12 Thoracic Outlet Syndrome Exercises for Lasting Relief

Dr. Ryan Klopfer • August 12, 2022

Table of Contents

What causes thoracic outlet syndrome?


Thoracic outlet syndrome occurs when nerves or blood vessels become compressed in the area between the clavicle (collarbone) and first rib. This space is known as the thoracic outlet. Symptoms of thoracic outlet syndrome   can include the following:

 

  • Arm pain
  • Back aches
  • Cold hands and fingers
  • Neck pain
  • Numbness in upper extremities
  • Swelling in the arms, hands, or fingers
  • Tingling or pins and needles sensation in the hands and fingers
  • Weakness in the shoulders, neck, arms, or hands

Once TOS has been diagnosed by a healthcare professional and any acute pain is under control, exercises and stretches are the  next step  in treatment. Certain exercises can  help alleviate  those suffering from TOS.

 

Is stretching good for thoracic outlet syndrome? 

Stretching is good  for TOS. Many of the exercises below are stretches. You’ll want to visit a physical therapist or chiropractor before trying strenuous movements. They  can help you build an exercise program based on your specific needs.

 

While the  majority  find stretching and strengthening helpful, symptoms  may worsen  for those who have other conditions. That’s another reason it’s important to discuss new exercises with a professional.

 

TOS exercises focus on 3 areas: the neck, the upper back, and the chest. Stretching muscle groups in these areas should help relieve the tension and pressure causing impingement in the thoracic outlet.

 

 

Thoracic outlet syndrome exercises

We’ve compiled a list of stretches and exercises that both strengthen and improve range of motion.

 

Scapular Rotations

This stretch exercises the muscles around the scapula, or the shoulder blade.

Starting position : Stand with the arm of the affected side outstretched in front of you.

  • Lift (elevate) the shoulder while keeping the arm straight
  • Pull the shoulder back (retraction) still keeping the arm straight
  • Lower (depress) the shoulder continuing to keep the arm straight

The goal is basically to make circles with your shoulder.

Scapular rotation exercises for Thoracic Outlet Syndrome
Image Source: “Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations”

Reps:  5

Sets:  3

Frontal and Lateral Raise

Frontal and lateral raises require small weights, such as 1-5 lb dumbbells. Frontal raises work the shoulders (anterior deltoids), the upper back (trapezius muscle), and parts of the pectorals.

Starting position:  Stand with knees slightly bent and with hands gripping the individual dumbbells. Your knuckles should face away from you.

  • Slowly and smoothly lift the dumbbells directly in front of you, no higher than your eyes
  • Hold for 3 seconds
  • Slowly and smoothly lower the dumbbells to starting position

Lateral raises also work the shoulders and upper back. This latter exercise is quite similar to the former, except your arms raise from the sides rather than the front. Starting position is taking a dumbbell in each hand, with knuckles facing out, and standing with your arms by your sides.

  • Lift the weights until you reach the height of your shoulders
  • Hold for 3 seconds
  • Lower the weights to the starting position
Frontal and lateral raises to help with Thoracic Outlet Syndrome
Image Source: “Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations”

Reps:  5-10

Sets:  3

Nerve Gliding/Flossing

One study  found nerve gliding crucial to conservative and surgical forms of treatment for TOS. Nerve gliding is the gentle technique of stretching nerves, as you might sore muscles, to reduce irritation.

The ulnar nerve running down the arm is often responsible for tingling sensations. The ulnar nerve glide should help relieve this TOS symptom. Starting position is standing while making the “O.K.” sign with the fingers of the affected arm.

  • Place your hand on your face so that the circle created by your index finger and thumb is over your eye (creating a sort-of monocle)
  • The elbow should be high and the arm should form a triangle
  • Slowly take your hand away from your face and outstretch your arm, all the while holding the O.K. sign
  • Tilt head away from the outstretched arm

Reps:  15

Sets:  2

Standing External Rotations

This exercise works the infraspinatus muscles. It requires a band and a towel. Anchor the band to a doorknob and place the towel between your side and the affected arm. Starting position is gripping the band with your arm at a 90 degree angle.

