First Rib Manipulation (supine)

Position of the therapist:

• Standing at the opposite side of the rib to be manipulated facing in cranial direction

Position of the patient:

• Supine crook lying position close to the edge of the bench
• Arms folded in front of chest with the arm on the side of the examiner being lower and wrapped tightly around the thorax to create pre-tension

Hand placement:

• Make a fist without enclosing the thumb in the hand
• Place thenar aspect over the first rib (2-3cm laterally from C7)
• Therapist’s other hand fixates patient’s elbows together

Thrust:

• Patient is rolled over the therapist’s fist
• Patient exhales and performs a bridge
• Therapist applies a high-velocity low amplitude thrust in dorso-lateral direction using the trunk