this is from an article posted in the thread "1st PT appt" found here : http://http://neurotalk.psychcentral.com/thread47270.html

MODALITIES THAT OFTEN DON'T WORK AND CAN MAKE SYMPTOMS WORSE:
1. Strengthening exercises
2. Theraband use
3. Resistance exercises with machines
4. Neck traction
5. Exercises with weights
6. The concept of "No pain - No Gain"

I think the top rib can be mobilized a number of ways - the PTs always did the technique while I was sitting up and them behind pressing / pushing down, the chiro does more of a tweak thing when I am sitting or laying.

Thinking back on it, mine did pop up a few times, from certain uses, but I knew what it was right away and chiro was able to get it back down easily.

I suppose if TrPs are in the scalenes or SCM it would keep the muscles from totally releasing also.

chiro used some pretty firm thumb pressure/tension when he worked on my neck muscles and that was quite awhile before the top rib mob was tried by the PT.
I was off work by then and really focusing on doing the home stretches, TrP, rest and relax, heating pad, posture work...

1. Strengthening exercises (2-3 lb weights - upper back to improve posture)
2. Theraband use (yes - upper back to improve posture)
3. Resistance exercises with machines (yep again.. 3-5 lb - upper back to improve posture)
4. Neck traction (tried once. I think this set off massive neck/headaches 2 days after... didn't do again)
5. Exercises with weights (2-3 lb weights - upper back to improve posture)
6. The concept of "No pain - No Gain" (no, he doesn't want me to push through pain)

He is doing first rib mobilization. He said it is more mobile than when we began. It may be helping a little, but if so, not much.
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I've got an appointment Friday with a Neurologist who was referred to me by Dr. Noon (one of the vascular surgeons mentioned on this and other TOS sites). I'm hoping he can refer me to a pain management/physical medicine doctor who may be able to help manage the symptoms and monitor PT... maybe refer me to another physical therapist.