondritis, can be managed conservatively. This may include:

• Rest and activity modification
• Ice or heat therapy
• Over-the-counter pain medications
• Physical therapy exercises

Pharmacological Interventions

In cases of more severe pain or inflammation, healthcare providers may recommend:

• Prescription-strength NSAIDs
• Topical anti-inflammatory medications
• Short-term use of oral corticosteroids

Interventional Procedures

For persistent or severe cases, interventional procedures may be considered:

• Local anesthetic and steroid injections
• Nerve blocks
• Regenerative medicine techniques (e.g., platelet-rich plasma therapy)

What factors determine the appropriate treatment approach for chest wall injuries? The choice of treatment depends on several factors, including the specific diagnosis, duration and severity of symptoms, patient age and overall health, and response to initial conservative measures.

Prevention and Long-Term Management of Chest Wall Conditions

While not all chest wall injuries can be prevented, there are strategies to reduce the risk and manage long-term symptoms:

Ergonomic Considerations

Proper posture and ergonomics can help prevent strain on the chest wall structures:

• Maintaining good posture during daily activities
• Using ergonomic workstations and tools
• Avoiding prolonged periods of poor positioning

Exercise and Strength Training

Developing core and chest wall strength can provide support and stability:

• Targeted exercises for the chest, back, and core muscles
• Low-impact cardiovascular activities to maintain overall fitness
• Stretching routines to improve flexibility

Lifestyle Modifications

Certain lifestyle changes can contribute to long-term chest wall health:

• Maintaining a healthy weight to reduce stress on the chest wall
• Quitting smoking to improve overall respiratory health
• Managing stress through relaxation techniques

How can patients best manage chronic chest wall pain? A multidisciplinary approach is often most effective, combining medical management, physical therapy, and lifestyle modifications. Regular follow-up with healthcare providers and adherence to prescribed treatment plans are crucial for long-term success.

Understanding the complex anatomy of the chest wall and the various conditions that can affect it is essential for both healthcare providers and patients. By recognizing the signs and symptoms of different chest wall injuries and implementing appropriate diagnostic and treatment strategies, we can improve outcomes and quality of life for those affected by these conditions. Ongoing research in this field continues to enhance our understanding and refine management approaches, offering hope for even better care in the future.

Complex Chest Wall Injury | Rib Injury Clinic

The Chest wall is a complex structure consisting of a bony skeleton with multiple joints between the sternum (breastbone) and vertebrae (spine), and between the bony parts of the ribs and the costal cartilage part of the rib cage at the front of the chest between the ribs and sternum. In addition, there are multiple ligamentous, tendinous and muscle attachments. Many of this ‘junctional’ areas can be sources of injury or prone to inflammation and damage.

Annotated image of a CT 3D reconstruction showing the (a) anterior and (b) lateral chest wall structures.

Manubriosternal junction

Refers to where the manubrium sterni (top of sternum) and body of sternum joint together with the 2nd rib. It is a fibrocartilaginous joint and easily palpable as an often raised prominence as the manubrium joins the sternum at a slight angle (referred to as the sternal angle).

Symptoms

The maubriosternal junction can be injured through a direct blow or indirectly through acceleration-deceleration compressive-decompressive type of injury (for example during a front on collision in a seat belted passenger). This results in a dislocation and can lead to severe pain, tenderness and swelling (a step) in the area. If such an injury is suspected a chest CT scan is required to diagnosis and to assess for other chest injuries.

A more insidious problem is the development of localised inflammation in the area leading increasing pain, discomfort and occasionally the area can be hot or swollen. A high clinical suspicion is regarded and together with radiological investigations such as an MRI.

Manubriosternal junction or Sternal angle (highlighted with red circle)

Costosternal junction

Ribs can be classified on the basis of their costosternal attachments: true ribs if their costal cartilage attaches directly to the sternum, false ribs if their costal cartilage attaches to the cartilage of the next most superior rib (as part of the costal arch), and floating ribs if there is no costal cartilage connection. Ribs 1–7 are true ribs, ribs 8–10 are false ribs, and ribs 11 and 12 are floating ribs.

