Body Region: Thoracic Spine |
Technique Name: 1st Rib Thrust Manipulation
Indications: mechanical neck pain (MNP), cervical radiculopathy (CR), thoracic pain, shoulder pain |
Instructions: |
Patient Position: |
- The patient is seated in the center of the treatment table with their legs hanging over the side.
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Clinician Position: |
- Stand behind the patient with one foot on the plinth and your thigh next to the patient’s unaffected side
- The patient’s arm is supported on the your thigh (this takes tension off the brachial plexus)
- Gently place your contralateral hand on the patient's head, with your elbow resting gently across the contralateral upper trapezius and clavicle.
- Gently push your hip into the patient’s back, which will force the spine into slight extension.
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Technique Description: |
- Using the 2nd metacarpo-phalangeal (MCP) joint on the ipsilateral hand, the locate the shaft of the 1st rib. A lumbrical grip (MCP flexion and IP extension) is maintined on the 1st rib by moving the trapezius posteriorly.
- The patient’s head is side-bent toward the affected side and rotated away
- Impart a gradual, progressive mobilizing force to the patients 1st rib to produce depression. The direction should be toward the midline of their body.
- When the restrictive barrier is engaged, deliver a high-velocity, low-amplitude thrust inferiorly and towards midline. (attempting to reach the opposite axilla).
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Key Points: |
- Use your entire body to translate the patient's cervical / thoracic spine until the restrictive barrier is engaged
- Ensure the patient can tolerate the pressure you are applying with your manipulating hand prior to thrusting
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