Quick Case: First Rib Pain with SOAP and Odd Self Testing | Modern Manual Therapy Blog

Quick Case: First Rib Pain with SOAP and Odd Self Testing

Here is a quick case from the recent Pitt-Marquette Challenge Eclectic Approach to Spinal Manipulation (or High Speed Mobilization in Pennsylvania - Boo!)

Will is a young therapist who had "first rib" pain and wanted me to take a look at it. Instead of looking at his first fib, I asked him what bothered him. His limitations were
  • doing SOAP notes (a complaint I heard several times that weekend)
  • and this weird self testing movement
    • someone did ask me if this was a first rib test movement, and perhaps it is, but not one that I've learned

rot R, SB L... painful and limited or DP
Ummm... why do you do this Will? A simple answer like any patient, because it hurts and doing it the other way does not. Ok... good enough, so we have a semi functional baseline pre and post test. Quick MDT screening of the cervical spine revealed unilateral loading loss to the ipsilateral painful side. Remember for this movement assessment, passively retract the patient, and maintain the retraction, this loading often brings out asymmetry which as a pattern, is limited to the painful side.

oooo, that's a nice cervical retraction and SB right!

would be "normal" if not for the asymmetry compared to the uninvolved/right side
Treatment was, light IASTM to left cervical and upper trap patterns for about 30-40 seconds each. Then repeated cervical retraction with passive overpressure to the left for about 40 repetitions. It started out as a yellow light, mild discomfort during motion, which progressed to end range, then not at all for the last several reps.

Upon retest, the cervical retraction with SB left and OP was symmetrical, pain free, and that weird head movement was also now pain free and symmetrical. Homework was naturally repeated cervical retraction with SB left to be performed hourly. The next day he was still pain free, and his "first rib" felt much better!

Another bonus! This particular PT emailed me and stated on Monday, he used techniques I presented at the weekend course on 3 patients who he had stalled with previously and all 3 were completely pain free by the end of their visit!

A full vid of this Quick Case can be found on the OMPT Channel, Eclectics Channel.

Staying Eclectic and Easy all at once...


  1. Like many cases, it was a simple matter of finding the directional preference and repeatedly loading it! Thanks!

  2. Yea, it's a good reminder not to over-think things. I tend to do 'too much' at times when the answer is more simple when you look at asymmetries, as in this case.

  3. Yes, as much as I love the SFMA and regional interdependence model, sometimes a neck is just a neck.

  4. I think he was trying to demonstrate the Cervical Rotation Lateral Flexion Test (CRLF) for 1st rib hypo mobility.

  5. Understood. I have found the test useful in directing me to manip/mob to the first rib to improve the ability to get to end range. Thanks for the feedback and the info provided on your blog!

  6. No problem at all! I have moved away from rib mobilizations in lieu of light IASTM to the upper traps. Often the "elevated bone" was just tone, and once inhibited, is no longer there to palpation. Thank you for reading and your support.