Costochrondral junction

Refers to the junction or joint between the ribs and the costal cartilage at the front of the chest typically away or lateral to sternum. Like the costosternal joint, the upper 8 costochondral junctions forms a type of joint (hyaline cartilaginous joints) which are more like the junction between the first rib and sternum (synchondrosis) so form a tough type of joint very little movement. The 9th and 10th rib costochondral junctions are fibrous.

Symptoms

The main types of pain seen are due to either injury from a blow or indirect trauma and inflammation.

Illustration of Costosternal and costochondral junctions

Acute trauma to costosternal / costochondral joint from an injury to the front of the chest such as a direct blow, or indirectly. It can be quite minor such as a twisting injury whilst lifting or even a violet cough or sneeze. It is typically associated with sudden and severe pain in the area next to the breastbone at the level of the injury or further away from the sternum with costal cartilage meets its rib connection. The pain is likely to be tender over the spot, and can be associated with swelling, even bruising and occasionally a sense of movement or even ‘popping’ caused by subluxation (partial disconnection of the junction) or dislocation (complete disconnection).

Chest CT scan following fall of an acute costochondral facture (red circle)

Costochondritis (Inflammation of the cartilage junctions of the sternum or ribs) and Tietze syndrome (sudden chest pain and localised swelling at junction of the sternum and ribs) are inflammatory causes of sternal and chest wall pain, see Costochondritis and other inflammatory problems.

Costal arch

Costal arch or margin refers to the lower edge of the chest formed by the bottom edge of the rib cage. It is formed by the 7th to the 10th rib costal cartilages to create the costal arch. Interchrondal junctions or articulations are joints between costal cartilage forming the costal arch and the lower ribs. The costal arch because it is made of cartilage is actually quite difficult to image.

CT reconstruction and rendering of the costal cartilage (in blue) showing the costal arch or margin

The costal arch varies in shape with narrow (left) and broad wide costal arches (right). Age, gender, obesity (particularly truncal abdominal obesity (pot belly) influence the shape

There appears to be some variation between how the costal cartilage of the lower ribs particularly the 9th and 10th ribs articulate with the costal arch. If the lower costal cartilages are not fully attached to the costal arch it may lead to a condition called slipped rib syndrome.

The shape of the lower chest created by the costal arches is quite variable with variation seen. Rib flare refers to a particular type of costal arch that is prominent particularly on the left and is often but not always associated with pectus chest wall deformities.

Bilateral rib flare showing a right sided costal arch with a dip (or deficit) (arrow in green) where the lower costal arch has not formed completely. In this case it was associated with slipped rib syndrome. NOTE: Incidental pectus Excavatum.

Bilateral rib flare in a young man with no symptoms or other issues

Symptoms

The main types of pain seen are due to either injury from a blow or indirect trauma and inflammation.

Acute trauma to costal arch from an injury to the front of the chest such as a direct blow, or indirectly. As with costosternal and costochondral injuries it can be quite minor such as a twisting injury whilst lifting or even a violet cough or sneeze. It is typically associated with sudden and severe pain in the area of the costal arch. The pain is likely to be tender over the spot, and can be associated with swelling, even bruising and occasionally a sense of movement or even ‘popping’ or even a ‘step’ caused by subluxation (partial disconnection of the junction) or dislocation (complete disconnection).

Old fracture of the costal arch leaving a ‘lump’ and chronic pain (red circle)

Left costal arch with excision of 9th rib tip (with costal arch illustrated in grey)

Slipped rib syndrome refers to pain of the lower costal arch caused by abnormal movement of the lower costal cartilage (typically the 8th, 9th or 10th rib tips). It’s likely to be associated an abnormal or ‘lose’ connection between articulations of the costal arch which then allows movement leading to irritation and pain. See Slipped Rib Syndrome.

