Elevated First Rib and Mobilization

If you’ve been suffering from an elevated first rib or having any kind of first rib pain – then you’ve come to the right place. We are going to break down what exactly is first rib pain, what are the etiologies (causes), and how we can help alleviate this type of pain with the help of Osteopathic Techniques.  We have also included different types of 

First Rib Anatomy 

Before we can treat the first rib – we need to know the anatomy surrounding the first rib and it’s importance to the rest of the body. The first rib is clinically vital as many of the structures that cross or attach to it can cause many neurological symptoms such as numbness, tingling, and shooting pain. Anatomically speaking, the first rib has the most curvature of all of the ribs and is the shortest true rib. A true rib is a rib that is actually attached to the vertebrae as opposed to a false rib which is not. The main reason we are concerned about the first rib is it’s proximity to the bronchial plexus. What’s the bronchial plexus? The bronchial plexus is essentially a group of nerves that go down both sides of your neck to the arm.  These collection of nerves control the muscles of the shoulder, elbow, wrist and hand, as well as provide sensation in the arm.

Causes Of An Elevated First Rib

An elevated first rib can be the result of many different causes. For one and the biggest reason – trauma. Any kind of trauma to the thoracic or shoulder region can indeed cause an elevated first rib. Types of trauma include:

  • Car Accidents
  • Sports Injuries
  • Weight Lifting
  • Improper Sleeping Position

Besides Trauma, other causes for an elevated first rib are (although rare) a pancoast tumor. A pancoast tumor is essentially a malignant cancer of the lung that can eventually destruct the thoracic inlet and involve of the nerves known as the brachial plexus. They are not easily detected on plain chest X-rays (CXR) in their early stages of the disease. Important to note that this is extremely rare and please consult your medical professional for further workup.

Treat An Elevated First Rib

Technique #1  – Self Mobilization

To figure out if you do have a first rib problem, 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. Then, feel just inside of your collar bone, again on the side of pain. It should feel a little deeper than the opposite side, and will probably be painful. If you have these findings, do the following.

1. Place the hand of the effected side against your forhead (on the same side).

2. Take a deep breath.

3. 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!)

4. 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. Relax. 

Other Treatment Modalities

Other possible treatment modalities are posture braces but specifically CLAVICLE posture braces. A good example is the PostureMD brace below which we rank as our top brace. 

PostureMD Clavicle Brace

Clavicle Brace for First Rib