  • Slowly pull band away from the body, while holding the towel in place
  • Hold briefly
  • Slowly return arm to the starting position
Standing external rotation exercises for Thoracic Outlet Syndrome
Image Source: “Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations”

Reps:  10

Sets:  3

Serratus Push

This exercise activates the serratus muscles which cover the sides of the ribs. When is action, this exercise appears to be mini push-ups. Starting position is on hands and knees as though you were performing a modified push-up.

  • Do a chin tuck to get your head in the optimal position
  • Lower towards the ground, allowing scapular muscles to lead the movement
  • Push the ground to lift to the starting position
Serratus push exercises for Thoracic Outlet Syndrome
Image Source: “Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations”

Reps:  8

Sets:  2

First Rib Mobilization

The first rib is an atypical (shorter and structured differently) rib that can become elevated out of place. Mobilizing it or getting into its original position can relieve compression of the nerves and blood vessels in the thoracic outlet.

Starting position is sitting in a chair with the back straight. A strap lies over the affected side’s shoulder.

  • Pull strap towards the opposite hip
  • Tilt the head to the side, towards the affected side
  • Look down towards your upper arm
  • Hold for about 20 seconds

Reps:  4-5

Another way to free up your first rib requires a massage or lacrosse ball. Find the space or “pocket” just beneath the collarbone where the first rib lies. Take the ball and press down on the first rib. Feel free to apply quite a bit of pressure, but not so much that it’s painful. Breathe in deeply then release that breath.5

Banded Straight Arm Extension

This exercise stretches scapular musculature. A stretchy band is required for this exercise. Starting position is a relaxed standing position with both hands gripping the band.

  • Pull the band in opposite directions as far as possible
  • Focus on using your scapular muscles to help the pulling
  • Push your chest out
  • Gently return to the starting position
Banded straight arm extension exercises for Thoracic Outlet Syndrome
Image Source: “Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations”

Reps:  4

Sets:  3

Pec Minor Stretch

The pectoralis minor stretch is meant to open up the chest muscles and the rib cage. A foam roller is required for this particular exercise. Starting position is lying on your back on top of the foam roller. Be sure your neck and head are supported by the foam roller. Feet are flat on the ground with knees bent.

  • Spread your arms out to your sides with palms up and let them fall to the floor (you’ll feel the stretch in this starting position)
  • Slowly move arms up or down to find different positions that stretch different areas of your pecs

When you find a good stretch position, hold it for about 30 seconds, then give yourself a break.

Reps:  4

An additional, simple pec exercise that you can do standing or sitting is clasping your hands behind your back and pushing your chest out. Try to keep your palms touching. Hold for 30 seconds 3 times.

Chin Tuck

This may be the easiest exercise in our list. It stretches muscles that connect to the cervical spine.

  • Sit in a chair and make sure your posture is good- straight back (not slouched) with shoulder back and down
  • Pull your head back
  • Hold for about 10 seconds then relax

Think about it like you’re trying to create a double chin. We avoid that look at all costs; however, it’s the goal for this exercise.

Chin tuck exercises for Thoracic Outlet Syndrome
Image Source: “Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations”

Reps:  6-8

Thoracic Spine Foam Rolling

This stretch is great for helping to correct poor posture and aid thoracic extension. A foam roller is required. Starting position is sitting on the ground with the foam roller situated perpendicular to the spine. The foam roller should be placed at the base of the thoracic spine.

  • Grasp a stick of sorts with both hands
  • Extend arms as far above and behind your head as possible
  • Try to touch the floor with the stick
  • Keep bottom on the floor
  • Hold the position for 20 seconds

Reps:  3

Shoulder Extension with Abduction

This exercise stretches the shoulder muscles and requires a stick or cane. Starting position is standing while both hands grip the stick behind you.

  • Lift the stick up and away from your bottom as far as possible
  • Slowly lower the stick to starting position
Shoulder extension exercises for Thoracic Outlet Syndrome
Image Source: “Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations”

Reps:  10

Scalene Muscle Stretch

This neck stretch aims to alleviate stress on the blood vessels and nerves located in the interscalene triangle (the first rib forms the base and the anterior and middle scalenes form the sides). Starting position is sitting in a chair with the back straight. A strap lies over the affected side’s shoulder.

