Thoracic Outlet Syndrome - Massage Therapy

What is Thoracic Outlet Syndrome? 

Thoracic Outlet Syndrome (TOS) occurs when nerves, arteries, or veins are compressed in the thoracic outlet, the area between the collarbone (clavicle) and the first rib. This compression causes symptoms like neck, shoulder, and arm pain and hand numbness. 

Diagnosing TOS is generally tricky because it involves physical exams, imaging, and nerve studies, and its symptoms overlap with those of other conditions. Preventive measures include regular exercise, good sleep hygiene, and avoiding repetitive strain. Treatment varies, from massage therapy like the Iler Method® to physical therapy in the affected area and, in extreme cases, surgery. 

Categories of TOS - 

• Neurogenic TOS: This type, the most common form of Thoracic Outlet Syndrome, occurs when the brachial plexus, a bundle of nerves, is compressed in the narrow space between the collarbone and first rib, leading to irritation of the nerves. This compression results in pain, numbness, and tingling in the neck, shoulder, and arm, often exacerbated by certain arm movements. Neurogenic TOS is essentially a case of nerve entrapment requiring careful management to prevent further nerve damage.
• Vascular TOS: In this variation, the compression occurs on the subclavian vessels within the confined space of the thoracic outlet. Venous TOS manifests through swelling and pain due to vein compression, indicating irritation of the adjacent tissues, while Arterial TOS leads to symptoms like arm coldness and weakness stemming from restricted blood flow. These conditions highlight the critical nature of prompt treatment to mitigate the risks of severe complications associated with vascular compression.
• Nonspecific TOS: Diagnosed when patients have TOS-like symptoms without clear compression evidence. This controversial category involves a multidisciplinary approach, focusing on physical therapy and pain relief with massage therapy.

*Nonspecific is what most Iler Method clients present with when dealing with TOS.

Causes of TOS

Various factors, ranging from structural abnormalities to lifestyle habits, contribute to the development of this syndrome, impacting the quality of life and requiring targeted management strategies.

1. Anatomical Defects: Congenital variations, such as an extra cervical rib or tight fibrous bands, can compress neurovascular structures in the thoracic outlet, affecting the neck muscles and potentially leading to neck pain.
2. Trauma: Injuries that cause displacement or fractures of the collarbone or first rib can lead to compression in the thoracic outlet, a condition documented in various case reports and studies highlighting the impact on the shoulder girdle and upper body.
3. Repetitive Activities: Repetitive arm motions or activities raising the arms above the head can cause muscle enlargement or inflammation, leading to loss of range of motion and compression, exacerbating postural issues, and affecting the upper body's function.
4. Poor Posture: Slouching or keeping shoulders and the lower neck rolled forward decreases thoracic outlet space, compressing its contents. Clinical case studies have noted that postural issues can directly contribute to thoracic outlet syndrome.
5. Pregnancy: Body changes during pregnancy can compress nerves and vessels in the thoracic outlet, affecting the upper body and potentially leading to case reports of increased symptoms during this period.
6. Pressure on the Shoulders: Heavy lifting or carrying can put excess pressure on the shoulders, compressing the thoracic outlet and impacting the shoulder girdle. This situation is often discussed in case studies related to physical labor.
7. Weight Gain or Obesity: Excess weight can add pressure on the thoracic outlet's blood vessels and nerves, contributing to case reports of thoracic outlet syndrome in patients with obesity, highlighting the importance of managing weight for reducing symptoms.
8. Clenching and Grinding Teeth (Bruxism): This can lead to tight muscles in the neck and shoulders, indirectly affecting the thoracic outlet by altering posture and increasing muscle strain. Such conditions are often explored in case reports and studies, indicating a link between bruxism, postural issues, and thoracic outlet syndrome, with potential complications like blood clots in severe cases.

Symptoms of TOS 

Pain -

Individuals with Thoracic Outlet Syndrome frequently experience persistent pain localized in the neck and shoulder areas, often extending down the arm. Pain typically intensifies during certain activities or movements that exert additional pressure on the thoracic outlet area. 

Many also report experiencing sharp, severe pain radiating down the arm, a clear sign of nerve compression. Such pain can significantly limit and hinder everyday activities, emphasizing the impact of this condition on the overall quality of life.

Numbness - 

Thoracic Outlet Syndrome often manifests as a numbing sensation in the fingers or hands, a symptom frequently reported by sufferers. This numbness can be intermittent or sporadically respond to specific activities or postures. 

Without appropriate management or intervention, this numbness can progress to more severe neurological or vascular complications, potentially leading to permanent damage or loss of function in the affected areas.

Tingling -

Clients diagnosed with Thoracic Outlet Syndrome commonly describe experiencing a tingling sensation, often likened to 'pins and needles' in their arms or hands. 

