Just to prove that we are always learning, the term “elevated first rib” has now joined our vocabulary. Why you ask? Because that’s what the chiropractor said was behind our recent episode of a very sore neck! And by sore, we mean debilitating, agonising, and life disrupting pain . . .
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The First Rib Explained
The first rib is exactly that – the first true rib at the top of your chest. It sits just below your collarbone and is held in place by a series of supporting muscles.
From the top, the first rib is held in place by the scalene muscles which run up the side of your neck. They tend to pull the rib upwards. Working in opposition, the intercostal muscles that lie between ribs have a tendency to pull the first rib down. A balance is needed between these two muscle groups to keep the first rib in its proper position. When the balance is uneven, the position of the first rib can shift.
So What is an Elevated First Rib?
In physical terms an elevated first rib occurs when the rib moves up out of its proper alignment. In functional terms, it hurts! The pain comes from the misalignment (vertical) which tends to squash various veins, arteries, and nerves between the rib and your collarbone. The nerve bundle that sends sensation to your arm and hand (brachial plexus) as well as the arteries and veins that feed the arm pass directly over the first rib and under the collarbone. Real problems can occur if the first rib becomes locked into that position.
The other way that an elevated first rib can cause you distress is that it completely misaligns your upper body. This leads to neck, arm, shoulder, and back pain as all body systems are interdependent and any piece that is out of place stresses the surrounding structures.
What Causes an Elevated First Rib?
The scalene muscles are very strong as they must support your head on top of your spine. The head is a potentially unstable weight and considerable strength is needed to support it. This power means they have the ability to pull the first rib upwards if they become shortened, or inflexible. They are involved in most cases of elevated first ribs.
The usual cause for the rib rising up and staying there is poor posture over time. In the modern, sitting based world that many of us live in, it is all too easy create imbalances in our posture. A closely associated condition is having a forward head posture. When these behaviours are repeated over time, the fascia (membrane surrounding the muscle) around the scalene muscles will become thicker, less flexible, and shorter. This reduces the length of the scalene muscle group and will lift the first rib up, pinching or crushing the nerves and blood vessels in the area. However, it is also possible to end up with a raised first rib due to injury, and anyone who habitually holds their shoulders up through emotional tension is at risk too.
Treatment Options
From a recent, personal perspective, if your rib is elevated and stuck there, you are going to want it released as soon as possible! This is where you probably need a professional (unless very minor). In my case, my chiropractor managed to manipulate the offending rib back into position with a bit of skilled effort. Once back in place, you want it to stay there.
Unless you address the causes of the rib elevating, any fix will be temporary. You need to reflect carefully on the way you sit – at home and at work. It is highly likely that your posture needs to be adjusted so that you maintain a balance in the key muscles. A posture coach like the Lumo Lift will be helpful. Some other good starting points include:
1. Regularly stretch your scalene muscles to counter any shortening or tension
2. Critically assess the way you are sitting
Sitting Damaged Posture – Fight Back!
3. If regularly carrying a weigh, look for balance in the way you do it
This one is fairly common sense – keep any weight close to your body and regularly swop sides if the weight can’t be carried centrally.
4. Try to generally correct your posture
We have written a large number of posts on this topic. The bottom line is that postural imbalances – particularly those that lead to tension in your neck – create the risk of you developing an elevated first rib. A couple of posts that may be helpful are: 38 Posture Tips That Actually Work and Anterior Pelvic Tilt.
Myoskeletal alignment – deep tissue works well to release the scalene muscles and first rib
Hi Mark
Thanks for the contribution. We agree that as well as stretching, skilled massage of the scalenes is very helpful. They seem to build up a heap of tightness and possibly scarring over time.
Thanks
Dave
I have this right now. So painful and miserable.Every. Single.Day
Hi Michelle
I hear you. It is totally miserable. Have you sought any treatment?
http://www.askdoctorjo.com/content/first-rib-mobilization-neck-and-shoulder-pain-relief
U can try that yourself or see your chiropractor had mine aligned this morning
thanks for the link Sandy!