  • Pull strap towards the opposite hip
  • Tilt the head to the side, away from the affected side
  • Slightly turn your face towards the affected side
  • Tuck the chin gently
  • Hold for about 30 seconds

Reps:  5

Types of TOS

The 3 types of TOS include

  1. Neurogenic TOS- the brachial plexus nerves in between neck muscles (posterior and anterior scalenes) become compressed. It’s quite treatable via physical therapy. This is the most common form of TOS.
  2. Venous TOS- the subclavian vein becomes compressed as it passes through the costoclavicular space. It affects about 10% of TOS patients.
  3. Arterial TOS- the subclavian artery becomes compressed which can cause serious blockages or aneurysms. Affecting about 1% of TOS patients, it is the rarest form of TOS.

Sometimes venous and arterial TOS are together referred to as vascular TOS. While neurogenic TOS symptoms can be addressed with exercises and sometimes medication, vascular TOS is more serious and may require surgery to correct.

What causes TOS?

Several things could cause neurogenic thoracic outlet syndrome including

  • Congenital abnormalities such as a  cervical rib
  • Injury or trauma
  • Poor posture
  • Competing in sports
  • Repetitive use of arms overhead

What aggravates thoracic outlet syndrome?  Overuse or incorrect use of muscles surrounding the thoracic outlet or a poor sleeping position could aggravate thoracic outlet syndrome.

If you’re uncertain about whether or not you can safely do these exercises or if your symptoms are more severe in nature, don’t hesitate to seek medical advice from a trusted healthcare provider.

Ready to get to the root of your problem with chiropractic care? We’re currently accepting new patients at our Ball Ground office.

Sources

  1. Hanif, S., Tassadaq, N., Rathore, M. F. A., Rashid, P., Ahmed, N., & Niazi, F. (2007). Role of therapeutic exercises in neurogenic thoracic outlet syndrome.  Journal of Ayub Medical College Abbottabad, 19 (4), 85-88. Abstract:  https://pubmed.ncbi.nlm.nih.gov/18693607/
  2. Crosby, C. A., & Wehbé, M. A. (2004). Conservative treatment for thoracic outlet syndrome.  Hand clinics20 (1), 43-49. Abstract:  https://pubmed.ncbi.nlm.nih.gov/15005383/
  3. Kenny, R. A., Traynor, G. B., Withington, D., & Keegan, D. J. (1993). Thoracic outlet syndrome: a useful exercise treatment option. American  Journal of Surgery, 165 , 282-282. https://pubmed.ncbi.nlm.nih.gov/8427413/
  4. Novak, C. B., Collins, E. D., & Mackinnon, S. E. (1995). Outcome following conservative management of thoracic outlet syndrome.  The Journal of hand surgery, 20 (4), 542-548. https://pubmed.ncbi.nlm.nih.gov/7594276/
  5. Levine, N. A., & Rigby, B. R. (2018, June). Thoracic outlet syndrome: biomechanical and exercise considerations.  In Healthcare (Vol. 6 , No. 2, p. 68). MDPI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023437/
  6. Wehbé, M. A., & Schlegel, J. M. (2004). Nerve gliding exercises for thoracic outlet syndrome.  Hand clinics20 (1), 51-55. https://pubmed.ncbi.nlm.nih.gov/15005384/

