Thoracic Outlet Syndrome
Physical Therapies
Physical therapy (PT) is the most important part of TOS treatment. PT often improves symptoms enough that medication or other treatments are not needed. In addition, if surgery becomes necessary, PT can help improve outcomes afterward.
PT typically starts with techniques to decrease pain, swelling and other acute symptoms. This may include positioning your arm for comfort and using a shoulder immobilizer until pain is reduced.
As you get better, you can learn exercises designed to increase movement, strength and flexibility in your chest and shoulders. Your therapist can show you how to maintain good posture throughout the day. He or she also can instruct you on how to move your body so as to reduce pain and minimize pressure on the thoracic outlet area.
You may work with recreational, occupational and vocational therapists as well. Recreational therapists design exercises and adapt equipment so you can do the leisure activities you enjoy. Vocational and occupational therapists are trained to adapt work stations and equipment to help you function as well as possible at work.
Your treatments and exercises will change based on your needs and progress over time. Work with your physical therapist to design a program that meets your needs. Follow your therapy exactly as planned, both during therapy sessions and at home. Tell your therapist if you think a treatment is not working.
PT typically starts with techniques to decrease pain, swelling and other acute symptoms. This may include positioning your arm for comfort and using a shoulder immobilizer until pain is reduced.
As you get better, you can learn exercises designed to increase movement, strength and flexibility in your chest and shoulders. Your therapist can show you how to maintain good posture throughout the day. He or she also can instruct you on how to move your body so as to reduce pain and minimize pressure on the thoracic outlet area.
You may work with recreational, occupational and vocational therapists as well. Recreational therapists design exercises and adapt equipment so you can do the leisure activities you enjoy. Vocational and occupational therapists are trained to adapt work stations and equipment to help you function as well as possible at work.
Your treatments and exercises will change based on your needs and progress over time. Work with your physical therapist to design a program that meets your needs. Follow your therapy exactly as planned, both during therapy sessions and at home. Tell your therapist if you think a treatment is not working.
Your physical therapy plan may include:
- Manual (hands on) therapy. Some of the manual therapy tools used include
- nerve flossing, which can help the nerves involved better adapt to the length needed for comfortable movement.
- lymphatic pumping to move fluids that may stagnate near the first and second ribs
- Edgelow technique
- mobilization of the spine and ribs
- the Feldenkrais method, a type of bodywork that uses gentle movements to promote personal awareness of the body, increase flexibility and improve coordination. For more information, please see our full article on the Feldenkrais Method or visit www.feldenkrais.com.
- Heat or cold application. Moist heat helps relieve some people’s pain. Ice packs may help reduce swelling.
- Skin desensitization. This helps decrease your sensitivity to things that do not normally cause pain. For example, your physical therapist may start by rubbing your skin with very soft fabrics and progress to rough ones like burlap; start with light touch and move to deeper pressures; or progress from slight vibrations to greater ones.
- Stretching and strengthening exercises. Your therapist can recommend exercises to strengthen shoulder and chest muscles, increase flexibility and range of motion, and improve posture. Over time, these exercises can help to open the thoracic outlet and relieve pressure on nerves and blood vessels.
- Range of motion exercises. Your therapist may guide you through passive and active range of motion exercises of your spine, shoulder and joints.
- Relaxation. Deep breathing and other relaxation techniques can reduce stress and help you avoid tensing your shoulders.