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

NCT07064772 | Not Yet Recruiting

• 1 other identifier: 25-095
• Study Type: interventional
• Target: 64
• Locations: 1 country
• Sites: 1

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

Keywords

Manual Therapy; Physical Therapy; First Rib; Joint Mobilization; Shoulder Pain

Outcome Measures

Primary Outcomes (2)

• Range of motion

  Cervical and Shoulder active range of motion

  Cervical and shoulder active range of motion will be assessed in participants in both groups at baseline and immediately following the intervention

• Pain Intensity

  Pain Intensity will be assessed via the Numeric Pain Rating Scale (NPRS). On this scale, zero is equivalent to no pain and 10 indicates the worst possible pain.

  Change in pain intensity from baseline to immediately following intervention in both groups

Secondary Outcomes (1)

• Global Rating of Change

  This will be administered to participants in both groups immediately after intervention

Study Arms (2)

First Rib Mobilization Group

EXPERIMENTAL

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.

Other: First Rib Mobilization

Sham Mobilization

SHAM COMPARATOR

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.

Other: Sham Comparator

Interventions

First Rib Mobilization 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.

First Rib Mobilization Group

Sham Comparator 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.

Sham Mobilization

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

• 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

Sponsors & Collaborators

• Andrews University: lead
• Lebanon Valley College: collaborator

Study Sites (1)

Lebanon Valley College

Annville, Pennsylvania, 17003, United States

Location

MeSH Terms

Conditions

Shoulder Pain

Condition Hierarchy (Ancestors)

Arthralgia; Joint Diseases; Musculoskeletal Diseases; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Joseph R Hribick, Doctor of Physical Therapy

CONTACT

717-538-0786; hribick@andrews.edu

Elizabeth Oakley, Doctor of Health Science

CONTACT

269-471-6301; oakleye@andrews.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 7, 2025
• First Posted: July 15, 2025
• Study Start: July 14, 2025
• Primary Completion (Estimated): July 30, 2026
• Study Completion (Estimated): July 30, 2026
• Last Updated: July 15, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR
• Time Frame: Data will be available beginning 3 months following publication and will remain available for 5 years.
• Access Criteria: Access will be granted to qualified researchers with a methodologically sound proposal, subject to approval by the study investigators. Proposals should be submitted to the corresponding author.

Locations

US (1)