First rib dysfunction is an often overlooked positional fault when assessing shoulder and/or cervical dysfunction. However, with how often I see postural faults on a weekly basis it has become a primary assessment for me in my shoulder and neck cases. The first rib has attachments to the scalenes, serratus, and subclavius. It is important in breathing and shoulder movements.
A few months back I was warming up before one of my weight lifting sessions and did a few shrugs to finish off. I felt a pop in my neck and immediately had pain and limited ROM. Naturally I walked right out of the gym. I couldn't sleep or move my head from the increased stiffness. Fortunately, I had no neural symptoms. What remained was stiffness and pain that was excruciating. The culprit: the first rib. My first rib elevated and put my levators and upper traps on spasm, locking up around it. However with first rib mobilizations, soft tissue mobility of the upper traps, scalenes, and levators, in three days I was pain free and had full ROM. I worked on pain free ROM every hour on the hour in addition to my therapy. The point of this is to remind us of the importance of first rib dysfunction. I typically see it with my patients with poor posture and it tends to immediately improve patients cervical ROM when they are stiff.
Next time you see a patient with limited cervical ROM or increased stiffness check out the first rib in addition to the t-spine and c-spine.
Want to know how to treat cervical and first rib problems? Check out the Insider Access page for manual therapy techniques and assessment techniques!
Also- check out Brian's recent published posts on Paleohacks. http://blog.paleohacks.com/why-stretching-isnt-helping/
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
|The Student Physical Therapist||
Always evolving, Always learning