First Rib Mobilization
Restoring mobility to the first rib may increase the costoclavicular space and reduce the load on neurovascular structures in the thoracic outlet container. First rib mobilization may reproduce the patient’s symptoms, particularly upper extremity paresthesias. This may be the result of a release phenomenon caused by normalization of nerve function associated with unloading of the brachial plexus, in which case rib mobilization should be continued. (Hooper et. al., 2010)
First Rib Self Mobilization
(Hooper et. al., 2010)
Other Manual Therapy Techniques
- Sternoclavicular and acromioclavicular joint mobilization may restore end-range arthrokinematics of the clavicle during elevation activities (Hooper et. al., 2010).
- Glenohumeral joint mobilizations may restore end-range limitations that can lead to compromise of the costoclavicular space (Hooper et. al., 2010).
- Restrictions of the subclavius muscle may constrict the costoclavicular space (Vanti, 2007), so subclavius release techniques may facilitate opening up the space.
- Encouraging diaphragmatic breathing helps to reduce overuse of the scalenes and other accessory respiratory muscles that result in elevation of the first rib and rib cage and consequent reduction of the costoclavicular space (Hooper et. al., 2010).