I have this problem from an auto accident an have started physical therapy to help realign the rib back in place. The pain is unbearable at times. I feel positive that my therapy will help me correct this.
Very sorry to hear this Darlene. I hope that your treatment gives you relief soon.
Dave
I want to know I pilates, and especially planking, can cause this problem. I’ve had an elevated rib for some time but it was not diagnosed by the dr, chiropractor or physio!!! I am a teacher and painter and I am in constant pain and discomfort.
I went to my physiotherapist for a sore shoulder six months ago and on the third visit he pushed on my vertebrae (which was agony) and “adjusted my first rib” (whatever that meant.) Result? Excruciating neck and upper back pain ever since. My chiropractor was mad to hear this because, as I suffer from Spondylolithesis, I should never had my vertebrae pushed like the that. Annoyingly, my physiotherapist knew, but had forgotten, that I had Spondylolithesis. My chiropractor has helped somewhat, but I suspect my neck/first rib is still not right due to my ongoing pain. I’m going to see a remedial massage therapist this week. I’m also on anti-inflammatories for my initial shoulder pain (a stabbing pain I started getting from lifting incorrectly at work over a seven month period). I’m over the pain.
I have this right now… so painful! I’ve been to the chiropractor twice this week to have it adjusted but it still hurts really bad (although hands have stopped tingling). Any advice to get rid of the pain & keep it gone?
It truly is awful . . . and you have our full sympathy.It’s good that you are involving a health professional and I’m assuming that you are taking some anti-inflammatory pain medication?
There are probably two things that are working against your recovery right now. Firstly, the muscles around your neck/upper back are tight and inflamed. This is where the anti-inflammatory pain meds are very helpful, but you will need to help them relax through gentle stretching and possibly massage (if possible).
Secondly, the daily posture that led to your current crisis may still be feeding the cycle. Do you sit in a certain position for much time daily? Even sitting watching TV in a particular posture will continue the hurt at this point. You need to critically assess how you are holding your back and head/neck and consciously change to a healthier posture. The good news is that your body wants to stop this pain, but if you simply continue doing what you’ve always done it will come back. (Great news that the tingling has stopped – this means the pressure is reducing at least a little.) Short term, take the pain meds and continue getting physical manipulation (it will get better), long-term start improving your daily posture. Dave
I was in a car wreck and had my ribs pulled away from my sternum. All recovered and stay put except my 1st rib on my right side. I’m right handed. It’s getting unbearable to move my shoulder and neck when it goes out. My clavicle will be an inch or inch and a half higher. Is there something that will keep it in place (surgery, screws, something) if the tissue is worn out and can’t compete with the scalene muscles anymore?
Investigate prolotherapy for tissue regeneration
I have been struggling with what I think is this for almost two years now. I got adjusted by my Chiro (at the time) in the morning, then went to the gym that night. I lifted and played some basketball but was hit in the chest by someone’s shoulder. I was very restless in bed and had cold sweats throughout the night. I woke up and found myself twisted and my right arm stretched out all the way. I could not separate my chin from my right shoulder for the better part of the morning, until I tried stretching it enough that it loosened up a bit.
Fast forward to now, and I am on my third Ortho, which is inclined that this issue is “thoracic outlet syndrome” and suggests that we remove my first rib in the event that the MRI’s are positive on this issue. The last two MRI’s and x-rays were all negative, but the docs seemed to write me off quickly and when i took a second look at the x-ray, my SC joint is barley in frame. I’m constantly in pain.
– There is grinding that i can feel and hear if I ever move my shoulder
– My scapula is winging/unstable
– I have a weak rotator cuff (from a prior injury, but it doesn’t help the problem)
– my right Trap/Lats are always tight
-I have just about stopped working out my Chest and Back because that only increased the pain on a day to day basis dramatically, and my right pectoral will NOT grow or get targeted properly anymore – one quarter of it has atrophied.
