|Body Region:||Upper Ribs|
|Conditions Associated with TPs:||Top of shoulder pain, Neck pain, Headache|
|General Symptoms:||The most common symptom is pain at the base of the neck or upper shoulder, especially when tilting the head back and turning it to the painful side. In fact, this is generally diagnostic of an upper rib sprain/strain.|
|Common Causal Activities:||In a case history there is usually no history of trauma. Most often a person will state that it either came on gradually over time or came on suddenly in the morning with no reason (reaching for a drawer, stepping into a shower). The actual cause is a stretch placed on the joint between the rib and the vertebrae while a person sleeps on their side with their upper arm under their head as a pillow and continued long enough to cause minor damage to the ligament structure. The body will react to this minor damage with muscle spasms, abnormal tension across the joint and reduced movement of the joint.|
TPs are generally found in the back of the ribs about one inch from the spinous processes (bumps along the spine). Usually they will be along the first few ribs (top few inches of the shoulder) to about the bottom of the scapula.
Using tennis ball therapy works for those lower than the top of the shoulder. Using a hook tool can work on the upper ribs and top of the shoulder near the neck. Occasionally TPs will be found in the front of the rib near the sternum (breast bone) high and just under the clavicle (collar bone). Often there will be intercostal muscles (between the ribs) that develop TPs with this condition. See Detailed Instructions.
|Therapist Care:||Use a hand squeeze for the top of the shoulder, a double thumb post or reinforced finger tip for the anterior rib, a braced lateral 3 fingertip position for the intercostals and a double thumb post for the posterior paraspinals.|
This condition is a very common one which is very seldom caught by most doctors.
Unfortunately, TPT by itself is not enough for this condition. A doctor well trained in manipulation or adjusting of the body joints needs to do a special adjustment for the rib. This is not well done by many doctors or therapist that do adjusting. The key is a contra lateral bilateral thrust of the head and rib with the line of drive along the plane of the rib instead of posterior to anterior as is often incorrectly done. The hand on the rib should be flat and the force should be transferred through the fingers not the heel of the hand.
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