Do you carry a heavy pack often or sit at a desk? I bet your first rib needs a little help.

Recently I wrote about shoulder pain and how thoracic spine mobility can alter the mechanics of the shoulder. Today I want to dive in on a topic that gets a lot less attention, the first rib. 

Do you know where your first rib is located? If you are searching for the rib near the middle of your body, try again. The first rib is at the top of the rib cage. 

source, wustl.edu

source, wustl.edu

You will notice the first rib is quite high in the trunk. It is most easily found by pressing down through your upper trap, behind the clavicle, close to the neck. 

The first rib does not seem too glamorous. Most people I discuss the first rib with have no idea where it lives or its importance. 

Let's take a closer look at the anatomy here.  The first rib attaches to the spine and the sternum. the musculature that attaches is more interesting. The scalene muscles which originate at the cervical spine end up attaching to the first rib. The neurovascular bundle coming from the neck also pass near the first rib. 

source, instantanatomy.net

source, instantanatomy.net

Whoa, that's pretty complicated. A lot of things are happening here. Now, check out this lateral view of the neck and first rib.

source, healthtap.com

source, healthtap.com

Again, whoa. Now, imagine you are sitting slouched at your desk all day at work. The scalene muscles may just become shortened and stiff in that position. Obviously, there are a few critical tissues near the rib and scalenes that could be irritated here. Another common scenario I see often is mountain bikers, hikers, skiers wearing heavy packs for long periods of time reporting neck pain, numbness or tingling in the upper extremity. Think the first rib could be part of that problem? Hell yes!

So, the rib may be part of your shoulder, neck or arm pain, now what? Let's get it moving a little bit. A great mobilization I often use for the first rib uses a yoga strap or a piece of climbing webbing. I wrap the webbing around my shoulder, near the neck and sit on the ends to pin them down. Next step is to sit up tall to create tension on the strap and add should range of motion. Try a minute or two in this position. Back off if you feel numbness or tingling in the arm.

Yoga strap wrapped under the leg and over the shoulder to add pressure to the first rib. 

Yoga strap wrapped under the leg and over the shoulder to add pressure to the first rib. 

While sitting tall, add range of motion with the shoulder and search for tender zones .

While sitting tall, add range of motion with the shoulder and search for tender zones .

A second, more aggressive mobilization can be done in the squat rack. Place the bar in the rack around shoulder height with some weight. Step under the bar and apply pressure to the upper trap near the neck. As you stand up you will be mobilizing the first rib. More range of motion with the shoulder is good. It won't feel good but it is good. :) As always, no numbness or tingling here. 

Bar near the neck, pressure through the upper trap onto the rib. 

Bar near the neck, pressure through the upper trap onto the rib. 

Press your trunk upward into the bar and add range of motion with the shoulder. Ouch. :) 

Press your trunk upward into the bar and add range of motion with the shoulder. Ouch. :) 

Do you have a favorite technique to mobilize the first rib?