Do you currently suffer from shoulder pain? And if so, have you ever had your first rib assessed/treated before?

If not, hopefully, this article will prompt some further explanation. A dysfunctional first rib could genuinely be one of the missing pieces to your shoulder pain puzzle.

Shoulder pain is unfortunately all too common these days. Whether you’re an elite athlete, a weekend warrior, or someone who's just going about your life, the chances are you’ve had, are dealing with, or will be faced with some form of shoulder pain at some stage.

Proper treatment of any shoulder complaint requires a thorough assessment of you and your past in order to understand what’s going on and why it’s happening. From here, we can devise a specific rehabilitation program.

Interestingly, one of the most overlooked aspects of any shoulder complaint is the role of the first rib.

Its location means that not only will it have a strong effect on shoulder function, but also neck and upper back function as well. So it’s well worth taking the time to have your first rib assessed.

Thankfully it’s also easy to do yourself. And in this article, we’d love to show you how you can not only self-assess for first rib dysfunction but self-correct it as well. Furthermore, any treatment plan may ultimately fail unless we discuss why that first rib became an issue in the first place. So let’s get to it.

What is the First Rib:

As the name implies, the first rib is literally the first rib at the top of the ribcage.

Interestingly, many are surprised to learn how high the first rib actually sits when trying to find it on yourself.

Its origins just below the base of the neck are a little misleading as it subtly wraps around to insert underneath the collar bone into the top of the sternum.

And it’s this relationship to its surroundings that makes it such an impactful structure for shoulder pain.

How Does the First Rib Become Dysfunctional in the First Place?

To put it simply, the first rib is HEAVILY influenced by our postural habits. More specifically, it is challenged when we slouch. As we let our shoulders drop and roll forward we change the way the first rib is loaded. 

If this is the norm, the rib joint and its surrounding tissue have little choice but to stiffen and tighten to cope over time. The weight of an arm constantly hanging against gravity can be quite destructive mechanically to this area.

Interestingly, many describe the first rib as “elevated” and use techniques to bring this down again. And while this can obviously happen, it’s important to appreciate that when associated with poor posture, the rib (and shoulder girdle) consistently get pulled down and depressed. So if you have been working hard to fix an elevated first rib without success, consider the possibility that it may actually be depressed instead.

Following on from this, a restricted first rib area can block normal shoulder, neck, and upper back function ultimately setting it up for any number of shoulder complaints down the track.

How Does a Dysfunctional First Rib Contribute to Shoulder Pain?

At its most basic level, first rib dysfunction throws a spanner into the works of normal shoulder function. Its presence asks everything around it to work differently in order to compensate. And therein lies the issue.

You can’t have normal shoulder function without normal first rib function.

In order to lift your arm above your head, not only does your arm physically have to lift up but your shoulder blade needs to upwardly rotate and glide up across your upper back - provided everything is normal of course. If your upper ribs are stiff and restricted all of a sudden it has to try and move with a genuine handbrake on.

This can then leave the door for a lot of shoulder problems from shoulder impingement, biceps tendon pain, and rotator cuff dysfunction to thoracic outlet syndrome. All because that first rib isn’t playing ball.

How to Self-Assess For First Rib Dysfunction:

Ideally, we can assess your first rib and determine its involvement in your shoulder pain. We can then offer specific advice to correct any issues we might see. However, there is a really simple way to do it yourself. Using the ball technique from the video below, you can lie down and gently press the ball into your upper back - paying close attention to any stiff or tight areas. Comparing the same spots on both sides is a great way to get a sense of how things are going and where the issue might be. 

Most first rib dysfunction - where the actual first rib joins to the upper spine, is accompanied by local muscle spasm over the top. This spasm might be close to the spine, but it’s more commonly felt at the mid-rib level. And becoming aware of how stiff the rib joint is as well as any associated muscle restrictions is an important piece of the puzzle to understand. Freeing up that spasm on its own may not provide long-lasting relief if the reason for those trigger points (underlying joint restrictions) remains untreated.

And before we edge into self-treatment, it’s important to perform a few quick pre-treatment movements for later comparison. This way, you can see the exact impact you've had on your symptoms.

Based on the first rib’s location, there are two fantastic pre-assessments to do:

1. Turning your head right to left as far as you feel comfortable.

2. Lifting your arms up above your head as far as you feel comfortable.

It's important to take note of how far you go, how each feels to do, and how they compare left to right. Any pain is important as well of course. And once you have your baseline measures, it's time to self-treat that rusty first rib.

How to Self-Treat First Rib Dysfunction:

The video below highlights a fantastic ball mobility exercise for the first rib. This same technique doubles as both a thorough assessment tool and a highly effective self-treatment option.

Once you've spent some time working out your specific first rib dysfunction with a ball make sure to reassess your neck and shoulder range of motion.

Ideally, you'll likely see some positive changes to these movements straight away. Better still,, you may also see a genuine improvement in your specific shoulder pain and symptoms.

If you don't, but feel you performed the exercise well, then your first rib may not be a centerpiece of your shoulder pain.

Obviously, we advise you to come in and see us for a thorough assessment and specialized treatment plan. But hopefully this gives you a head start!

If you’d like some help with your shoulder, please come in and take part in our monthly shoulder pain workshops.