April 10, 2018

First Rib Release

4.8 (96.25%) 16 votes


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. This also stretches the subclavius muscle which goes from the first rib to the clavicle and helps to depress the clavicle, drawing it inferior and anterior.

This technique is a stretch using your client’s breathing and movement and is not an adjustment.

Subclavius Muscle

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I use this in conjunction with other techniques including work on the scalenes and pectoralis minor. If you stretch the scalenes without first releasing the first rib, you can pull the first rib up into the clavicle aggravate the symptoms of Thoracic Outlet Syndrome.

Symptoms of Thoracic Outlet Syndrome include pain, tingling or numbness radiating down to the 4th & 5th fingers, and the hands falling asleep while sleeping or when the arms are held up to shoulder level or above.

This technique can also help with an elevated clavicle. I had a client with shoulder and neck issues that had one clavicle higher (more superior) than the other. After using this technique on the elevated side her clavicle came down so that both clavicles were level.


Have your client lying supine. 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 pull in an inferior direction.

Have your client inhale, then on the exhale pull both your client’s arm and their first rib in an inferior direction. 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. I ask clients to raise their shoulder before they inhale because inhalation will cause the first rib to raise and we want to keep it down to get a good stretch.

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 pectoralis minor.


Related Techniques:

First Rib Release Side Lying
Thoracic Outlet Syndrome
Soft Tissue Release – Scalenes
Soft Tissue Release – Pectoralis Minor
Scalene Stretch
Scalene Side Lying Variation
Anatomy – Scalenes