31/07/2021
What to Expect in Thoracic Outlet Syndrome Physical Therapy
Thoracic outlet syndrome (TOS) is a cluster of disorders that occur when the nerves, arteries, or veins that run between your clavicle (collarbone), highest rib, and two of the scalene muscles are pinched or compressed. It is named for the pathway (the thoracic outlet) through which these blood vessels and nerves travel en route to your arms and hands.
While anyone can get TOS, individuals participating in repetitive overhead activities or sports, those with poor posture or weak shoulder muscles, people in their middle ages, and females are the most likely to experience it.
Fortunately, in many cases, the symptoms of thoracic outlet syndrome can be addressed with physical therapy. This article will discuss physical therapy assessment, goals, exercises, and outcomes for thoracic outlet syndrome.
Thoracic Outlet Syndrome Exercises
During the course of physical therapy for thoracic outlet syndrome, several specific exercises are used to manage your symptoms. Some of the hallmark techniques traditionally utilized are listed below.
Postural Stretching
Falling into a rounded shoulder and forward head posture can cause your neck and chest muscles to become tight. Maintaining this posture for a long period of time can also compress the structures that travel through the thoracic outlet.
Because of this, your therapist will typically teach you stretches for the chest (pectoral), neck (scalene, sternocleidomastoid, suboccipital), and scapular (levator scapulae, trapezius) muscles. Gaining flexibility in these structures can help you stay in a better sitting or standing posture and is one of the keys to improving your TOS symptoms.
Scapular Strengthening Exercises
In addition to stretching, strengthening the scapular muscles in your upper and mid-back can help you maintain a more erect posture while you are sitting and standing. This, in turn, can help prevent symptom reoccurrence.
Machines or other types of gym equipment may be utilized by your physical therapist to strengthen these areas, though in most cases a simple resistance band or dumbbell is all that is necessary. While there are many different strengthening exercises that target these regions, several common techniques are often utilized in rehab.
Lying on your stomach and performing a prone shoulder row or prone shoulder extension exercise can target the muscles that bring your shoulder blades into a down (depressed) and back (retracted) position.
Similarly, doing a reverse fly or rested external rotation movement with an elastic band can also activate these important structures.
Finally, the push-up plus exercise, which encourages you to bring your shoulder blades into a forward or protracted position at the end of the movement, is another effective technique.
During your time in therapy, your physical therapist will walk you through a wide variety of exercises that can address any weakness that may be contributing to your thoracic outlet syndrome symptoms.
Nerve Gliding Techniques
Another common addition to your TOS rehab is nerve gliding. These movements attempt to free a nerve from any restriction or compression by gently flossing or gliding the structure back and forth.
To do this, the therapist will instruct you on gently moving your arm between a position that tenses the nerve and one that relaxes it. Alternating between these two arm movements can help relieve some of your TOS symptoms over time.
