The Immediate Effects of First Rib Mobilization on Pain and Range of Motion in Patients With Shoulder Pain

NCT ID: NCT07064772

Last Updated: 2025-07-15

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 64 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-07-14
• Study Completion Date: 2026-07-30

Brief Summary

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 to immediate improvements in pain and movement in individuals with shoulder pain. We hypothesize that this single treatment will result in reduced pain and increased ability to move the shoulder and neck. Researchers will compare first rib mobilization to a sham mobilization (a look-alike hands-on position that does not mobilize the first rib) to see if first rib mobilization works to immediately reduce pain and improve movement in patients with shoulder pain.

Participants will receive first rib mobilization or a sham mobilization during a single session of physical therapy and will receive pre and post intervention measurements of their pain levels and neck and shoulder range of motion.

Conditions

Shoulder Pain

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

First Rib Mobilization Group

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 Type: EXPERIMENTAL

First Rib Mobilization

Intervention Type: OTHER

Participants in the mobilization group will receive either a seated or supine three stage progressive muscle energy technique (MET) plus a singular high-velocity, low-amplitude thrust (HVLAT) mobilization technique directed to their first rib on their symptomatic side based on the discretion of the treating physical therapist.

Sham Mobilization

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.

Group Type: SHAM_COMPARATOR

Sham Comparator

Intervention Type: OTHER

Participants in the sham mobilization (control) group will be placed in a supine, hook-lying position identical to the mobilization group; however, they will be instructed to inhale and exhale 3 times using diaphragmatic breathing (avoiding upper chest recruitment) as the physical therapist gently rests his or her hand over the area of the upper trapezius muscle just proximal to the first rib to simulate a sham mobilization hand placement. Therefore, physical therapists will not use any significant compressive force to the musculature, perform any tactile cueing for upper chest breathing, perform any mobilizations, nor perform any HVLAT techniques to participants in the sham mobilization group.

Interventions

First Rib Mobilization

Participants in the mobilization group will receive either a seated or supine three stage progressive muscle energy technique (MET) plus a singular high-velocity, low-amplitude thrust (HVLAT) mobilization technique directed to their first rib on their symptomatic side based on the discretion of the treating physical therapist.

Intervention Type: OTHER

Sham Comparator

Participants in the sham mobilization (control) group will be placed in a supine, hook-lying position identical to the mobilization group; however, they will be instructed to inhale and exhale 3 times using diaphragmatic breathing (avoiding upper chest recruitment) as the physical therapist gently rests his or her hand over the area of the upper trapezius muscle just proximal to the first rib to simulate a sham mobilization hand placement. Therefore, physical therapists will not use any significant compressive force to the musculature, perform any tactile cueing for upper chest breathing, perform any mobilizations, nor perform any HVLAT techniques to participants in the sham mobilization group.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Men and Women
• Ages 18-75 years old
• Attending physical therapy
• Primary complaint of shoulder pain
• Pain intensity >3/10 on the Numeric Pain Rating Scale (NPRS)
• A Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick DASH) score greater than 16% impaired

Exclusion Criteria

• Previous shoulder or neck surgery
• Clinical signs of a full rotator cuff tear (positive drop arm test)
• Having positive MRI findings of a complete rotator cuff tear
• Having a positive Spurling's test
• Having a steroid injection in the cervical spine and/or shoulder in the last two months
• Having any red flags (history of cancer, upper motor neuron disorder, fractures, osteoporosis, acute inflammatory process)
• Expressing fear/anxiety related to receiving manual therapy treatment

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 75 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Lebanon Valley College

UNKNOWN

Sponsor Role: collaborator

Andrews University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Lebanon Valley College

Annville, Pennsylvania, United States

Countries

United States

Central Contacts

Joseph R Hribick, Doctor of Physical Therapy

Role: CONTACT

hribick@andrews.edu

717-538-0786

Elizabeth Oakley, Doctor of Health Science

Role: CONTACT

oakleye@andrews.edu

269-471-6301

Facility Contacts

Michael L Fink, Doctor of Science

Role: primary

fink@lvc.edu

717-867-6847

Joseph R Hribick, Doctor of Physical Therapy

Role: backup

hribick@andrews.edu

717-538-0786

Other Identifiers

25-095

Identifier Type: -

Identifier Source: org_study_id