Rehabilitation For Your Thoracic Outlet Syndrome (TOS)!
Now that we already understand what Thoracic Outlet Syndrome (TOS) is, let’s move on to the therapy you can do to improve your quality of life!
My rehab program for Thoracic Outlet Syndrome consists of 4 major components: postural re-education, life-style modification, manual therapy and therapeutic exercises.
⭐ Postural Re-education
Poor posture is one of the main culprit causing TOS, people with TOS are usually having “Forward Head Syndrome” at the same time! Such as texting or computer using……, are you one of them? ?
Make sure to optimize your work station to promote ergonomic positioning!
Poor Upper Body Posture ⇒ Narrowed Thoracic Outlet Area ⇒ TOS
✨ Engage your core muscles, and maintain the good posture is the key to relive your TOS symptoms!
⭐ Life-style modification
✨ Weight-loss program: Being overweight can easily stress your shoulder and neck muscles, resulting in shifted collar bone or first rib ⇒ TOS
✨ Modify everyday activities that aggravate your symptoms!
* Avoid working above shoulder level whenever possible!
* Stop over-bending your neck when texting or playing your cell phones/tablets !
✨ Sleeping: Never sleep on your affected side, it will make your symptoms worse!
* Make sure your neck is well supported with your pillow! Also maintain a good alignment for your cervical spine!
⭐ Manual Therapy
The purpose of manual therapy for TOS is to release the tight muscles around your thoracic outlet region. Especially Pectoralis Minor and Scalenes muscles.
⭐ Therapeutic Exercises
✨ Cervical Stretching (Each stretch should stay at least 15 seconds, 10 x 3 times/day!)
✨ Door Stretching (15 seconds, 10 x 3 times/day!)
* Caution! If you start feeling tingling and numbness when doing part C stretching, you should stop it and only resume part A & B stretching exercises.
✨ Brachial Plexus Gliding (10 x 3 times/day!)
✨ Shoulder Blade Squeeze (10 x 3 times/day!)
⭐ Bottom Line
In general, conservative treatment for TOS can be effective at reducing symptoms, improving function, and facilitating return to work when compared to surgery. Rehab program for TOS can assist patients to improve their muscle imbalances and poor posture, eventually a better quality of life!
Please feel free consult your occupational therapist or physical therapist if you have any question about the therapy program above!
Andrew believes rehab-related knowledge should be easy to learn and follow at home, because "knowledge is power only when we can share it" !
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Hi Lola,
Thank you for your feedback! Yes I still need to work on my SEO, will appreciate if you have any suggestion!
Thank you!
Andrew Tan
Hi there, I have not been diagnosed ( in part there is no specialist in Canada) but I started seeing a hand therapist for TOS. I was to do the exercises I have the swollen and blue hands. When I do the door jam, corner stretch, and overhead arm. I get a rush sensation up my arm, chest pain and a rushing feeling in the center of my nose and sinuses, I stop and it goes away. What is this? I see you say don’t do this if feel tingling.
Hi Mona! Great question!
With TOS, one of the most important precaution is to avoid “overhead” activity, which means not to elevate your arm above shoulder level, it may easily narrow your thoracic outlet area then causing the tingling and numbness sensation.
So whenever you do your home exercise, including door/corner stretch, make sure not to elevate your are more than 90 degree, for some people I will just keep their arm elevated in 45 degree. Also don’t forget to monitor your posture, and muscle tightness!
I hope you feel better soon!
I’ve been looking at thoracic outlet syndrome as I was diagnosed with shoulder impingement syndrome last January and despite many sessions of physio with different physiotherapists things have got worse and I now have tingling and pain down my left arm and sharp pain in the thoracic outlet area on the left. I also do have bursitis in both shoulders and a partial supraspinatus tendon tear on the left. Whenever I try stretches, particularly bands and doorway stretches they make the tingling and pain worse. I am getting at my wit’s end. I suspect the nerve is irritated in the thoracic outlet area and that when I stretch the nerve is more irritated. ( I have a depressed sternum which is congenital so when I stretch I also get sternal discomfort). Do you know of other physical exercises can I do that don’t involve stretching ?
Hi Anne,
Have you discussed your tingling and shooting pain with your physiotherapist or physician?
I will recommend you see a neurologist for an imaging exam to confirm TOS.
If you do have these nervous symptoms while stretching I will definitely recommend stop the exercises,
usually for TOS, you don’t want to raise your arm above shoulder level as it can easily pinch your nerves.
For TOS, you can basically do all the exercises I posted in the article, also added on lower trapezius strengthening exercise, such as this on https://www.youtube.com/watch?v=bHs1D5KfSVA
Again, always consult with your medical providers if our current exercise is making it worse, hope you are feeling better soon!
Hi Andrew – Many thanks for your reply. I have told the physiothreapist, yes. And I am under a rheumatologist who gave me steroid injections in my shoulders due to the bursitis but they didn’t make much differenece. I told him when the tingling sensation started and about the sharp pain but he seems to not take much notice of that. I had an MRI of my shoulders last January but the tingling and very sharp pain wasn’t there then – that all came on about two months ago when things were getting worse which made me think it was TOS and not just bursitis and a partially torn tendon. I will go back to the rheumatologist !
In my opinion, if the cortisone injection didn’t work for the first time, it’s no point to try the second. And it is recommended doing cortisone injection under ultrasound imaging guidance.
Usually what a rheumatologist can do is to rule out all the possible self-immunization disease which may cause your sharp pain or tingling. If your there’s no problem with your self-immunization system, I still highly recommend a neurologist to check out the possibility of TOS. MRI for shoulder can only see the pathology in your shoulder joint, it won’t see anything in your thoracic outlet area.
I had the steroid injections under ultrasound guidance but they still didn’t make any real difference. I will definitely ask to be referred to a neurologist or to have a neurophysiologist test the nerves in my left arm so that I can get this sorted out. Thanks Andrew for your advice !
Dr. Tan. I am interested in your comment about not sleeping on the affected side of TOS. I believe I’ve had TOS for forty years and almost conquered it through posture correction, stretching, and a shoulder brace. Nevertheless, every time I thought I had it beaten, I’d have a relapse.
My TOS mainly affects my right side/hands and arms, and I’ve sleeping on my right side all my life.
So you’re saying sleeping all the 40 years on my affected right side could have aggravated my symptoms causing my relapses?
Have you had any patients for whom correcting their sleeping position (mainly stopped sleeping on the affected side) dramatically helped their TOS?
Hello John,
Sorry for such a late reply! Yes I still believe when sleeping on your affected side, you can stress your thoracic outlet more and causing more problem.
Sleeping posture modification is just a part of treatment, it won’t dramatically help your symptoms just by changing your posture. Other intervention like stretching, manual therapy, breathing technique, strengthening for core muscles and standing/sitting posture correction are all important.
Please feel free to email me so I can reply to you more promptly in the future!
[email protected]
Thank you!