First Rib Mobilization: Relieve Headaches, Shoulder Pain and Numbness

If you spend most of the day sitting or if you carry a heavy purse or backpack, you probably feel pain in your shoulders and back. First rib mobilization may be the answer to your pain and discomfort…but what is it?

What is First Rib Mobilization?

First Rib Mobilization (FRM) refers to treatment used to help ease neck disorders, headaches, shoulder pain, and numbness. Restoring mobility to your first rib through manual therapeutic procedures can decrease these symptoms.

What is the First Rib and Why is it Important?

Where is your first rib?

The first rib is located at the top of the rib cage. It is the most superior of the twelve ribs. The first rib is attached to the spine and sternum. The scalene muscles originate at the cervical spine and end up attaching to the first rib. The neurovascular bundle coming from the neck also pass near the first rib.

The ribs form the main structure of the thoracic cage which protects the thoracic organs (lungs, heart, part of the esophagus, trachea, thymus gland, etc.). The thoracic cage ( often called the “rib cage” has 12 pairs of ribs which are separated by intercostal spaces.

The first rib has several attachments:

  1. Anterior scalene muscle: scalene tubercle
  2. Middle scalene muscle: between groove for the subclavian artery and transverse tubercle
  3. Intercostal muscles: from the outer border
  4. Subclavius muscle: arises from the distal shaft and first costal cartilage
  5. First digitation of the serratus anterior muscle
  6. Parietal pleura: from the inner border
  7. Costoclavicular ligament: anterior to the groove for the subclavian vein

When do You Need First Rib Mobilization?

When you sit at your desk in a slouched position for long periods, the scalene muscles may become shortened and stiff. This shortens the functional length of the scalene muscle group and may pull the first rib up, crushing or pinching the nerves and blood vessels in the area.

In some cases where the individual carries heavy backpacks for hours, such as mountain climbers, mountain bikers, and hikers, they complain of neck pain, numbness or tingling in the upper extremity.

Other cases wherein you may need First Rib Mobilization:

  1. Birth trauma which can last into adulthood
  2. Impacts on one side of the head or neck
  3. Whiplash
  4. Infection (e.g. septic arthritis, osteomyelitis)


  • Septic arthritis is a painful joint infection. It can come from germs traveling through your bloodstream from another part of your body. It can also occur when a penetrating injury delivers germs directly into the joint. The infection can quickly and severely damage the cartilage and bone within the joint, so it is important to have it treated immediately.


  • Osteomyelitis is an infection of the bone. People who smoke and those with chronic health conditions such as diabetes or kidney failure are more prone to developing osteomyelitis.
    1. Trauma (e.g. fracture)
    2. Malignancy (e.g. chondrosarcoma, enchondroma, metastases)


  • Chondrosarcoma is a rare type of cancer that usually begins in the bones but can sometimes occur in the soft tissue near bones. The most common locations for chondrosarcoma tumors are in the pelvis, hip, and shoulder. There are rare cases of these tumors affecting the base of the skull.


  • Enchondroma is a type of benign bone tumor that originates from cartilage


  • Metastases commonly develop when cancer cells break away from the main tumor and enter the bloodstream or lymphatic system.
    1. Thoracic outlet syndrome


Thoracic outlet syndrome (TOS) is a term used to describe a group of disorders that occur when the nerves and/or blood vessels in the lower neck and upper chest area are compressed, injured or irritated. The thoracic outlet is the space between your lower neck and upper chest where this grouping of nerves and blood vessels is found.


TOS affects approximately 8% of the population and is three to four times common in women as in men between the age of 20 and 50 years.


Symptoms of TOS range from mild pain and sensory changes to limb-threatening complications in severe cases.

8. Pancoast tumor (superior sulcus tumor)


Pancoast tumors refer to where cancer is located within the lung. Most lung cancers develop lower down in the lungs but Pancoast tumors grow at the top of either lung.


The most common symptoms are chest and/or shoulder pain as well as arm pain. Weight loss is fairly common among patients with this condition.

How can First Rib Mobilization help with first rib dysfunction?

First Rib Mobilization is the first line of treatment for first rib dysfunction. If you are suffering from thoracic outlet syndrome, for example, your physical therapist will teach you how to do exercises that will strengthen and stretch your shoulder muscles to open the thoracic outlet, improve your posture, and improve your range of motion. Done repetitively, over time, these exercises can take the pressure off your nerves and blood vessels in the thoracic outlet.

Note: Palpating 1st rib dysfunction is difficult

The first rib is the most difficult rib to palpate. It is the most tightly curved of all the ribs and the broadest one of the ribs. It lies both below and behind the clavicle and there is a thick layer of muscle in front of it.


There are some videos online that show how you can do first rib mobilization at home. They are relatively simple and easy to do. However, you need to consult your doctor first if you feel shoulder and/or back pain, have a feeling of numbness or if you always have headaches.

Your doctor will determine what treatment you should have and refer you to a physical therapist for first rib mobilization treatment if needed.

You can also consult our physical therapist at Vigor Physical Therapy and Rehabilitation.

At Vigor Physical Therapy and Rehabilitation, we create a customized physical therapy plan for every patient designed to address the root cause of the individual issue.

All our therapists have several years of experience and are highly skilled at what they do. Each one of them is dedicated to providing excellent, personalized care to all patients who seek professional health care at our facility.

If you have questions, feel free to give us a call.