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June 09, 2021 9 min read

In the world of fitness and sport, injuries are unfortunately not uncommon. Thoracic outlet syndrome is one of such many conditions. If you often experience arm pain, back pain, numbness, or a weak upper body, it is possible you suffer from thoracic outlet syndrome. 

In addition to those who lead an active lifestyle, those of us who work from home and spend a lot of time slouched at a desk are also at risk for developing thoracic outlet syndrome.

To both help and prevent TOS, strengthening the thoracic spine and improving posture are top priorities.

Medical illustration to explain Thoracic outlet syndrome

What Is Thoracic Outlet Syndrome?

Thoracic outlet syndrome, abbreviated TOS, is a condition in which the nerves or blood vessels around the base of the neck become compressed. More specifically, these compressions can occur between the first rib and the clavicle bone in the brachial plexus area, or in certain parts of the cervical spine.

TOS disorder can be difficult to diagnose and treat because of the varying types, severities, and causes. Despite this, TOS is not uncommon, and once diagnosed, treatment can be simple. The types of thoracic outlet syndrome, which are categorized by the аffected area or type of compression, are:

  • Neurological TOS: Caused by pinched or squeezed nerves, neurological TOS affects 95% of all TOS patients
  • Postural TOS: Poor posture can cause a multitude of health problems, one of them being TOS. This is because certain muscles can become tight or otherwise affected by bad posture, resulting in pressure on blood vessels and nerves.  
  • Vascular TOS: Vascular TOS typically affects the arm and can be potentially dangerous if left untreated. This type of TOS occurs when certain veins become inhibited from carrying blood efficiently through the arm.

In addition to the types of TOS, there are also several subcategories of thoracic outlet syndrome depending on the type and the location of the condition, including arterial TOS, neurogenic TOS, neurogenic pectoralis minor syndrome, venous pectoralis minor syndrome, arterial pectoralis minor syndrome, and venous TOS.

How To Know If You Have TOS

The unfortunate aspect of TOS is symptoms that are not uncommon in other conditions or issues, making it a difficult issue to diagnose. TOS cannot be officially diagnosed without a medical doctor. However, there are a few symptoms to look out for, including:

  • Pain tingling, numbness, or weakness in the upper extremities or underneath the collarbone area
  • Pain in the head and neck sometimes concentrated in the trapezius muscles
  • Pain and swelling of the affected arm
  • Discoloration of the affected arm or fingers
  • Coldness in the upper limbs
  • Cramping in the arms

Not all of these symptoms have to be present in order to have a TOS diagnosis. Symptoms and severity of symptoms depend on your subtype of TOS.

Causes of TOS

Thoracic outlet syndrome can be caused by a host of different things, from sudden injuries to the neck to prolonged poor posture. In addition to this, TOS can also be caused by certain movements of the neck and head, growth or change of the neck muscles, personal anatomy, or blockage of blood flow.

People who have recently sustained a head or neck injury like those that commonly occur in some car accidents are most at risk for TOS. Repetitive movements of the muscles can also сontribute to TOS. So, if you’re at the gym training your upper body several days a week, especially the scalene muscles and pecs, you might be at risk for developing TOS.

Treatment of thoracic outlet syndrome usually requires nothing more than strengthening exercises. However, some cases of TOS are much more severe. Certain types of TOS may need surgery or medications to properly fix, so reporting pain immediately to a healthcare provider is very important.

7 Thoracic Outlet Syndrome Exercises & Stretches

The good news about TOS is that there are several at-home physical therapy exercises and stretches you can do for potential pain relief. These exercises can also be implemented into an already established upper body routine. As with any injury, however, seeking advice from a healthcare professional before performing any of these movements is advisable.

1. Chin Tuck

Chin tucks are an easy and effective stretch for strengthening and improving mobility in the neck and shoulder muscles. In addition to helping those with TOS symptoms, chin tucks are also good for anyone who may suffer from poor posture or engage in excessive screen time.

To do this stretch, simply sit up straight with your head and neck in a neutral position. Keep a forward gaze to ensure a straight cervical spine. It may be helpful to focus your eyes on a single object.

Next, begin tucking your chin to your neck by moving your entire head straight back. This should not be a downward tilt of the head, but a slight movement inward. Your goal is not to touch your chin to your neck. Rather, think about creating a double chin with as little movement as possible.

Keep your eyes focused on whatever object you chose in order to maintain a good neutral spine. With this movement, you should feel a stretch at the back of your neck and up into your head. You may also feel a slight stretch in the trap muscles, as well.

2. Band Pull-Apart

Resistance bands are some of the best tools for strengthening muscles, stretching, and rehabilitation of injured areas. Unlike dumbbells, resistance bands are light, making them especially great for tender muscles.

The band pull-apart exercise is good for posture, back strengthening, and arm work. To do this exercise, choose a light resistance band. Stand with good posture and with feet shoulder-width apart. Hold the band out in front of you at the full stretch of your arms and with both hands. Hold the band at chest height.

To begin the movement, pull the band in opposite directions to create tension. Pull until your arms are stretched out on either side of your body, then slowly return to the starting position. Repeat this movement several times being careful not to overwork the muscles.

sportswoman uses a foam roller massager for relaxation, stretching muscles and back pain

3. Thoracic Spine Rolling

Foam rollers are a staple for anyone who works out. While rollers are often used on muscles after strenuous workouts, they can also be used for the rehabilitation of the muscles in the body.

To use the foam roller for the management of TOS symptoms, sit on the floor and place the roller perpendicular behind you. Lay back on the foam roller and position it in the middle of your back, keeping your glutes on the floor.

