Many people seek care from a chiropractor for neck pain. After all, it’s one of the most common conditions we treat. Sometimes, however, the reason your neck hurts is not due to the neck itself but rather something else close by: the first rib.
The first rib is just that…it’s the rib that is highest up and close to your neck. It goes from the T1 vertebra (the vertebra just below the ‘cervical’, or neck, vertebrae) to the upper portion of the sternum, on the front side. The clinical importance of the first rib (in this case) is that it has two very important muscles that attach on it. Those muscles are the anterior and middle scalenes muscles.
Why are these muscles important? Well, mechanically, when they contract on one side, they flex the neck a bit to the same side and elevate the first rib. They are also important because the brachial plexus, or the nerves, arteries, and veins that go to your arm and shoulder region, go between these two muscles. Should the first rib be fixated, or not move properly, this creates problems with neck movement and it can create neurological problems as well. If the scalenes were either too tight or too loose, this could be an issue.
It is essential to be sure that your first ribs (left and right) move properly so as to ensure proper function of the scalene musculature. Being the first rib is seldom, if ever, evaluated, it is often missed as a major contributor to neck pain and dysfunction. When this occurs, the treatment to the cervical spine is not warranted and this can create other problems. After all, we should be treating the musculoskeletal dysfunction, not treating areas that are not truly involved.
Although there is a way for a properly trained chiropractor to assess motion of the first rib to determine if it needs to be manipulated, in most cases, all one has to do is look up and over a shoulder. For example, if we want to see if the right first rib could be fixated (not moving properly), the patient would extend their head (lookup) and rotate the head to the left while laterally flexing the head to the right a little. An inability to achieve proper movement when performing this motion many times is indicative of a first rib fixation. In addition, the patient will likely feel stiff and sore in the area of the first rib (base of the neck on either side). Of course, there is a hands-on movement assessment to confirm this when the doctor is working with the patient, but more times than not, when you are unable to perform this movement, the first rib is fixated, or stuck. As stated earlier, a problem in this area can also have a hand in some neurological issues, but we’ll save Thoracic Outlet Syndrome for another discussion.
Treatment for a first rib fixation involves manipulation (an adjustment) of the articulation along the vertebra. Only through this approach can movement of the first rib be restored. Of course, the patient, with the chiropractor’s help, might need to work on postural patterns so as to address why the first rib is getting fixated in the first place. However, first by re-establishing proper joint movement, the involved anterior and middle scalene musculature can again regain their proper normal resting length. This means they will no longer be under stress from trying to make up for the lack of motion of the first rib, and this means that they’ll function normally again.