Thoracic Outlet Syndrome (TOS) is a condition that involves the compression of nerves and blood vessels between the collarbone (clavicle), the first rib and the scalene muscles.
This compression can lead to pain in the neck and chest, numbness, tingling, and weakness in the arm and hand.
As a physiotherapist, I help patients manage and alleviate their symptoms through evidence-based treatment and I also provide advice on lifestyle adjustments.
A key aspect of managing TOS is knowing what activities or habits to avoid. Avoiding or taking control of the following 7 things can significantly help you take control and aid recovery from TOS.
The Seven Things to Avoid if you have TOS
The following seven things are the advice that I provide to all my TOS patients. By following the advice my patients are able to reduce their symptoms and start meaningful recovery. By embracing them you could achieve the same too.
#1 Overhead Repetitive Movements
One of the most common triggers for TOS symptoms is repetitive overhead movements. Actions like lifting objects above shoulder height, painting, swimming, or serving in tennis can increase pressure on the thoracic outlet, compressing the nerves and blood vessels. If you repeatedly exacerbate your symptoms by doing this you will sensitise the nerves even further making it harder for them to recover.
What to Do Instead: Modify tasks to avoid overhead activities. For example, keep objects at waist or chest height, take frequent breaks when performing tasks that involve raising the arms, and try to avoid holding any position for extended periods.
Try modifying your technique if you’re a tennis player or a swimmer. Consider taking a short break from competing and concentrating on training activities that do not aggravate your TOS.
#2 Heavy Lifting and Carrying
Carrying heavy objects, particularly in awkward positions, can strain the shoulders, neck, and chest, which worsens TOS symptoms. Lifting heavy weights with poor posture, particularly in the gym or at work, is also problematic.
What to Do Instead: Use proper lifting techniques by engaging your legs instead of your shoulders and back. When possible, use assistive devices like trolleys or ask for help when lifting heavy objects.
In the gym, switch to lighter weights and exercises that avoid straining the shoulder girdle. Consider avoiding overhead pressing movements completely as you recover.
# 3 Poor Posture
Slouching, forward head posture, and rounded shoulders are common postural habits that can contribute to the development and worsening of TOS. Spending long periods sitting or standing with poor posture puts the thoracic outlet under strain.
Over time, the muscles that control posture can become weak and shortened, placing even more strain on the Thoracic Outlet.
What to Do Instead: Focus on maintaining proper posture. Follow an exercise regime that contributes to better postural control. You can watch this video in which I talk you through my 5 minute posture fix.
#4 Carrying Heavy Bags on One Shoulder
Shoulder bags, purses, or backpacks that place an uneven load on one shoulder are a major contributor to TOS symptoms. This can cause muscle imbalances and uneven pressure on the thoracic outlet.
I see my patients do this all the time without realising. They tell me that after a while they have to swap shoulders when carrying their bags.
What to Do Instead: The simple solution is to avoid this altogether. Switch your shoulder bags to bags that you have to hand carry and make sure that rucksack straps are placed over both shoulders. If this is still symptomatic, you must stop using a rucksack temporarily.
#5 Prolonged Static Postures
Sitting or standing in the same position for extended periods can worsen TOS symptoms. This includes sitting at a desk, driving for long periods, or standing without moving.
These positions reduce our circulation and increase the chances of the muscles around our thoracic outlet becoming tight.
What to Do Instead: Take regular breaks to change positions, stretch, and move. Set a timer to remind yourself to take breaks every 30-45 minutes, especially if you’re working at a desk. Incorporate gentle stretching and mobility exercises during breaks to relieve muscle tension.
#6 Intense Overhead Exercise Routines
Certain exercises, particularly those involving overhead presses, chin-ups, and shoulder-intensive movements, can increase strain on the thoracic outlet. These exercises can worsen TOS symptoms if performed incorrectly or too frequently.
Exercises that engage the shoulders and chest too intensely can compress the thoracic outlet and exacerbate the condition. The repetitive strain of these exercises can further damage the affected nerves and vessels.
What to Do Instead: Modify your exercise routine to focus on gentle strengthening, stretching, and postural correction. Exercises like scapular retractions, gentle rows, and chest-opening stretches can help strengthen muscles without causing compression.
For personalised rehabilitation, you should always seek the advice of a Physiotherapist.
#7 Stress and Tension
Emotional stress and tension can contribute to muscle tightness, particularly in the neck, shoulders, and upper back. Tension in these areas can increase compression on the thoracic outlet.
Stress often leads to tightened muscles around the thoracic outlet, worsening compression and symptoms like pain, tingling, and numbness. Chronic stress may also contribute to poor posture, which further aggravates the condition.
What to Do Instead: Incorporate relaxation techniques like deep breathing, meditation, or progressive muscle relaxation into your daily routine. Regularly practising stress management can reduce muscle tightness and improve overall well-being.
Read my article on the best breathing techniques to manage your TOS symptoms here.
Conclusion
Living with Thoracic Outlet Syndrome requires making careful adjustments to lifestyle and work. Avoiding repetitive overhead movements, heavy lifting, poor posture, and stress can help prevent further compression of the nerves and blood vessels.
Strengthening and mobilising your body and nerves will help your symptoms and crucially reduce your incidences of reoccurrence.
If you’re unsure where to start to begin taking control of your symptoms read this article next:
Thoracic Outlet Syndrome – Tips for Effective Management and Relief
You can get direct access to help from me here if you would like personalised support too:
Good luck!
