This randomized controlled trial aims to evaluate the effectiveness of first rib mobilization and scalene muscle energy technique (MET) in improving respiratory function and reducing symptoms in patients with asthma. Asthma is a chronic inflammatory condition of the airways characterized by bronchoconstriction, airway hyperresponsiveness, and mucus overproduction, often leading to respiratory difficulty and increased use of accessory muscles such as the scalene.

Manual therapy techniques like first rib mobilization and scalene MET are believed to restore upper thoracic mobility, reduce muscle tightness, and optimize breathing mechanics. In this study, 47 asthmatic patients will be randomly assigned into two groups: Group A will receive first rib mobilization combined with respiratory physiotherapy, while Group B will receive scalene MET along with the same physiotherapy protocol. Treatment will be administered three times a week for four weeks.

Inclusion Criteria:

• Both male and female age range: 18-65 years.
• Diagnosed with asthma according to the Global Initiative for Asthma criteria.
• Presence of musculoskeletal symptoms; Complaints of chest tightness, neck stiffness, or restricted upper thoracic mobility, often associated with dysfunctional breathing patterns.
• Ability to provide informed consent and comply with the treatment protocol.

Exclusion Criteria:

• clinically unstable or had a neuromuscular disease, unstable cardiovascular disease, or musculoskeletal disease that may interfere with exercise
• History of thoracic or cervical spine surgery, trauma, or fractures
• Pregnancy or postpartum status
• Rheumatologic diseases, a history of musculoskeletal trauma, or musculoskeletal malformations.