There are those of you suffering from chronic pain or spasms in your neck, shoulder(s), or mid-back. You’re beyond frustration. You’ve tried several healthcare providers, including chiropractors and physical therapists, all issuing different treatment plans but nothing has helped. You’ve even tried massage but that provided nothing more than temporary relaxation. X-rays and MRI results are normal. What is going on and why can’t you find relief? The answer could be First Rib Fixation Syndrome. A lot of people haven’t heard of this and don’t realize they have it.

What Is First Rib Fixation Syndrome?

Doctors tend to overlook this syndrome as part of their first examination and diagnosis. It’s easy to miss, which is too bad because an elevated first rib can cause a plethora of symptoms and complications, leaving someone to suffer unnecessarily for years. This syndrome can be a long-held issue developed over time. Common causes include bad posture, long hours at the desk, over exercising, moving heavy objects, having a physical job, or possibly sustaining an injury.

Over time, a muscular imbalance occurs known as The Upper Crossed Syndrome which elevates the first rib. When this happens, shoulder muscles (the subscapularis and infraspinatus) load up with trigger points, resulting in weakness and pain. With muscles now compromised, the shoulder is unable to move normally. People then tend to compensate for the pain by rounding the shoulders forward and jutting the head out further from the neck. The neck muscles (scalenes, serratus anterior, and sternocleidomastoid) overcompensate and develop more active trigger points. Referred pain from these new trigger points manifests as what may seem like random, erratic symptoms. Since these muscles attach to the first rib, even more elevation occurs. The trapezius muscle in the back then goes into immediate self-protection mode, resulting in tightness and spasm. This has a tendency to compress the brachial plexus and subclavian artery to eventually throw the person into a possible state of Thoracic Outlet Syndrome. Vicious, isn’t it?!

Sleeping habits play a large part in the development and treatment of this syndrome. Elevated first ribs typically occur in stomach sleepers. Some sleep with one arm tucked under their head, or sleep with minimal or multiple pillows. These now compromised muscles work extra hard if the person spends long hours working in front of computers using a mouse or has an intense job with repetitive movements. Changes in sleep style post treatment speed recovery and help prevent trigger points from reforming.

Also, all athletes should be evaluated as an elevated first rib is common in that type of lifestyle, particularly tennis players and weight lifters.

Symptoms

• Shoulder pain
• Neck pain
• A heavy hurting feeling or throbbing in the arm
• Dull achy pain and tightness in upper back and shoulders
• Headaches
• Trapezius spasm
• Radiculopathy (a neuropathy)
• Jaw pain
• Mid-back pain
• Paraesthesia (tingling, prickling, or burning)
• Chest & sternal pain

Treatment: Can It Go Away?

So what do I do that’s different than others? When someone presents a certain set of physical complaints that resemble this syndrome, I palpate effected areas for tenderness, spasm, and edema. A person will automatically jump or pull away when an elevated first rib is touched. Through various soft tissue mobilization techniques (MFR, PNF, ART, TPT, Gua Sha, Massage Cupping) active and latent trigger points in almost all of the muscles listed above are manipulated until pain ceases. This can take as little as one treatment for someone to experience immediate relief but can take up to a handful of sessions for more aggressive cases (those with repetitive work related movements that reform trigger points). These sessions are different than “typical” massages as the entire time can be spent on removing and breaking up the trigger points. This is aggressive and intense so I am sure to only work within the person’s tolerance level.

If this sounds familiar, please contact me. I also strongly recommend visiting your chiropractor for them to adjust the first rib(s) back in place. Again, this is a great example of the kind of pain you don’t have to live with. Let’s knock it out so you can feel good in your skin again.

See you on the table!