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If you are suffering from sinus headaches, we invite you to visit us and take the first step towards lasting relief. Stop Sinus Headaches From Interrupting Your Life Sinus headaches are a common condition that can significantly impact daily life. Understanding the symptoms, causes, and treatment options is crucial for effective management. At Georgia Upper Cervical, we specialize in providing gentle, non-invasive chiropractic care tailored to each patient's unique needs. Our comprehensive approach includes thorough diagnostics, personalized treatment plans, and lifestyle recommendations to help patients achieve lasting relief from sinus headaches. If you are experiencing sinus headaches and are looking for a holistic approach to treatment, contact Georgia Upper Cervical today. Our team of experts is dedicated to helping you achieve optimal health and well-being through gentle, effective chiropractic care. Don't let sinus headaches control your life – take the first step towards lasting relief and improved quality of life with Georgia Upper Cervical. --- Sources 1. National Headache Foundation. Sinus Headaches. Full text: https://headaches.org/2020/07/16/sinus-headache/ 2. Mayo Clinic. Sinus Headache. Full text: https://www.mayoclinic.org/diseases-conditions/sinus-headache/symptoms-causes/syc-20351996 3. Cleveland Clinic. Sinus Headache. Full text: https://my.clevelandclinic.org/health/diseases/9637-sinus-headaches 4. WebMD. Sinus Headaches: Symptoms, Causes, and Treatments. Full text: https://www.webmd.com/migraines-headaches/sinus-headaches 5. Healthline. Sinus Headaches: Symptoms, Causes, and Treatment. Full text: https://www.healthline.com/health/sinus-headache 6. Harvard Health Publishing. Sinus Headaches. Full text: https://www.health.harvard.edu/a_to_z/sinus-headaches-a-to-z 7. American Migraine Foundation. Sinus Headache. Full text: https://americanmigrainefoundation.org/resource-library/sinus-headache/
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By Ryan Klopfer October 2, 2024
What are Cluster Headaches and What Do They Mean? Cluster headaches are one of the most severe types of headaches, characterized by intense pain on one side of the head, often around the eye. They occur in cyclical patterns or clusters, hence the name. These headaches can significantly disrupt daily life due to their severity and frequency. Unlike other types of headaches, cluster headaches are known for their excruciating pain and sudden onset, making them a debilitating condition for those affected. Symptoms of Cluster Headaches Cluster headaches present with a distinct set of symptoms, some of which are often unrecognized or uncommon. Common symptoms include: Intense Pain: Severe, burning, or piercing pain typically located around or behind one eye. This pain can radiate to other areas of the face, head, neck, and shoulders [3]. Redness and Tearing: The eye on the affected side may become red and tear excessively [4]. 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The intensity of the pain can lead to tension in the neck and shoulders. The autonomic symptoms (like tearing and nasal congestion) can affect the sinuses and respiratory system. Additionally, the stress and anxiety associated with anticipating an attack can have widespread effects on overall health, including cardiovascular and mental health impacts. Factors / Causes of Cluster Headaches The exact cause of cluster headaches remains unclear, but several factors are believed to contribute: Hypothalamus Dysfunction: The hypothalamus, a part of the brain that regulates biological rhythms, is thought to play a role [3]. Genetics: A family history of cluster headaches can increase the likelihood of developing the condition [3]. Triggers: Alcohol, tobacco, strong smells, and high altitudes can trigger attacks [3]. Differentiating Between Cluster Headaches and Other Types Cluster headaches need to be distinguished from other types of headaches to ensure proper treatment. Other common types of headaches include: Migraines Tension Headaches Sinus Headaches While migraines and tension headaches can be debilitating, the intensity and cyclical nature of cluster headaches, along with their specific symptoms, set them apart. Sinus headaches involve pressure and pain in the sinus areas but do not typically include the severe eye pain and autonomic symptoms seen in cluster headaches [3]. Diagnosing Cluster Headaches Diagnosing cluster headaches involves a thorough evaluation, as their symptoms can sometimes overlap with other conditions. Key diagnostic steps include: Medical History: Detailed patient history, including the frequency, duration, and nature of the headaches [6]. Symptom Assessment: Evaluation of specific symptoms, particularly those unique to cluster headaches [6]. Physical Examination: Checking for autonomic signs and other associated symptoms [3]. Imaging Studies: MRI or CT scans to rule out other potential causes of