First Rib Mobilization for Shoulder Pain

Overseen By Joseph R Hribick, Doctor of Physical Therapy

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Andrews University

Disqualifiers: Rotator cuff tear, Spurling's test, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 1 session

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a hands-on physical therapy technique, called first rib mobilization, can quickly ease shoulder pain and improve movement. Participants will receive either this therapy or a placebo version that resembles the treatment but does not target the rib, to compare results. The trial seeks individuals experiencing shoulder pain, currently undergoing physical therapy, and finding their pain disruptive in daily life. As an unphased trial, it offers a unique opportunity to explore innovative therapy techniques that could enhance the physical therapy experience.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that first rib mobilization is safe for individuals with shoulder pain?

Research has shown that first rib mobilization is usually well-tolerated. In studies using this method, people with shoulder pain often experienced less pain and improved mobility, without major side effects. No reports have linked serious problems directly to this therapy, suggesting that first rib mobilization is safe for treating shoulder pain. However, as with any treatment, individual experiences may vary, and discussing any concerns with a healthcare provider is always advisable. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about first rib mobilization for shoulder pain because it offers a hands-on, non-invasive approach that targets a specific area often overlooked in traditional treatments. Unlike standard care options like anti-inflammatory medications, physical therapy focusing on general shoulder exercises, or even corticosteroid injections, this technique specifically addresses the first rib's potential role in shoulder discomfort. By mobilizing the first rib, it may relieve pressure and improve shoulder mechanics, potentially offering relief more directly and effectively than broader treatment methods.

What evidence suggests that first rib mobilization is effective for shoulder pain?

Research has shown that moving the first rib can help reduce shoulder pain and improve movement. One study found that participants experienced a 51% decrease in shoulder pain and improved shoulder movement after treatment. Another study discovered that combining rib movement with exercise enhanced shoulder function and pain, demonstrating benefits beyond a placebo effect. In this trial, participants in the First Rib Mobilization Group will receive this treatment to assess its effectiveness. Meanwhile, the Sham Mobilization Group will receive a sham treatment to determine the true impact of rib mobilization. These findings suggest that first rib mobilization might help people with shoulder pain feel better and move more easily. ^{1 2 3 6 7}

Are You a Good Fit for This Trial?

This trial is for individuals experiencing shoulder pain. Participants will undergo a single session of physical therapy where they'll receive either first rib mobilization or a sham treatment, which mimics the real technique without actual mobilization.

Inclusion Criteria

My arm, shoulder, and hand function is over 16% impaired.

I am either a man or a woman.

I am currently attending physical therapy.

Exclusion Criteria

I have had surgery on my shoulder or neck.

Positive MRI findings of a complete rotator cuff tear

Positive Spurling's test

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive either first rib mobilization or sham mobilization during a single session of physical therapy

1 session

1 visit (in-person)

Follow-up

Participants are monitored for immediate effects on pain and range of motion after treatment

Immediate

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• First Rib Mobilization
• Sham Comparator

Trial Overview

The study aims to determine if one session of first rib mobilization can immediately reduce pain and increase range of motion in patients with shoulder pain, compared to a sham procedure that does not involve actual mobilization.

How Is the Trial Designed?

Group I: First Rib Mobilization Group Experimental Treatment 1 Intervention

Participants in this arm will be randomly assigned to receive a first rib mobilization on their affected side of shoulder pain by a licensed physical therapist.

Group II: Sham Mobilization Placebo Group 1 Intervention

Participants in this arm will be randomly assigned to receive a sham mobilization to the region of the first rib on their affected side of shoulder pain by a licensed physical therapist.

Who Is Running the Clinical Trial?

Andrews University

Lead Sponsor

Trials

4

Recruited

120+

Lebanon Valley College

Collaborator

Trials

1

Recruited

250+

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8183555/

First rib dysfunction in patients with neck and shoulder pain

This Delphi study produced a cluster of clinical tests aimed to identify first rib dysfunction in patients with neck and/or shoulder conditions.

2.

clinicaltrials.gov

clinicaltrials.gov/study/NCT07064772?term=AREA%5BBasicSearch%5D(AREA%5BBasicSearch%5D(AREA%5BBasicSearch%5D(AREA%5BConditionSearch%5D(%22Shoulder%20Pain%22))))&rank=4

The Immediate Effects of First Rib Mobilization on Pain and ...

The purpose of this clinical trial is to examine whether one session of a specific manual physical therapy technique, known as first rib mobilization, can lead ...

3.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC2813499/

The Immediate Effects of Thoracic Spine and Rib Manipulation ...

Post-treatment effects demonstrated a 51% (32mm) reduction in shoulder pain, a corresponding increase in shoulder range of motion (30°-38°), and a mean patient- ...

4.

sciencedirect.com

sciencedirect.com/science/article/pii/S1836955324000857

In people with shoulder pain, mobilisation with movement ...

Adding MWM to exercise improved function, pain and active range of movement in people with shoulder pain. These benefits were not placebo effects.

5.

jospt.org

jospt.org/doi/10.2519/jospt.2011.3440

The Effect of Therapeutic Exercise and Mobilization on ...

Therapeutic exercise is an effective intervention for patients with shoulder dysfunction, which is often supplemented by joint mobilization techniques.

6.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/32956019/

First rib dysfunction in patients with neck and shoulder pain

This Delphi study produced a cluster of clinical tests aimed to identify first rib dysfunction in patients with neck and/or shoulder conditions.

7.

clinicaltrials.gov

clinicaltrials.gov/study/NCT07036887

Effectiveness of 1st Rib Mobilization and Scalene Muscles ...

Manual therapy techniques like first rib mobilization and scalene MET are believed to restore upper thoracic mobility, reduce muscle tightness, and optimize ...