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 |
Upper Crossed Syndrome |
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.
https://itunes.apple.com/ca/app/mobilizeme/id576108153?mt=8
https://play.google.com/store/apps/details?id=com.hongji&feature=nav_result#?t=W251bGwsMSwxLDMsImNvbS5ob25namkiXQ
Great post, good to see another therapist out there in the blog world and enjoying crossfit! I've been doing some 1st and second rib mobilizations for patients with difficulty reaching overhead. Usually manip the T-spine in a few areas, first rib mobility and then re-test overhead. Great point about the referrel patterns, especially posterior scalene. I've been learning from some colleagues that the posterior scalene is responsible for a lot of issues that can be confused as rotator cuff or even heart attack!
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