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NCT Number: NCT07064772

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

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.

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Key information

Conditions

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

Age range

18 year–75 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Lebanon Valley College

Annville, Pennsylvania, 17003, United States

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

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.

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.

Primary outcomes

  1. Range of motion

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

    Cervical and Shoulder active range of motion

  2. Pain Intensity

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

    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.

Secondary outcomes

  1. Global Rating of Change

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

    The GROC is a single-item measure that captures a patient's perceived change in their condition over time. It uses a 15-point scale ranging from -7 ("a very great deal worse") to +7 ("a very great deal better"), with 0 indicating "no change."

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Sponsors and collaborators

Lead sponsor

Andrews University

Other

Collaborators

  • Lebanon Valley College

Registry information

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Jul 15, 2025
Registry last updated
Jul 15, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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