Xiphersternal junction

At the bottom of the breastbone (sternum) is a further junction between the bony bottom of the sternum and the cartilaginous xiphisternum or xiphoid process. Xiphersternal junction is a type of joint with very little or no movement.

Symptoms

Pain caused by the xiphoid process is called xiphoidalgia. Xiphoid process pain occurs for varying reasons but is often related to minor trauma to the area, over exercise (such as abdominal crunches) or can become more prominent following excessive weight loss. Local inflammation can also occur. See Costochondritis and other inflammatory problems.

Chronic xiphersternal junction fracture (red circle) following direct blow leading to a lump and chronic pain on exertion

Treatment

Complex chest wall injuries can be treated either conservatively involving rest, restrictions of activities and painkillers, or through some form of intervention including targeted physical therapy, trigger point injections or a variety of surgical options. See Treatments.

Rib Injury – Tufts Medical Center Community Care

What is a rib injury?

A rib injury is a bruise, strain, break, separation, or irritation of one or more of the ribs in your chest. It can also be an injury to the tissue called cartilage that attaches the top 10 ribs to the breastbone.

What is the cause?

A fall or direct blow to the chest may bruise, strain, or break the ribs or injure the rib cartilage. Breaks usually happen in the outer curved part of the rib cage.

When a rib tears away from the cartilage, the injury is called a costochondral separation. It may result from a blow to the ribs, a fall, or landing hard on your feet. It might even be caused by forceful coughing or sneezing.

Irritation of a rib is called costochondritis. It may be caused by an infection or repeated coughing, or by overuse, like from rowing or heavy lifting. Sometimes the cause is not known.

What are the symptoms?

A rib injury causes pain and tenderness in the ribs. You may have pain when you breathe, move, laugh, or cough.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history. Your provider will examine your chest and listen to your lungs. Tests may include X-rays or other scans.

How is it treated?

Rib injuries can be painful and make it hard to cough or take a deep breath. Your healthcare provider may prescribe pain medicine.

You may need to do breathing exercises while you heal to prevent lung problems.

Rib injuries usually heal without surgery. Bruised ribs or a costochondral separation usually take 3 to 4 weeks to heal. Broken ribs take 6 to 8 weeks to heal.

How can I take care of myself?

To relieve pain and help the injury heal:

• Rest.
• Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the injured ribs every 3 to 4 hours for up to 20 minutes at a time.
• Take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
  • Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don’t take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.
• If coughing is painful, holding a pillow against your chest may help.

Follow your healthcare provider’s instructions. Ask your provider:

• How and when you will hear your test results
• How long it will take to recover
• What activities you should avoid, including how much you can lift, and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

How can I help prevent rib injury?

Ribs are often injured in accidents that are not easy to prevent.

In contact sports like football it’s important to wear the proper protective equipment.

Adult Advisor 2015.1 published by RelayHealth.
Last modified: 2014-10-21
Last reviewed: 2013-07-19

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Copyright ©1986-2015 McKesson Corporation and/or one of its subsidiaries. All rights reserved.

Sprain of the muscles and ligaments of the chest symptoms and treatment in Moscow

The structure of the chest is represented by tendons and 2 main muscle groups. Most often, it is not the ligamentous elements that are subject to stretching, but the muscle tissues. In the chest, they are responsible for breathing, bringing the hands to the body, their dilution and the functions of rotation of the hands.

Highest risk area – major and minor muscle support of the chest.

1. The large muscle is located closer to the skin, it is “attached” by strong tendons to the ribs and collarbone. Its stretching often occurs when lowering heavy loads (including a barbell), performing a bench press. In 10% of cases, the chest suffers due to a blow to its area (stretching of the muscle due to the applied load).
2. Small muscle corset located closer to the bone, attached to the shoulder blade and ribs. Its stretching can occur when lifting your own body weight on your hands.

