Neck pain? First rib mobilization can fix that!
If you answer yes to any of the three questions below, you will need a first rib mobilization.
- Have you been experiencing neck pain?
- And an unexplainable shoulder pain?
- What about pain situated in your upper back?
Then you’re probably among the thousands of people who are suffering from a first rib injury.
If you’re suffering from an elevated first rib injury, you should know that you’re not alone. First rib dislocations are real. The first rib out of place is the number one cause of neck, shoulder, and upper back pain!
Due to the position and location of the first ribs, their attachment to the neck bones, and close proximity to the shoulders, the first ribs easily become stiff (also called immobilized first ribs). When that happens, people usually start experiencing neckaches and shoulder pains; others also complain of upper back pain.
First rib mobilization is a technique used to improve the motion of the first rib, which is located at the top of the rib cage. The first rib can become subluxated or partially dislocated from its normal position due to various factors, such as trauma, muscle tension, and repetitive overhead movements, and even extensive cough from allergies.
First, rib mobilization can be done by a physical therapist or other healthcare professional. It is a gentle technique that involves applying pressure to the first rib to help it return to its normal position.
There are two main types of first rib mobilization:
- Posterior glide: This technique involves applying pressure to the back of the first rib to help it glide posteriorly or backward.
- Inferior glide: This technique involves applying pressure to the bottom of the first rib to help it glide inferiorly or downward.
Both posterior and inferior glide mobilizations can be done with the patient lying on their back or sitting up.
Anatomy of the first rib
Compared to typical ribs from the anatomy of the human ribs, the first rib is short and thick, and the cribriform joints have only one articular surface. The first rib has three parts a head, neck, and axis, but no discrete angulation.
The shaft is indented laterally, and the notch of the subclavian artery, which contains the lowest brachial plexus trunk and the subclavian artery, is present.
The anterior part of the oblique muscular tuberosity is another notch of the subclavian vein.
Its inferior surface is devoid of a cribriform groove.
It has two nodes.
Transverse node: posterior and lateral to the neck; articular surface with T1 transverse process
Oblique node: anterior to the subclavian arteriovenous groove; the anterior oblique muscle inserts here, also known as Lisfranc’s node, described by Lisfranc in 1815.
Blood supply
The arterial blood supply is supplied from the internal thoracic artery and the superior intercostal artery.
The internal thoracic artery pumps blood to the anterior body wall and its associated structures from the clavicle to the umbilicus. It originates from the first part of the subclavian artery at the base of the neck.
The superior intercostal artery is a direct result of the embryonic development of the intersegmental arteries.
These arteries are paired structures in the upper thorax and usually form to provide blood flow to the first and second intercostal arteries.
Innervation
The first intercostal nerve innervates the first rib.
The intercostal nerves belong to the somatic nervous system and originate from the anterior branches of the thoracic spinal nerves running from T1 to T11.
Unlike the anterior branches of the other spinal nerves, which travel independently and do not form a plexus, the intercostal nerves are mainly located in the pleura and peritoneum.
The first intercostal nerve is connected to the brachial plexus through a branch that corresponds to the lateral cutaneous branch of the remaining intercostal nerves.
Another exception to the first intercostal nerve is the absence of an anterior cortical branch. It is very small when compared to the rest of the nerves.
Attachments
The first rib has several attachments, as listed below.
Anterior oblique muscle: oblique node
Middle oblique muscle: between the subclavian artery groove and the transverse tuberosity
Intercostal muscle: from the outer edge
Subclavian muscle: originates from the distal trunk and the first rib cartilage
First acupressure of the anterior serratus
Mural pleura: from the medial edge
Costoclavicular ligament: in front of the subclavian vein groove
If you’re experiencing any of the symptoms mentioned here, then this article is for you!
How to do a first rib mobilization
Here’s a complete procedure of how to carry out a first rib mobilization exercise by yourself.
Follow these First rib mobilization techniques carefully to achieve the best result for your first rib mobilization exercise.
- Before you start this first rib mobilization technique, you must determine whether you have a first rib problem. To do this, palpate (feel) your upper shoulder on the side you have pain between the top part of your shoulder joint and your neck.
- If your first rib is “off” it should feel hard, almost like a knot.
- Next, feel just inside of your collarbone, again on the side of the pain. It should feel a little deeper than the opposite side, and
will probably be painful.
If you have these findings, do the following.
- Place the hand of the affected side against your forehead (on the same side).
- Take a deep breath.
- While holding that breath, attempt to move your chin towards your armpit (all on the same side).
- Using your hand against your head, resist this movement (do not let your head move).
- Use about 1 pound of force (it’s not much!).
- Count to 10. Exhale and relax.
- Repeat the sequence 1-4 after having let your head relax down a little bit towards your armpit.(it will have moved maybe 3” or so). NO PAIN.
- After repeating 1-2 times, bring your head to neutral and stretch your arm up above your head…
- Hold for 4 deep breaths.
- At this time, you’ve completed your first rib mobilization exercise and now it’s time to relax.
Congratulations, you have completed your first rib mobilization exercise! Now, don’t forget to tell us how it went via the comment below.
Sources:
https://radiopaedia.org/articles/first-rib?lang=us
https://www.hopkinsmedicine.org/health/conditions-and-diseases/thoracic-outlet-syndrome
https://pubmed.ncbi.nlm.nih.gov/2774913/
https://www.sciencedirect.com/science/article/pii/S1472029910002328