Treatment of a superiorly subluxed first rib on the left

  • Patient is seated with the therapist standing behind.
  • The patient’s right arm rests on top of the therapist’s right leg.
  • The therapist places the finger pads of the 2nd, 3rd, and 4th fingers anterior to the left trapezius muscle pulling it posteriorly.
  • The finger pads are placed on top of the left 1st rib.
  • The therapist’s right hand and forearm control the right side of the patient’s head and neck. The patient’s head is flexed forward down to the level of the first rib.
  • Left side bending and slight left rotation of the patient’s head and neck are introduced to take the left scalenes off tension.
  • The therapist’s left thumb applies a firm anteriorly directed force to the posterior aspect of the first rib.
  • The patient is asked to attempt to side bend the head to the right with exhalation to reciprocally inhibit the left scalenes while the therapist applies a firm counterforce to prohibit the neck from moving.
  • Following relaxation the therapist repositions the patient’s head into more left side bending all the while maintaining a firm anteriorly directed push on the posterior aspect of the first rib.
  • After three to four repetitions and after the final contraction and relaxation effort the therapist rotates the patient’s head fully around to the left to take T1 to the left while maintaining the anterior pressure with the left thumb so that the rib can drop down without force.
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