How can you tell a sprain from an adjacent injury?

Such chest injuries have a number of features in terms of their manifestation. Pain in this case is not an indicative sign, since when stretched, it can come later. In the very first seconds after stretching, discomfort is felt in the chest and retrosternal cage, a feeling of tension may appear. Discomfort is exacerbated when you try to bring your hand closer to the chest.

30-120 minutes after sprain, a hematoma effect may appear in the area of ​​injury. Puffiness is usually not observed except when the athlete consumes steroid cocktails.

Risk group

Such additives, if taken uncontrolled, increase the risk of chest distension. This also includes the use of corticosteroids.

• Steroid cocktails increase the muscles in the chest with a simultaneous decrease in the elasticity of the fibers of the supporting tissue. There is a disproportion in which less force on the chest is required for stretching.
• With corticosteroids, the situation is simpler – these drugs cause swelling, increasing the risk of sprains.

For these reasons, detailed information before making a diagnosis for pain in the retrosternal space and chest becomes one of the key conditions. At the second level of diagnostics, functional tests and palpation of the chest are carried out. A hardware study may also be required – ultrasound, x-ray control to exclude ruptures during stretching, MRI.

Help in case of injury to the soft supporting tissues of the chest

Immobilize the body immediately after detecting signs of stretching. The hand should be brought as close as possible to the body (it can be fixed in a sling). Apply cold to the damaged area of ​​the chest (for 25-30 minutes every 2-3 hours).

Since sprain is a type of mechanical damage, as such, directed therapy is not carried out for it (an exception is a tear or rupture of the connective tissues of the chest). The complex of actions for recovery after stretching is usually reduced to three goals.

1. Minimizing the risk of further damage to the chest and more. Stretching in the sternum often provokes muscle spasms in the abdomen and neck.

2. Fast recovery. To do this, carry out warming procedures, massage, use acupuncture techniques. It is possible to work with the chest only after the pain effect has gone.
3. Search and treatment of the processes that caused muscle spasm (it is this that gives a painful effect when stretched), if the chest injury is caused not by training, but by other conditions – an unbalanced diet, steroids, medications.

In case of severe pain, the traumatologist will prescribe pain blockades (injections) for calving of the chest. To avoid further injury, the doctor may recommend the use of a supportive sling.

Funnel deformity – the influence of nutrition and sports

Table of contents

1. Suggested exercise program
   With malformations (the so-called malformations), which is funnel chest deformity, the only means of correcting the defect is surgical intervention.

   – Therapeutic physical training, massage and sports help only with deformations resulting from external mechanical impact.

   – Vitamin and hormonal preparations can help if the deformity is caused by a metabolic or general hormonal development disorder

   However, this does not mean that sports are excluded as an ineffective method. Moreover, sports, massage, gymnastics are a necessary (but not sufficient!) Attribute of treatment, they are necessary for the complete recovery of the patient.

   The use of the Nass method in the correction of pectus excavatum allowed the patient to play sports during the recovery period, which made the correction of deformities even more effective. Physiotherapy exercises and massage are shown during the period when the plate is installed to the patient: this contributes to the development of muscles, as well as the formation of correct posture. Sufficient attention to physical exercises allows you to achieve excellent results in the correction of pectus excavatum.

   Chest deformity exercises

   According to statistics, for every 1000 children 6-8 have congenital deformities of the chest. The cause of deformities of the chest is considered to be an abnormal growth of cartilage between the ribs and the sternum, which arches the sternum inward or outward. In the first case, the anomaly is called a funnel-shaped deformity (Pectus Excavatum), in the second – a keeled deformity (Pectus Carinatum). In some cases, these deformities can be effectively treated with non-invasive methods, including exercise therapy.

   As the muscles are trained, chest deformity can be reduced, or at least not worsened. In addition, intensive pumping, especially in the torso area, allows you to increase muscle mass and create a good cosmetic effect – the curvature becomes less noticeable.