Place a comfortable amount of pressure on your back by leaning into the roller. Take a few seconds on each area of the back, concentrating on painful areas. Be sure to keep your neck neutral and do not over-extend the spine.

4. First Rib Work with Strap

Often, the cause of TOS is a lack of mobilization or movement in the first rib, known as the cervical rib. This rib sits much higher than you may expect, typically right under the trapezius muscle. 

While strengthening exercises work well for most, sometimes a more manual therapy approach is needed. In most cases, a mixture of both works best. For this particular stretch, you’ll need a strap of some sort, such as a long belt or yoga strap. You’ll also need a chair.

First, sit comfortably in the chair with good back posture. However, be sure to stay relaxed. Next, take your strap and put it over your shoulder like a purse. Sit on one of the strap and take the other end in your opposite hand. So, if it is your right shoulder that is bothering you, you’ll grab the strap with your left and sit it across your body much like a seat belt.

Keeping the strap on top of your trapezius, pull the strap slightly to create some tension on your neck. Hold this tension for a few seconds, then let go. You should feel a slight massage from the strap with each pull. Repeat until you feel your neck muscles and first rib loosening up. You can also experiment with tilting your head as you compress the shoulder.

5. Anterior Scalene Stretch

There are several stretches that require no equipment, making them easy to do throughout the day. The anterior scalene stretch is one of these exercises. To do this stretch, simply find a stable structure that is about hand height. This can be a banister, chair arm, or you can find the stretch station at your gym.

To do this exercise, grab onto whatever stable structure you’ve found with the arm that correlates to your affected side. Keep your shoulder down and relaxed throughout the entire stretch. Next, turn your head in the opposite direction of your affected side and tilt your chin slightly up.

This will stretch the shoulder and neck muscles without putting too much pressure on them. Hold the stretch for a few seconds, then release. Do this stretch several times for best results.

6. Wall Shoulder Stretch

For this stretch, you will need to find an open doorway or wall. Stand in the doorway and place both forearms on the wall with your body in the open doorway. Check-in with your posture. Maintain a forward gaze to ensure a neutral neck. To begin the stretch, stand with your feet hip-width apart.

Then, slide one foot behind you and use the front leg to lean into the wall with your body weight. You should feel a good stretch in the front of your chest, neck, and shoulders. You can experiment with the height of the arm placement to find where you need the stretch the most.

7. Pec Minor Stretch 

For a pectoralis minor stretch, which can be an area of concern in certain types of TOS, you will need a foam roller. Like the last roller stretch, this exercise takes place on the floor but this time with the roller parallel to the spine.

Simply lay down on top of the foam roller so that your shoulder blades are on either side of the roller. Your tailbone should also sit on the roller rather than on the floor to avoid injury to the lower back.

Next, Bend your elbows and put your forearms together. Then, slowly move the arms apart as if to squeeze the roller with your scapular bone, or shoulder blades. Return to the starting position. Repeat this movement several times.

This exercise can feel a bit painful, especially to those with TOS, so be sure to take the stretch slowly and breathe often. If you find the foam roller to be too hard on the spine, try a towel. Simply roll the towel in a cylindrical shape that mimics the foam roller’s shape, then do the exercise as described above.

Additional Advice for TOS

Whether you have TOS or are prone to developing TOS, there are many ways to prepare your body before exercise, things you should do during exercise, and things you can do throughout the day to help manage or prevent symptoms. 

  • Use heat: Applying heat to injured muscles is one of the most beneficial ways to soothe pain, avoid injury, and prepare for exercise. You can do this by applying a warm compression prior to stretches and exercise, or even taking a shower in warm water. Avoid high temperatures as you can burn the skin. Heat therapy can also be used after workouts for pain relief.
  • Warm-up: While warming up is an often neglected part of a workout, for those with pain or injury, a warm-up session is necessary. Much like using a heat compress, stretching and doing light exercises to warm up the areas of concern promotes blood flow, preparing your muscles for whatever impact or strain you may apply to them.
  • Be gentle: It may be tempting to go straight into your strenuous workout session, pumping all that heavy iron like you’re used to. However, when dealing with an injury, being gentle and careful with your body is important in preventing further issues. Even if your pain seems to be minimizing, pushing beyond your means during a workout might mean a slower and harder recovery period. Thus, resulting in fewer gains made over time.
  • Move slowly: Many cases of TOS are due to sudden and explosive movements, so moving slowly during stretches and workouts is important. Moving in a slow and controlled manner is also important for focusing on good form. Good form is vital to avoiding or exacerbating an injury such as TOS.
  • Pay attention to posture: Your posture throughout the day can make or break the status of your back health. Poor posture can lead to a multitude of health issues, TOS being just one of them. Many of our lives revolve around seated desk work, making postural awareness more important than it has ever been before.

Thoracic Outlet Syndrome: Conclusion

Prevention is better than treatment, and many of these exercises can be implemented in both recovery and prevention exercise programs. So even if you don’t currently have thoracic outlet syndrome, finding room for some of these movements in your current routine can help improve your range of motion and build back strength.

For athletes and individuals who lead active lifestyles, avoiding injuries and disorders like TOS can be all in the recovery. Still, the recovery period is often neglected yet is just important as that killer gym session you just completed, leaving you hungry for more. If you struggle with muscle and mind recovery, utilizing the power of a recovery supplement has a lot of potential for recovery improvements.

TOS is a painful and difficult condition to deal with, but with the proper rehabilitation, you can eventually be TOS-free. In some cases, seeing a physical therapist may be the only way to achieve pain relief. Additionally, certain cases of TOS cannot be treated through physical therapy alone and may require more aggressive treatment.