This sensation is particularly noticeable when they elevate their arms, such as during overhead activities or simple tasks like hair brushing. The tingling often intensifies with prolonged arm elevation, indicating increased pressure on the soft tissue and nerves in the thoracic outlet area. 

Over time, it may progress to a chronic condition, persistently affecting hand sensation. The frequency and intensity of this numbness vary widely among individuals with Thoracic Outlet Syndrome.

Weakened Grip -  

Thoracic outlet syndrome can significantly impair grip strength by compressing nerves in the shoulder area. This weakening of grip makes it challenging for individuals to hold or grasp objects firmly, affecting everyday tasks such as writing or lifting. 

The loss of strength is often noticeable and can worsen if the syndrome remains untreated. Consequently, this symptom impacts physical capabilities, leading to limitations and frustrations in everyday activities. 

Iler Method Addresses the Symptoms of TOS

Iler Method® Therapists utilize three specialized trigger point therapy techniques targeting key muscles, such as the sternocleidomastoid, scalenes, trapezius, teres major and minor, and levator scapulae, to alleviate the symptoms of Thoracic Outlet Syndrome (TOS). 

Focusing on these specific muscles often reduces the compression of nerves and blood vessels in the thoracic outlet area, directly addressing the underlying causes of TOS and significantly improving client outcomes through tailored manual therapy interventions.

Ring and Middle Finger Technique - Using the ring and middle fingers together is particularly effective for treating Thoracic Outlet Syndrome symptoms because it harnesses the inherent strength and structural soundness of these fingers to precisely target and manipulate the muscles implicated in TOS, such as the sternocleidomastoid and scalenes. 

When tight or in spasm, these muscles can compress nerves and blood vessels in the thoracic outlet, leading to symptoms. The ability of these fingers to evenly distribute stress and apply focused pressure perpendicular to the hand’s shape allows for deep, targeted muscle manipulation. 

This can help release muscle tension, improve blood flow, and alleviate the nerve compression that characterizes TOS, making it a strategic approach in the manual therapy treatment of this condition.

Straight Fingers Technique - This technique applies precise pressure using the middle, ring, or index fingers, directly targeting the teres major, teres minor, and levator scapulae muscles involved in TOS.

This method is particularly adept at identifying and addressing fine trigger points, adhesions, and the intricate spaces between muscles, which are crucial for relieving the compression of nerves and blood vessels characteristic of TOS. 

Your therapist avoids using their pinky due to its relative weakness and focus on the stronger fingers. This technique ensures a more focused and effective manual therapy intervention, which is crucial for alleviating TOS symptoms.

The hand and finger-over-finger - This technique is particularly beneficial in treating thoracic outlet syndrome(TOS) as it amplifies and ensures even pressure distribution, which is essential for accessing and treating deeper tissues within the neck muscles, trapezius, and teres major and minor. 

By stacking one hand over the other, the top hand intensifies the pressure applied by the bottom hand's fingers, marrying the benefits of deep pressure with the nuanced sensitivity of finger manipulation. 

This dual approach allows targeted therapy on areas requiring substantial pressure and delicate touch. It effectively addresses the muscle tightness and adhesions contributing to the compression of nerves and blood vessels in TOS, offering a comprehensive manual therapy solution.

Final Thoughts: 

At the Iler Method®, we employ a targeted and effective strategy to manage Thoracic Outlet Syndrome (TOS), addressing the condition with our specialized trigger point therapy techniques. Our approach focuses on alleviating symptoms such as pain, numbness, tingling, and weakened grip by targeting and releasing the muscle tensions contributing to the compression of nerves and blood vessels. 

Using methods that allow for precise pressure application and deep tissue manipulation significantly reduces the discomfort and potential complications associated with TOS. Our focused treatment plan provides immediate relief and promotes long-term health and functionality, enhancing the quality of life for individuals dealing with this complex condition.

Thoracic Outlet FAQs

Is massage good for thoracic outlet syndrome?

Yes, massage therapy provides relief for individuals with thoracic outlet syndrome by reducing muscle tension. 

Where do you massage thoracic outlet syndrome?

Massage therapy for thoracic outlet syndrome typically focuses on the neck, shoulder, and upper chest area to alleviate muscle tension and reduce compression on nerves and blood vessels.

How do you release thoracic outlet syndrome?

Skilled massage therapists identify and apply targeted pressure to trigger points in the affected muscles, such as the neck and shoulder, to alleviate muscle tension and reduce pain. This technique releases muscle knots and improves blood flow, relieving some TOS symptoms.

How do you heal thoracic outlet syndrome?

Healing Thoracic Outlet Syndrome typically involves a multifaceted approach that may include trigger point therapy, where pressure is applied to specific muscle knots to alleviate tension and improve circulation. This therapy and other physical therapy and lifestyle modifications can help alleviate symptoms and promote the healing of Thoracic Outlet Syndrome over time.