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Treatment Considerations for Thoracic Outlet Syndrome (TOS)

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TOS Treatments That Helped Me

  • In my case there was a fine line between physical therapy (PT) that helped my TOS and PT that irritated it too much. When the PT was just right it would loosen up my shoulder and I would gain more pain free movement. If I over did things, my whole arm would go numb and I couldn't even drive myself home from the physical therapist's office. If I over did things, sometimes I used to have to lie still on the floor on my physical therapists office with a cold pack on my shoulder until the irritation went away and I before I could regain enough use of my left arm and hand to drive home. For most of my fibromyalgia pain problems, heat packs usually worked the best, but for the TOS cold packs were what helped the most, especially whenever my hand and arm went numb.

  • Since my TOS was caused in part by an elevated shoulder with a big muscular knot in the middle of it, one of the main things that helped me was to put hot packs and massage the shoulder knot daily to try to get it smoothed out. Some people who have TOS from an extra rib have to have surgery to have the rib removed. Until I saw an x-ray of my rib cage, I thought I had either an extra rib or a pushed up rib because the muscles in my shoulder were so tight and solid it felt like there was bone there. But to my surprise, the x-rays didn't show any bone structure in my elevated shoulder, meaning the hard substance I could feel was just a big knotted muscle.

  • I have a hard foam roller that I got from my physical therapist. I lay on it lengthwise and roll from side to side like a rolling pin. It pushes my shoulder back and is a great antidote to being hunched forward over a keyboard all day.

  • Nutritional deficiencies, especially those of magnesium, can cause tight muscles which I think were a factor in my TOS. Many medical web sites mention a link between TOS and anxiety and depression, and I suspect a logical reason for the link is that all three condition may be exacerbated by magnesium deficiencies.
  • This article from the emedicine site has some pretty good treatment ideas for TOS.

  • When I would go for a walk sometimes my TOS would act up. My physical therapist said this was from my arm pulling down on the nerve bundle. He told me to walk with my arms supported, like putting them in my jacket pocket. I tried that and it worked great.

Exercises and Tips

I suspect that the exercises for TOS probably depend a lot on the root cause. In my case a main factor was an elevated shoulder from scoliosis. So the simple answer for TOS exercises is that because your shoulder area hurts that is where you should stretch and focus your exercises. The human body is complicated, however, and a simple solution may not be sufficient to solve a complex musculoskeletal problem.

My rheumatologist told me that my left shoulder was elevated because it was "holding up the left side of my body". When he said that to me, it was one of those profound, light bulb turning on moments in my brain. My left shoulder was higher and taut because my right shoulder was getting pulled down by a big knot in my right leg.

So if I had only worked at getting out the knot in my left shoulder and not finding out what caused the knot to begin with, my thoracic outlet syndrome would not have improved. I understand that is it is unconventional thinking to get a knot out of your leg to improve your shoulder pain, but if you think about it, it is is highly logical. Doctors often treat people like they are made of car parts where you can replace one part and not effect the structure and balance of the remaining parts. However, humans aren't built like cars. We're stacked more like a house of cards or a Jenga game. The structure of our bones, ligaments and muscles are to some extent interdependent upon the structure of the surrounding body parts.

Most books on thoracic outlet syndrome, and other conditions often labeled repetitive stress injuries, only have exercises for the arms and shoulder. So for people like me, and I suspect many others with overall body alignment problems, they didn't help that much. A good book that does take a whole body approach is Pain Free at Your PC by Pete Egoscue.

woman doing yoga frog pose

If traditional TOS treatments aren't working for you, give yoga a try. It is a mistake to think you only need to stretch where it hurts. Yoga works the whole body and helps to balance out uneven muscles.

Most of the exercises in his book are based on yoga poses, which I found to be very helpful for thoracic outlet syndrome and many of the other related conditions that I had. As with the other books I recommend, I don't do every pose in this book, but I'm working up to the point where I can do all of the exercises without pain.

The exercises that helped my TOS the most from this book were:

Gravity Drop - p. 51 - this helped to stretch out my calf muscles so they weren't pulling on my upper body.

Static Wall - p. 52 - this also helped to reduce tension in my legs, which in turn reduced tension in my upper body.

Sitting Floor Twist - p. 65 - my torso used to have a slight twist to the right, which I think is part of the reason my left shoulder is so tight. The muscles in my right shoulder were overdeveloped from the constant tension of the twisted torso. The twisting poses like the ones in this book really helped me to stretch out my shoulder muscles by counter twisting to the left. I do the pose in both directions, but I hold the left twist a bit longer..

woman doing spinal twist yoga post   Spinal twists on the floor are the types of yoga poses that helped my TOS the most.

Upper Spinal Floor Twist - p. 69 - this is probably the one most helpful pose I found for my TOS. I twist my legs to the right and stretch out my arm to the left, and for me it really helps reduce tension in my left shoulder area. When I'm on the PC and my shoulder starts to hurt, this is the first exercise that I do.

All of the office therapy exercises starting on page 73 are also pretty good.

Standing Spread Foot Forward Bend - p. 145 - this pose helped both my scoliosis and TOS.

Return to => Part I





Related sections of interest:

Natural Treatments for Fibromyalgia

My Personal Causes of Neck Pain

Thoracic Outlet Syndrome Defined

What Causes TMJ?


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