Finding relief from the symptoms of Thoracic Outlet Syndrome (TOS) can often be challenging. However, regular breathing exercises will help calm the nervous system and relax the muscles surrounding the Thoracic Outlet. This results in decreased pain and nervous system sensitivity.
What is Thoracic Outlet Syndrome (TOS)?
There are three types of TOS presentations but by far the most prevalent is Neurogenic Thoracic Outlet Syndrome which accounts for approximately 90% of all cases.
It occurs when the bundle of nerves called the Brachial Plexus become impinged in the Thoracic Outlet. This is the area of the body between the first rib, the clavicle (collar bone) and scalene muscles (muscles in the front of the neck). As the nerves pass through this area, pressure can be placed on the Brachial Plexus causing symptoms.
It is more prevalent in females.
What Causes TOS?
The most common cause is poor posture associated with weakness and tightness in the muscles surrounding the thoracic outlet.
It can also occur as a result of damage such as a fractured clavicle or dislocated shoulder.
A common presentation is with people who have occupations requiring repetitive above-head activities or in athletes with similar presentations such as swimmers or tennis players. In these instances, muscles often become overdeveloped and larger which encroach further into the Thoracic Outlet.
What are the Symptoms of Neurogenic Thoracic Outlet Syndrome?
The symptoms of TOS can be varied and sometimes vague. The physical manifestations most common are:
- Neck Pain
- Weakness in shoulder, arm and hand
- Pain in the inner portion of the forearm and elbow
- Headaches
- Pain in the upper chest
- Hand Paraesthesia
Treatment
Physiotherapy is the first line of management of TOS. A skilled physiotherapist will help your symptoms by helping you to identify the lifestyle changes that may need addressing, provide you with exercises to improve your posture and mobilise your brachial plexus.
They will often perform manual techniques which will help the muscles to relax as well as gentle movements to mobilise your thoracic spine and ribs, particularly the first rib.
Prognosis is often excellent with most people successfully overcoming their symptoms. Even those small numbers that go on to need surgery have successful outcomes.
In my experience those who embrace their lifestyle factors such as modified sleeping positions, occupational adaptations and training adaptations not only overcome their symptoms but have much smaller reoccurrence rates than those patients who fail to embrace these factors adequately.
You can read my article on the Best Sleeping Positions for TOS here.
How breathing affects TOS
The way that we breathe can have a profound impact on TOS. When you breathe poorly, often shallowly or by using the muscles located on the sides of your neck called the Scalenes, we can make these muscles overactive and when overly engaged, they can contribute to the compression of the nerves in the thoracic outlet.
By engaging in exercises that promote diaphragmatic breathing or belly breathing as it is sometimes called, we can reduce the pressure on the muscles that can impinge into the Thoracic Outlet as well as calm down the overly sensitised nervous system.
Breathing Exercises for TOS Relief
These are the three breathing techniques that my patients have used to obtain relief from their symptoms.
1. Diaphragmatic Breathing (Relaxed Breathing)
This is my favourite and the easiest exercise to perform.
- Lie on your back with your knees bent or sit comfortably in a chair with your feet on the floor.
- Place one hand on your chest and the other on your abdomen.
- Breathe in slowly through your nose and feel your belly rise as you breathe in. Your chest should remain still.
- Exhale slowly through your mouth, letting your belly fall. Focus on emptying your lungs completely.
- Repeat this for 5 minutes, aiming to keep the breath slow and steady.
This is an excellent exercise to reduce tension in the neck, shoulders and chest which relieves pressure on the thoracic outlet. It also encourages better postural control.
2. Box Breathing
Using the same set-up as for the Diaphragmatic Breathing Exercise perform the following:
- Inhale slowly through your nose for a count of four. Make sure that you are making your belly rise
- Hold your breath for a count of four.
- Exhale through your mouth for a count of four.
- Hold your breath again for a count of four.
- Repeat the cycle for 5 minutes.
By performing the Box Breathing exercise regularly, you will promote relaxation and reduce stress. This will relax the nervous system as a whole as well as the muscles of the thoracic outlet.
3. Pursed Lip Breathing
Again, set up the same as the previous two exercises although I like to suggest to my patients that they perform this exercise in sitting or standing in good posture.
- Inhale deeply through your nose for two counts.
- Purse your lips as if you are going to whistle, and exhale slowly and gently for four counts.
- Continue this cycle for 2 minutes, focusing on the slow, controlled exhalation
This is a great exercise for reducing neural tension and improving posture which will reduce the pressure on the Thoracic Outlet.
Posture Matters
Maintaining good posture while performing these breathing techniques enhances their effectiveness. Whether you’re sitting, standing, or lying down, ensure that your spine is aligned and your shoulders are relaxed. This allows for full lung expansion and reduces tension in the neck and shoulder areas this will reduce strain on the thoracic outlet.
Incorporating Breathing Exercises into Daily Life
Consistent application of the breathing exercises is the key to success.
Although these exercises can be used as first aid when symptoms are particularly bad, they are best incorporated as a regime of daily breath work for the best results over time.
My recommendations for you are as follows:
- Morning Routine: Start your day with a few minutes of diaphragmatic breathing to set the tone for relaxed, efficient breathing throughout the day.
- Work Breaks: Take short breaks at work to practice pursed-lip breathing or box breathing, particularly if you spend long hours sitting, which can exacerbate TOS symptoms.
- Before Bed: End your day with diaphragmatic breathing to calm your nervous system and promote a good night’s sleep
Combining Breathing Exercises with other TOS Management Strategies
While breathing exercises can significantly reduce symptoms, they work best when combined with other management strategies. For optimal results:
- Focus on posture – Good posture is crucial for preventing muscle imbalances that can lead to or worsen TOS. Breathing exercises can help reinforce proper alignment, but attention to ergonomics throughout your day is essential.
- Exercise – to improve strength of the postural muscles and to improve the mobility of the muscles of the neck, chest and shoulders.
- Neural mobility – Neural glide exercises to improve the pathway of the brachil plexus.
- Manage stress – Stress often leads to shallow breathing and increased muscle tension. By regularly practicing these breathing techniques, you’ll not only reduce physical tension but also improve your ability to manage stress, a key factor in preventing TOS flare-ups
- Review the lifestyle factors which may be contributing to your symptom and make relevant chnges.
Conclusion
I prescribe breathing exercises succesfully for my patients struggling with symptoms of TOS. Incorporating these techniques into your daily routine can help reduce muscle tension, promote better circulation, and enhance relaxation, all of which are essential for relieving TOS symptoms.
Remember, breathing techniques are just one component of a comprehensive management plan. Consistency and proper technique are key, and if symptoms persist, don’t hesitate to seek further guidance from your physiotherapist.
If you would like personalised help with your TOS symptoms please feel free to reach out to me here.
