Treatment Considerations for Thoracic Outlet Syndrome (TOS)
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.
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.
- 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
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.
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
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
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..
twists on the floor are the types of yoga poses that helped my TOS
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
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.
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