Technique Highlight: Getting Fancy with 1st Rib Non-Thrust Manipulation | Modern Manual Therapy Blog

Technique Highlight: Getting Fancy with 1st Rib Non-Thrust Manipulation

Suspect first rib dysfunction in most upper quarter dysfunctions. It can cause

  • referral to the subcranial area and produce HA (along with upper trap TrP)
  • limits in ipsilateral shoulder elevation
  • peripheral neuropathic pain syndrome
  • limited and painful cervical motion toward or away
Make sure to screen when the patient presents with
  • shoulder impingement
  • TOS or PNP like complaints
  • cervical derangement with radiating complaints
  • frozen shoulder
  • cervical/tension HA
The video shows the standard supine inferior glide, anterior and posterior glides to the anterior and posterior first rib, plus movement/functional based releases. Hope you find something new!


  1. This video is amazing! I didn't know there were so many ways to mobilize the first rib. Do you perform the first rib manip in supine as well? I was taught this manip with the patient sitting, but I always have trouble getting the force/velocity I need. Thanks for all the great videos and posts!

    Nicole Clifford, SPT
    Regis University
    Class of 2012

  2. Thanks Nicole! I don't normally need to thrust the first rib but would in supine if I did. Sitting is too difficult because their is more resting tone in the upper trap. Glad you learned something!

  3. Can't view the video. All black screen. Can you re-post please?

  4. What are you viewing from? I just tried from my pc and it was working.

  5. I've recently discovered an interesting mobilization of the first rib where I sidebend ipsilaterally, put inferior pressure on the 1st rib and have the pt deeply inhale. In case of a hypomobile first rib, I can usually produce a cavitation during the inhalation. I've even reproduced this in myself. Have you had any experience with this?

  6. Not with the caviation, and I've mobilized in the hundreds that way. I was originally trained to mobilize 1st ribs that way, always wondered why I couldn't get them to cavitate.