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For clients with Thoracic Outlet Syndrome, there may be compression of nerves between the clavicle and the first rib. This release helps to create more space for the nerves by allowing the first rib to move inferiorly. I use this in conjunction with other techniques including work on the scalenes and pectoralis minor.
Stand at the head of the table with your client lying on their side. With your outside hand passively bring your client’s shoulder toward their ear. Contact the first rib (inferior to the clavicle) with the fingers of your inside hand and push the rib in an inferior direction. Then with the thumb of your outside hand palpate the first rib between your client’s scapula and spine, then press inferior.
Have your client inhale, then on the exhale push the rib in an inferior direction with both your fingers and your thumb. Ask your client to raise their shoulder toward their ear before inhaling. Maintain an inferior pressure on their first rib as they raise their shoulder.
The intention is to create space between the clavicle and the first rib by having your client raise their clavicle while you hold the first rib in place.
Tightness in the scalene muscles can pull the first rib up, so this technique works well in conjunction with work to release the scalenes and pectorals minor.
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