Thoracic Outlet Syndrome, or TOS, is a group of disorders that occur when the blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) become compressed. This can cause pain in your shoulder and neck and numbness and tingling in your arms and/or fingers. There are three different types of TOS: neurological, vascular and idiopathic. This doesn’t necessarily change treatment, just different structures involved. Although this may change your symptoms, depending on which type of TOS you have.
Common causes of thoracic outlet syndrome include physical trauma from a car accident, or any type of accident, repetitive injuries from job- or sports-related activities, certain anatomical defects (such as having an extra rib), poor posture, and pregnancy. Sometimes doctors can’t determine the cause of thoracic outlet syndrome. TOS can involve some very delicate structures, nerves and veins, which can make it tricky to diagnose and treat. Please always see your doctor first for a diagnosis.
In the medical community the prescription for treatment of TOS is physical therapy, pain management by medications — which can often lead to other side effects — and if necessary, surgery. I want to explore in this article another treatment that can help alleviate TOS and the discomfort associated with it: massage.
In the thoracic inlet, you have a bundle of nerves running right over your armpit area called your brachial plexus, and when they get compressed, often you will feel pain, discomfort, numbness, and tingling. But what causes the compression? Not too often an anatomical abnormality can cause the compression, but most often it is our tight, tense muscles that run through this area that can cause this compression. Common muscles that tighten up are pec minor and major, and your anterior and medial scalenes in the neck. Adhesions in these muscles can cause the muscle fibers to adhere or attach to one another, causing less space in the area as well.
How can massage help?
Massage lengthens tight, tense muscles, gets blood flow and oxygen into an area to promote healing, and also can remove adhesions/restrictions.
Is there anything you can do to prevent this?
As anything in life, there are things you can do to decrease or minimize your chances of developing TOS. Earlier mentioned was poor posture as a common cause of TOS. A lot of what we do in our daily lives promotes poor posture, but specifically things that anteriorly rotate your shoulders, or pulls them in forward, contributes to this syndrome. Computer work is a huge part of our day to day lives, but most importantly our working lives. Unfortunately I see many young students with bad posture because tablets have replaced textbooks, promoting bad posture. It’s not just the large amounts of time we are on our various computer devices, but also driving as well. Unfortunately for us side sleepers out there, this contributes to our anterior shoulder rotation too. How many of us carry some type of bag, weighted with our daily necessities, over one shoulder? Being mindful and aware of what our daily activities are doing to us is the first step in preventing injury, and doing a little self-care will help too.
So what can you do?
Getting regular massage will help you keep these tight muscle groups loosened up, promote healing and release any restrictions there might be. In your back you may also have a group of muscles that are overstretched and weak, from trying to hold onto your shoulder. These muscles need to be strengthened, which is why working with a physical therapist or a personal trainer, along with massage, can be beneficial. Be mindful of your posture, especially with activities that keep you in one place for long periods. Set a timer to get up and walk and stretch your whole body, it will thank you. Try a yoga class. This is the only exercise that tones you, stretches you and promotes whole body awareness/posture all at once — perfect for busy lives. Finally, lighten the load that you carry in your bag(s) on a daily basis.