If you have Thoracic Outlet Syndrome, is stretching helpful? Let’s take a quick look at what Thoracic Outlet Syndrome is and see if stretching is actually beneficial. I have TOS myself and I’ll share what I do to manage my symptoms as well.

What is Thoracic Outlet Syndrome (TOS)?

Also called brachial plexus syndrome, TOS occurs when the nerves or blood vessels are compressed by the rib, collarbone or neck muscles at the top of the outlet. The thoracic outlet is the ring formed by the top ribs, just below the collarbone.

Types of Thoracic Outlet Syndrome

There are 3 types of Thoracic Outlet Syndrome:

1. Neurogenic TOS. This occurs when the nerves leading from the neck to the arm (the brachial plexus) are compressed. This type is the most common.

2. Venous TOS. Occurs when a vein is compressed, leading to upper body thrombosis.

3. Arterial TOS. Occurs when an artery is compressed.

In this article we’ll discuss Neurogenic TOS as more than 90% of cases are this type. If you’d like more detailed information on the TOS, please check out this John Hopkins Medicine page about TOS.

Common Symptoms of Neurogenic TOS

When I first got TOS, I started waking up with tingling fingers and progressed to being unable to grasp items. It was really scary! Luckily I had an awesome physical therapist who gave me exercises and techniques for reducing my symptoms. Changing patterns of movement helped as well.

These symptoms can come and go but because holding things up (even just your arm in the air!) can increase symptoms, it’s easy to make the symptoms worse. Symptoms generally are:

• Tingling or discomfort in the fingers

• Pain or weakness in the shoulder and arm

• Arm that tires quickly

Combining TOS and hypermobility spectrum disorder (HSD) can make diagnosis and treatment a challenge.

Treatment for Neurogenic TOS

The success of any treatment depends on how it’s received by the particular body but these are the top 3:

1. Physical Therapy is your first line of defense! It’s a great starting place as it’s relatively easy to integrate into your life and more budget-friendly and body-friendly than other treatments.

2. Botulinum toxin (Botox) injections are sometimes effective. However, some people are allergic to Botox so this doesn’t work for them. Botox is usually not a long-term solution.

3. Surgery is a possibility if injections and physical therapy don’t work. This could look like cutting small muscles of the neck or removing a rib.

By now we know that treatments for Thoracic Outlet Syndrome are very individualized. They depend on:

• the type of TOS

• whether a person has co-morbidities, such as a hypermobility spectrum disorder

• price of treatment

• insurance coverage, and more

Muscular Compression - Potential Causes

In this blog, we’re focusing on muscular compression relief. Compression of the nerves or blood vessels by muscles can happen when the muscles around the front of the shoulder and in the arms get ‘tight’ - this may happen from:

• working out

• repeated motions such as in swimming or careers like hairstyling where the arms are in motion frequently

• holding the shoulder and neck areas in an unmoving position for long periods of time

Exercise for TOS Symptom Relief

There are 3 symptom relief techniques that I use and recommend to clients:

1. Mobility work

2. SOFT foam roller work

3. Shoulder support

I never recommend stretching to my clients.

Why do I not recommend stretches for Thoracic Outlet Syndrome?

There are 3 main reasons why I don’t recommend stretches for Thoracic Outlet Syndrome.

1. Hypermobility: Most of my clients have a joint hypermobility syndrome such as hEDS or HSD. This means that it can be difficult for them to feel a stretch or target a stretch in their body. And stretching may increase the chance of a subluxation or dislocation.

2. Muscle tension is a sign that the nervous system feels that area needs some muscular support. Attempting to lengthen (‘stretch’) a very contracted (‘tight’) muscle could potentially tear the muscle or cause it to tighten more. This could lead to increasing the tightness in the area and perhaps increasing nerve or vein compression.

3. My physical therapist said no. ;)

Soft foam roller exercises for TOS relief

Use a SOFT (this is important!!) foam roller to gently compress and release the muscle tissues down the arm and shoulder. The compression also allows the tissues to pull in and release necessary fluids, like a sponge. The roller exercises below have made the biggest change in TOS symptoms for myself and many of my clients. Again it depends on your body - for some people it makes their symptoms worse so they choose another option.

The soft foam roller I use is OTPT Pro brand. It’s half size so not as expensive as the regular size, and also of great quality. Here are the details on Amazon.

The specific exercises I recommend to clients are available on my YouTube channel: Pilates for Hypermobility. I’ve linked two videos below for Thoracic Outlet Syndrome foam rolling.

Mobility Exercises for TOS

I recommend a gentle circling of the arms to slowly regain some movement in shoulder muscles that might be tight and reluctant to move. Here are written instructions for the exercise:

1. Start with palms together in front of your heart.

2. Keep palms together as you raise your elbows to approximately the same height as your shoulders.

3. Separate your hands about shoulder distance apart, then lower your elbows and bring your hands together in front of your lower ribs.

4. Continue gently circling in this direction a few times, then change direction.

Breathing exercises can be beneficial as well, although again that depends on the body and mobility of your ribcage. It’s best to start very gently.

1. Lie down in a comfortable position. Make sure your breath stays gentle and easy for this exercise.

2. Place your opposite hand on the front of the affected shoulder (where your pec minor is in the picture above). You could also use a weighted small pillow or ball if your opposite shoulder doesn’t like this position.

3. As you inhale, imagine you are gently expanding into the weight of your hand.

4. As you exhale, lengthen your exhale a little bit more than normal, and let the weight if your hand soften into your shoulder tissues.

Shoulder Support Position for TOS Symptom Relief

Sitting on the couch with your forearm and elbow supported by pillows can give your shoulder muscles some relief from having to hold your arm in your shoulder socket against gravity all day long!

Thoracic Outlet Syndrome Symptom Relief is Possible!

Neurogenic TOS symptoms can be puzzling and scary for some people. But for many, the symptoms can be managed so you can continue doing your regular activities. Maybe not to the same degree that you did before, and you’ll have to be more thoughtful about the movements and time spent, but with some effort you will make progress.

Not how to get started? Book a Discovery Call with me and let’s chat about what you’re looking for!

-Nicole