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1st Rib Thrust Manipulation

Body Region: Thoracic Spine
Technique Name: 1st Rib Thrust Manipulation

Indications: mechanical neck pain (MNP), cervical radiculopathy (CR), thoracic pain, shoulder pain


Patient Position:
  • The patient is seated in the center of the treatment table with their legs hanging over the side.
Clinician Position:
  • Stand behind the patient with one foot on the plinth and your thigh next to the patient’s unaffected side
  • The patient’s arm is supported on the your thigh (this takes tension off the brachial plexus)
  • Gently place your contralateral hand on the patient's head, with your elbow resting gently across the contralateral upper trapezius and clavicle.
  • Gently push your hip into the patient’s back, which will force the spine into slight extension.
Technique Description:
  • Using the 2nd metacarpo-phalangeal (MCP) joint on the ipsilateral hand, the locate the shaft of the 1st rib. A lumbrical grip (MCP flexion and IP extension) is maintined on the 1st rib by moving the trapezius posteriorly.
  • The patient’s head is side-bent toward the affected side and rotated away
  • Impart a gradual, progressive mobilizing force to the patients 1st rib to produce depression. The direction should be toward the midline of their body.
  • When the restrictive barrier is engaged, deliver a high-velocity, low-amplitude thrust inferiorly and towards midline. (attempting to reach the opposite axilla).
Key Points:
  • Use your entire body to translate the patient's cervical / thoracic spine until the restrictive barrier is engaged
  • Ensure the patient can tolerate the pressure you are applying with your manipulating hand prior to thrusting
  • Evidence

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