Just to prove that we are always learning, the term “elevated first rib” has now joined our vocabulary. Why you ask? Because that’s what the chiropractor said was behind our recent episode of a very sore neck! And by sore, we mean debilitating, agonising, and life disrupting pain . . .
The First Rib Explained
The first rib is exactly that – the first true rib at the top of your chest. It sits just below your collarbone and is held in place by a series of supporting muscles.
From the top, the first rib is held in place by the scalene muscles which run up the side of your neck. They tend to pull the rib upwards. Working in opposition, the intercostal muscles that lie between ribs have a tendency to pull the first rib down. A balance is needed between these two muscle groups to keep the first rib in its proper position. When the balance is uneven, the position of the first rib can shift.
So What is an Elevated First Rib?
In physical terms an elevated first rib occurs when the rib moves up out of its proper alignment. In functional terms, it hurts! The pain comes from the misalignment (vertical) which tends to squash various veins, arteries, and nerves between the rib and your collarbone. The nerve bundle that sends sensation to your arm and hand (brachial plexus) as well as the arteries and veins that feed the arm pass directly over the first rib and under the collarbone. Real problems can occur if the first rib becomes locked into that position.
The other way that an elevated first rib can cause you distress is that it completely misaligns your upper body. This leads to neck, arm, shoulder, and back pain as all body systems are interdependent and any piece that is out of place stresses the surrounding structures.
What Causes an Elevated First Rib?
The scalene muscles are very strong as they must support your head on top of your spine. The head is a potentially unstable weight and considerable strength is needed to support it. This power means they have the ability to pull the first rib upwards if they become shortened, or inflexible. They are involved in most cases of elevated first ribs.
The usual cause for the rib rising up and staying there is poor posture over time. In the modern, sitting based world that many of us live in, it is all too easy create imbalances in our posture. A closely associated condition is having a forward head posture. When these behaviours are repeated over time, the fascia (membrane surrounding the muscle) around the scalene muscles will become thicker, less flexible, and shorter. This reduces the length of the scalene muscle group and will lift the first rib up, pinching or crushing the nerves and blood vessels in the area. However, it is also possible to end up with a raised first rib due to injury, and anyone who habitually holds their shoulders up through emotional tension is at risk too.
From a recent, personal perspective, if your rib is elevated and stuck there, you are going to want it released as soon as possible! This is where you probably need a professional (unless very minor). In my case, my chiropractor managed to manipulate the offending rib back into position with a bit of skilled effort. Once back in place, you want it to stay there.
Unless you address the causes of the rib elevating, any fix will be temporary. You need to reflect carefully on the way you sit – at home and at work. It is highly likely that your posture needs to be adjusted so that you maintain a balance in the key muscles. A posture coach like the Lumo Lift will be helpful. Some other good starting points include:
1. Regularly stretch your scalene muscles to counter any shortening or tension
2. Critically assess the way you are sitting
3. If regularly carrying a weigh, look for balance in the way you do it
This one is fairly common sense – keep any weight close to your body and regularly swop sides if the weight can’t be carried centrally.
4. Try to generally correct your posture
We have written a large number of posts on this topic. The bottom line is that postural imbalances – particularly those that lead to tension in your neck – create the risk of you developing an elevated first rib. A couple of posts that may be helpful are: 38 Posture Tips That Actually Work and Anterior Pelvic Tilt.