I was asked to do a post on 1st rib dysfunction on the MobilizeMe page so here goes!

How do you know if you have a problem with the 1st rib?

  • Neck/shoulder pain
  • Upper trapezius tightness/spasm
  • Headaches
  • Jaw pain
  • Referred pain into neck, shoulder, chest or arm
  • Pins & needles into neck, shoulder, chest or arm
  • Chest pain

Scalene trigger point referral

The first rib serves as an attachment point for your scalene muscles (anterior, middle and posterior), subclavius and serratus anterior. If your scalenes are  too tight, they can pull the 1st rib superiorly (upwards) and cause the joint to become stiff. Trigger points in the scalenes can refer pain into the chest, thoracic/scapular region and into the shoulder, arm and hand.

Upper Crossed Syndrome

First rib dysfunction is usually (but not always) the result of poor posture, which is commonly referred to as “Upper Crossed Syndrome” or “Forward Head Posture”. This frequently seen posture occurs when the head sits anteriorly on the spine, which loads up the posterior musculature (upper trapezius, levator scapulae, etc). The normally lordotic cervical spine becomes more kyphotic, the shoulders round forwards due to tight pectoralis major/minor and the thoracic spine becomes stiff and hyperkyphotic. The deep neck flexors at the front of the neck become long and weak, as do the rhomboids, middle and lower trapezius. In addition, this posture results in altered biomechanics at the shoulder joint which can ultimately cause rotator cuff injuries, impingement, etc.

Thoracic Outlet Syndrome (TOS) is another condition which can be the result of a hypomobile or elevated 1st rib in which the nerve and blood supply from the superior thoracic outlet is compromised. The compression usually occurs between the anterior and middle scalenes, and can result in pain, paresthesia (pins and needles) and weakness of the upper limb. There are other mechanisms, such as a cervical rib, a Pancoast tumor or abnormalities of the clavicle, that can also cause thoracic outlet syndrome.

So what can be done about this?

  • Stretch/trigger point release/mobilize/massage your scalenes, upper trapezius, levator scapulae, pectoralis major/minor
  • Strengthen your lower trapezius, rhomboids and deep neck flexors
  • Mobilize your thoracic spine (foam roller, massage balls)
  • Mobilize the 1st rib  –>  http://www.youtube.com/watch?v=RfiTL-0sW_c
  • Work on improving your posture
  • Take regular breaks from your computer if you work at a desk
  • Keep your head back against the headrest whilst driving. Girls – take your hair out of a ponytail (if you wear your hair in one) whilst driving.
  • Strengthen your rotator cuff muscles

If you are experiencing any neurological symptoms (referred pain into the shoulder, chest or arm), pins & needles, weakness or loss/change of sensation – it is highly advised that you seek out Professional advice from your Physiotherapist, Chiro or Osteopath. They will be able to assess you thoroughly to figure out what is going on and then provide you with treatment to help ease your pain!

There is scalene and upper traps stretches in the MobilizeMe app – go check them out on the App Store or Google Play.