– I can no longer swim due to the pinching pain in my lung after pushing my limits in the pool. (I was a competitive swimmer for ten years mind you, but this was NOT the issue. it happened at the gym, far from the pool, but all the doctors like to blame swimming. I was swimming casually with a masters team when this happened, retired from competition 10 years ago.
not sure if you have solved this, but if not, please try stregthneing the intercostal muscles. The scalenes and intercostal muscles are in a “tug of war”, so if the intercostals are too weak then it leads to overly tight scalenes and TONS of pain.
I injured my ribs about 5 years ago, and literally took me 4 years to figure out the issue( probably the most miserable years of my life). In order to release the scalenes you need to strengthen the opposition muscles (intercostals). Specifically take deep breaths, and be sure to REALLY focus on the exhalation. Exhale until you cant anymore and feel your intercostals tighten up.
Hope this helps you
Any solution?
Sounds exactly what i had. Turns out i had some herniated thoracic disc and scoliosis, i have done a lot of stuff on my own and have regained, the ability to use my right pec and loosen my right lay and trap! I can point you in the right direction and show you what i used…. also would like to hear more about you
HI all – so glad to have found sympathetic stories! I don’t actually know what happened to mine. It has been primarily characterized by a terrible pain directly beneath my clavicle; I believe where the first rib passes under. It has been so bad at times that I in the beginning, I thought I must have fractured my clavicle. I had terrible pneumonia and that is when this all started; two and half years ago. I also had severe chest pains, that turned out to be my third rib out of place. I had extensive physio to try and get my neck muscles and rhomboids relaxed and untwisted, but this front chest/shoulder pain is killing me. I also had extensive rotator surgery about 9 years ago now. I want to go back to physio but I can’t quite seem to be able to properly describe to them what this pain is. I’m so tired. Any advice is great advice. I’m a 45 year old female.
Hi Jacqueline, wow, you have (and are having) a very tough time! It sounds as if you are battling more than one issue here. A question – how do you know your third rib was out of place? I ask because if I were you I would want to systematically check/eliminate possibilities. The best way to do this would be to start with an MD and get some scans/x-rays done. I think physios and chiropractors can be awesome, but you sound like you’ve tried therapy over an extended time – with limited results. It’s possible that you are experiencing some form of thoracic outlet syndrome (due to compression in the upper chest/neck area), but you really need a medical professional to check that out. Hang in there, you just need to get systematic about resolving this. Dave
Hi Dave – thank you so much for your reply. My third rib problem was discovered/diagnosed by a new physiotherapist (at that time). He did a few things and used KT in the area for about 3 weeks, and I have not had problems with that specific area since. I have been told by physio people and massage people that my neck muscles tend to be quite tight. I actually have very good posture, especially as it applies to my head and shoulder positioning. I feel after reading your article and the posts/responses that I can perhaps explain this better, both to my doctor and perhaps to a physio person. In the meantime, I will actively work on stretching the scalenes as you’ve mentioned. When I do those stretches, I can feel that my bad side is much tighter than my good side, so perhaps this will help me to an accurate diagnosis and treatment. Thank you, thank you, thank you.
I was struck 3 years ago, Feb. 25th crossing the street. No broken bones, supposedly, all I had was “soft tissue” damage. Saw different doctors for over 2 years. They made me feel like crap and basically tell me I’m crazy.
I am currently doing PT for my first rib being out of place which seems to be causing my arm, numbness, pain (neck too), migraines, etc. I honest believe my issues are due to being struck. I’m having a difficult time proving this because when I started medical treatment it was cervical, then it was this and that, to now being psychosomatic – “supposedly”.
I’m so frustrated and NO one has really spent the time with me to explain or fully understand what I’m going through.
I was in pain for a year r so, after falling off a ladder while trying to fix a lamp in my room, and ever since, it has never been the same in my neck or shoulder! But thanks to this post and a bunch of other articles which I read, I am now totally free of pain! i found articles on this site. http://dislocatedrib.org/ it’s also totally worth a read.
Thanks for this info. I am currently dealing with this thanks to an injury at school from whiplash. Am seeing a physical therapist but still having some tingling in rt arm/hand. First rib misalignment discovered yesterday and put back in place…still having neck and shoulder pain though it is slowly improving. Hoping this won’t be a permanent issue now.
