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  • Writer's pictureMiracle Rehab Clinic

First Rib Mobilization: What Is It and How It Can Help Me?

If you've never heard of first rib mobilization, we're not surprised as the condition, and its treatment have not been given enough attention or research.

However, the first rib issue is an often overlooked cause of neck, shoulder pain, headaches, tingling, numbness of the arm, and decreased range of motion.

These problems occur when the first rib is elevated, which can happen because of trauma, like after a car accident, poor posture, repetitive motions, sleeping on the stomach, and similar situations.

Let's look into the first rib, 1st rib mobilization, and how it can help improve the quality of life for many patients.

What Is the First Rib and Why Is It Important?

Human body has 12 pairs of ribs that are separated by intercostal spaces. These createthe thoracic cage that protects the thoracic organs (heart, lungs, etc.)

The first rib is, well, the first one of the twelve ribs, and it's an atypical rib that's shorter and has a different structure.

The first seven ribs increase in length progressively, and the lower five ribs then begin to decrease in length.

If you want to test, you can find your first rib by pressing down through your upper trap, behind the clavicle, close to the neck.

The first rib is a pretty unstable structure that acts as the attachment site for several muscles, including the scalenes. However, when it gets "jacked up" in some cases, it can freeze into inaction.

This leads to possible brachial plexus compression, thoracic outlet syndrome, and other problems like shoulder pain at night and decreased range of motion. In the worst-case scenario, the pain can lead to surgical removal of the first rib.

Elevated first ribs

Elevated first ribs commonly occur for people who sleep on the stomach or with one arm tucked under their head.

When the first rib is elevated, the Brachial Plexus (the nerve bundle that sends sensation to the arm and hand) and the arteries and veins that go between the collarbone and first rib can become compressed, causing symptoms down the arm.

In other cases, the first rib elevation happens during whiplash-type injuries or activities and sports involving repetitive movements. For example, tennis, golf players, construction, etc. workers have a higher risk of neurovascular compression from first rib fixations.

With elevated first rib, people typically complain of constant dull, aching pain and tightness in the upper shoulder girdle.

Luckily, certified physical therapists (PTs) can correct an elevated first rib with first rib mobilization.

What Is First Rib Mobilization?

Improving the mobility and position of the first rib alleviates irritation of the nerves and blood vessels just below it, can get rid of pain and discomfort.

Physical therapists use muscle energy techniques or manipulation, dry needling, and assist with special exercises to alleviate the symptoms for first rib mobilization.

Part of the rehabilitation is also releasing spastic soft tissues as part of a comprehensive rehab program and boosting overall body function with different exercises that can be done with the therapist and at home.

First rib fixations are painfully exhausting and interfere with the quality of life, so it's important to consult with the professional as soon as possible.

Patients can also incorporate first rib self-mobilization with certain at-home exercises.

Using a ball

Keeping your back straight, push a therapeutical or lacrosse ball into your shoulder as close to your neck as possible as strongly as you can bear.

It will help increase space between the clavicle and the first rib, where it most often compresses. Hold the position for half a minute and repeat 2-3 times.

Pulling apart a resistance band

Stand upright and hold a resistance band in each hand. Initiate pulling motion with your shoulder blades and shoulders. It will stretch your chest and back, especially beneficial if you sit a lot.

Chin tuck

Sit on a chair and tuck your chin towards the front of the upper part of your neck. Feel the muscles at the front of your neck activate and a stretch in the back of the neck. Don't push too hard, and don't move your neck too much.

Cow-Cat stretch

Physiopedia also recommends this traditional cow-cat stretch. Get to your hands and knees, with knees under hips and hands under your shoulders.

Inhale as you move your sit bones up towards the ceiling, arching the back and pressing the chest towards the floor as you lift the head up (cow). Inhale and round out your back, pushing shoulder blades away from you as your spine forms a "C" curve in the opposite direction (cat). Repeat ten times.

Diaphragmatic Breathing

This one is very effective yet simple for 1st rib self-mobilization. Lay down on your back, place one hand on your stomach and the other on your chest. Breathe deeply into your stomach without allowing the chest to move. Your belly should rise while breathing, but the ribs stay in place.

When do You Need First Rib Mobilization?

With an elevated first rib, most people experience extreme discomfort and pain through the neck and shoulders as well as numbness and tingling sensation in the arms and hands.

Thoracic Outlet Syndrome

It is possible that if you have these symptoms, you have thoracic outlet Syndrome. Your spinal column nerves run between muscles and bones, but when the nerves become compressed at some point along the way, e.g., between the first rib and the collarbone, etc., the thoracic outlet syndrome occurs.

Also, as MayoClinic explains, thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed.

If you're experiencing the symptoms mentioned above or fall in the risk group of this syndrome. In this case it's recommended to avoid repetitive movements and lifting heavy objects, watch your weight, stop carrying heavy bags over your shoulder because all these can increase pressure on the thoracic outlet.

Make sure you're exercising and strengthening your muscles too.

Other symptoms

Another potential cause if you're experiencing these symptoms is first rib dysfunction, when the rib is displaced with minor force (for example, during a mild workout) yet causes significant dysfunction.

First rib dysfunction can also occur due to muscular imbalance or when the rib moves in/out of place. Rib dysfunction causes persistent symptoms such as trapezius spasms, neck, shoulder pain, headaches, jaw pain, mid-back pain, or even numbness down the arm.

However, you should get diagnosed by a professional physical therapist who will run multiple tests and give you the diagnosis.

How Can 1st Rib Mobilization Help With First Rib Dysfunction?

First rib dysfunction can be treated using 1st rib mobilization techniques by a physical therapist and reducing or eliminating pain.

First rib mobilization physical therapy includes stretching of the chest, neck, and shoulders. Learn about this and other types of physical therapy here.

It's also important to focus on posture re-training, thoracic spine mobility training, and learning of proper breathing techniques.


While it's difficult to immediately pinpoint the reasons for shoulder and neck pain as well as decreased mobility, numbness, and headaches, it's essential to get examined by a professional.

If established that you have an elevated 1st rib, your physical therapist will create a comprehensive rehabilitation plant which will include 1st rib mobilization with manual manipulation, exercises, and other treatment modalities.

To find other techniques for physical therapy on your first rib problems please contact Miracle Rehab Clinic either in Farmington Hills or Warren and book your appointment.

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