   All physical exercises are aimed at solving the following problems:

   1. Increase the mobility and flexibility of the spine and chest.
   2. Stretch all shortened structures.
   3. Strengthen the muscles for a more amplitude movement of the chest.
   4. Restore normal posture.

   Exercises mobilize joint mobility, stretching the soft tissues around the sternum so that they do not interfere with the movement of the chest. In addition to the mobility of the articular-ligamentous apparatus, muscle tone improves.

   Stretching and mobilization exercises

   1. Stretching straight arms in a kneeling position.

   The patient is in a pose on bent knees, arms extended forward. Holding on to the Swedish wall at a height of 50-80 cm, slowly lower the upper body, and lead the shoulder blades towards the floor. You should feel a stretch in your anterior armpit and shoulder. Hold for 8 seconds (you can breathe deeply, increasing the stretch of the chest), then relax. Repeat 20 times. Such approaches should be done 4 times a day.

   The purpose of the exercise is to stretch all the anterior chest muscles, especially the pectoralis major muscle.

   2. Rotation of the upper body in a standing position.

   The patient becomes sideways to the wall. Put the hand closest to the wall on the wall at a level slightly above the shoulder. We rotate the pelvis in the opposite direction, while not taking our hand off the wall. The stretch should be felt in the front of the shoulder and upper chest. Hold 8 seconds. You can then relax and return to the starting position. Relax and continue on the other hand. Do 4 sets of 20 reps per day.

   This exercise gives the greatest range of motion of the thoracic vertebrae, allowing you to pull in different directions the ligaments, muscles and joints in the sternum.

   3. Upper torso flexion in sitting position.

   The patient is in a sitting position. Side bends are performed. When tilting to each side, the opposite arm stretches above the head in the direction of the slope. You should feel a stretch on the opposite side of your body. Hold the position for 8 seconds (at this time you can breathe deeply), return to the starting position. Repeat exercises 20 times 4 times a day. The purpose of the exercise is the same as in the second exercise.

   Strength training

   4, 5. Exercise with weights in the prone position.

   The patient is placed in the supine position. Place a polyurethane foam roller about 10 cm in diameter under your back. If using a roller is too painful, just lie flat. Stretch your arms back behind your head and grab them on the bar of the Swedish wall or on some heavy load at a distance of 10 cm from the ground. After that, take a deep breath and try to apply maximum effort, as if lifting the wall bar or load. Hold the position for 8 seconds, then relax. 10 such repetitions make up one series. You need to do 3 series 4 times a day.

   Purpose of the exercise:

   In this position, when the arms are fixed, the anterior chest wall rises, mainly due to the pectoral muscle. The maximum tension during the application of the lifting force causes the surrounding muscles involved in the breathing process to be mobilized. A roller placed under the back helps to expand and straighten the thoracic spine, correcting thoracic kyphosis.

   6. Stretching the upper part of the body, lying on the stomach.

   The patient lies on his stomach. Under the stomach, you can put 1-2 pillows. Hands behind your head. Legs can be fixed on the Swedish wall. Inhale deeply and raise your upper body, keeping your hands behind your head. bend over. Hold this position for 8 seconds, then relax. 10 such repetitions make up one series. You need to do 3 series 4 times a day.

   The purpose of the exercise is to strengthen the upper back muscles, to balance muscle strength. This helps to prevent thoracic kyphosis and maintain a beautiful posture.

   7. Push-ups.

   The patient lies on his stomach and begins to do push-ups. The easiest option is to lift only the torso, the more difficult one is to lift the whole body, and the most advanced option is to clap your hands in the upper phase of the push-up, lifting your hands off the floor. Start with the first option. If it comes out easy, move on to the next one. One series is 10 repetitions. After each series – rest. In total, you need to do 30 repetitions 4 times a day.

   The purpose of the exercise is the general strengthening of the muscles of the chest.