the headaches, such as tumors or vascular abnormalities [3]. Commonly Missed Signs and Symptoms Certain symptoms can be easily overlooked but are critical for a correct diagnosis: Restlessness and Agitation: Unlike other headaches where patients prefer to lie down, those with cluster headaches often pace or move around [2]. Autonomic Symptoms: Redness, tearing, and nasal congestion are key signs that differentiate cluster headaches from other types [2]. Typical Treatments for Cluster Headaches Treatment for cluster headaches typically involves managing acute attacks and preventing future episodes. At Georgia Upper Cervical, we emphasize the importance of chiropractic care in treating cluster headaches by addressing the root of the problem. Treatment Options at Georgia Upper Cervical 1. Gentle Chiropractic Adjustments: We provide precise, gentle adjustments to the upper cervical spine to relieve tension and improve nerve function. Our methods avoid the cracking or popping commonly associated with traditional chiropractic treatments, focusing instead on subtle corrections that yield significant results. 2. Thorough X-Rays: Comprehensive x-rays help us assess the alignment of the cervical spine and tailor a treatment plan specific to the patient's needs. 3. Personalized Treatment Plan: Based on diagnostic findings, we create a customized treatment plan that includes chiropractic care, lifestyle recommendations, and stress management techniques. 4. Stress Management Techniques: Guidance on stress reduction methods such as mindfulness, relaxation exercises, and time management strategies to help prevent cluster headaches. 5. Posture Correction: Assessment and recommendation of ergonomic adjustments to reduce muscle strain and tension. 6. Physical Therapy: Targeted exercises and stretches to strengthen neck and shoulder muscles, reducing the frequency and intensity of headaches. 7. Lifestyle Modifications: Advice on maintaining a balanced lifestyle, including proper hydration, nutrition, and regular physical activity to prevent headaches [1]. Preventing Cluster Headaches Preventive strategies are essential for managing cluster headaches: Avoiding Triggers: Identifying and avoiding known triggers such as alcohol and tobacco. Maintaining a Routine: Keeping a regular sleep schedule and meal times. Stress Management: Implementing techniques to manage stress effectively [4]. Importance of Chiropractic Care Chiropractic care at Georgia Upper Cervical is crucial in addressing the root causes of cluster headaches. By ensuring proper alignment of the cervical spine and improving nerve function, we can reduce the frequency and severity of headaches. Our approach is gentle, patient-centric, and focused on long-term relief [1]. Accepting New Patients in Ball Ground, GA Georgia Upper Cervical is now accepting new patients in Ball Ground, GA. Our team is dedicated to providing holistic, effective treatment for cluster headaches and other conditions. If you are suffering from cluster headaches, we invite you to visit us and take the first step towards lasting relief. Find Relief for Your Cluster Headaches Cluster headaches are a debilitating condition that requires a nuanced approach for effective management. Understanding the symptoms, causes, and treatment options is crucial for those affected. At Georgia Upper Cervical, we specialize in providing gentle, non-invasive chiropractic care tailored to each patient's unique needs. Our comprehensive approach includes thorough diagnostics, personalized treatment plans, and lifestyle recommendations to help patients achieve lasting relief from cluster headaches. If you are experiencing cluster headaches and are looking for a holistic approach to treatment, contact Georgia Upper Cervical today. Our team of experts is dedicated to helping you achieve optimal health and well-being through gentle, effective chiropractic care. Don't let cluster headaches control your life – take the first step towards lasting relief and improved quality of life with Georgia Upper Cervical [7].  --- Sources 1. National Headache Foundation. Cluster Headaches. Full text: https://headaches.org/2020/07/16/cluster-headache/ 2. American Migraine Foundation. Cluster Headache. Full text: https://americanmigrainefoundation.org/resource-library/cluster-headache/ 3. Mayo Clinic. Cluster headache. Full text: https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080 4. Cleveland Clinic. Cluster Headache. Full text: https://my.clevelandclinic.org/health/diseases/9638-cluster-headaches 5. Silberstein SD. “Cluster Headache.” UpToDate. Full text: https://www.uptodate.com/contents/cluster-headache 6. Dodick, D. W. (2018). Cluster headache. BMJ, 361, k1652. Full text: https://www.bmj.com/content/361/bmj.k1652 7. Burish, M. J., Pearson, S. M., & Shapiro, R. E. (2021). Cluster headache is one of the most painful conditions. BMJ, 374, n2025. Full text: https://www.bmj.com/content/374/bmj.n2025
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