This has been the worst thing I’ve ever experienced and I have an insanely high pain threshold. Mine happened as a result of a car accident. My questions are as follows: is this something tang can be fixed permanently? My concern is that my pt pushes it down at appointments (most painful thing ever btw) but then as soon as I get back to life (a very careful and physically inactive life mind you) it seems to creep right back up. Now the other side is being affected as well and I’m all around miserable. My other question is, could my bed be the problem? I seem to be in more pain and have more issues when lying in bed than anywhere else? Literally, this is the worst thing I’ve ever experienced and I want it to be over!!
Hi Kalyn
That sounds awful. You really need to push for answers with a qualified health professional. If your PT is treating it, but the “fix” is only temporary, this is not a solution! If an accident caused the problem perhaps there are complications in play here. Have you had any scans to show exactly what is happening? It is almost impossible to tell what is causing your pain from behind a keyboard but there will be a doctor who can start you heading in the right direction. You may well need to fight for answers – hang in there.
Could be scar tissue as the body develoos this after injuries-my situtation- find someone qualified in Active Release Technique
I have a cervical rib also adding to the clogged environment in there. Solution after 3+ years of debilitation: Remove it. Wish me luck guys. I’ve tried everything else.
Hi all,
I totally sympathise with all of you. I am hopefully recovering from the same thing. A couple of weeks ago I had been working from home, sat at my desk all day and when I had finished i noticed I had a stiff neck. Then half an hour later I turned my head sharply (probably to shout at my children) and wham! I was in pain. But that seemed not too bad as I have cricked my neck washing my long hair in the shower before and it usually resolves after a couple of days on its own. However this stayed, then a few days later i was in agony. No doubt not helping is me sleeping on my left side…which is the side with the problem. So i carried on working, which is sitting at a desk and yes, no doubt with appauling posture (as i have diastasis recti from 2 large babies and a herniated disc between l5 and s1). So..wanting to cry continually with the trapped nerve down my left arm…I could not sleep or find any position which gave any relief. I was taking paracetamol…but was reluctant to take Ibuprofen as they affect my heart (increased Ventricular ectopics)….however i had to. I got an osteopath appointment on the Monday and he worked on my back etc. I was still in pain the following day. By the Wednesday it eased a little. Thursday had another appointment at which point he diagnosed it was the rib and manipulated my neck. Well it has done the trick…its 90% better, especially using ice and rest. I have another appointment next Thursday. However I am so scared now that i am going to do something and it will come back! I think posture and sitting at a desk is the cause. I really wish you all luck in getting a resolution because in my opinion the nerve pain was worse than a herniated disc!!
Is it possible that constantly stretching scalenes can pull the cervical rib upwards?
Hi Matt, it is unlikely. If you use sound stretching technique (start gently, hold the stretch, stretch further over time) it should only help reduce the tendency for scalenes to lift the first rib.
Dave
Dave, I’ve been trying to figure this out for years. I was in a motorcycle accident fractured my elbow, my acromion, and sprained my wrist and left ankle. I was put in a sling at the ER and was back working out a year later. When pressing some weights I felt a pop. Then pain. I saw 7 different orthopedic doctors over the next year. I finally went to the Mayo Clinic. The 7 doctors had all miss-diagnosed my very painful shoulder. The clavicle was broken in 3 places very distally. The ER had missed it and the sling allowed it to set, badly. Surgery helped but after having a broken collarbone for a year (which led to very bad posture) my first rib must have elevated. Every now and then it pops out. Thanks to you and your article I know what’s going on and how to correct it. THANK YOU!
Hi Andy, you may well be right. It sounds like your injury (and then mistreatment) could definitely put stress on the first rib. Best of luck sorting out the next step – sounds like you have the perseverance to get this resolved.
Hi there,
I have back/ shoulder issues. Does this cause the Rib to stick out of the chest as I have a raised bump on this rib towards the end of the rib near the centre of my chest? I am concerned about this or what could possibly be causing this?