Exercises for Thoracic Outlet Syndrome

Thoracic outlet syndrome is a group of conditions that occur when the nerves and/or blood vessels of the thoracic outlet are compressed.

Compression of the thoracic outlet can lead to symptoms such as pain, weakness, numbness/tingling, discoloration, swelling, muscle wasting, protruding veins, cold hands, and in severe cases, an aneurysm or embolism.

Rest assured, severe cases account for only 1%–2% of thoracic outlet cases.

There are three main types of thoracic outlet syndrome, and symptoms may vary depending on what is most affected. The three main types of thoracic outlet syndrome include:

• Neurogenic thoracic outlet syndrome: This is the most common form of thoracic outlet syndrome, accounting for around 95% of cases. It occurs when the nerves in the thoracic outlet (i.e., brachial plexus nerves) are compressed.
• Venous thoracic outlet syndrome: This type of thoracic outlet syndrome happens when one or more veins (i.e., subclavian vein, axillary vein) under the collarbone are compressed. This accounts for around 3%–5% of cases.
• Arterial thoracic outlet syndrome: The rarest and most dangerous form, arterial thoracic outlet syndrome occurs when the arteries (i.e., subclavian artery, axillary artery) under the collarbone are compressed, often resulting in an aneurysm. Only around 1%–2% of cases are arterial thoracic outlet syndrome.

Compression of the thoracic outlet can lead to symptoms such as pain, weakness, numbness/tingling, discoloration, swelling, muscle wasting, protruding veins, cold hands, and in severe cases, an aneurysm or embolism.

Before starting any exercise program, it’s important to get clearance by a healthcare professional first. Working with a physical therapist can help guide you through your diagnosis and give personalized exercise programs based on your condition.

In particular, physical therapy is often advised for people with neurogenic thoracic outlet syndrome but may not be appropriate for those with venous or arterial thoracic outlet syndrome, since surgery is often required. If conservative measures don’t help, it’s best to follow up with a physician.

The following exercises can help you with your rehabilitation, but should only be performed once you and a healthcare professional feel you’re ready. The goal is to strengthen the upper back and shoulder muscles, as well as your postural stabilizers. Retraining your posture often can also help improve symptoms.

Standing rows

1. Wrap a resistance band around a stable post. Alternatively, wrap the band around a doorknob and close the door so it’s stable.
2. Grab the resistance band with both hands and stand straight.
3. With elbows bent, gently pull the resistance band back until your elbows are just past the sides of your body. Use your scapula (shoulder blades) to pull the bands back, rather than your arms.
4. Then, gently return the bands back to starting position.
5. Perform 2–3 sets of 8–12 reps.

Note: Be sure to slide your shoulder blades down and back, squeezing them gently together in the back.

Quadruped thread the needle

1. Start on all fours, with your palms flat on the floor and your spine in a neutral position. Make sure your knees and hips are stacked and your shoulders and hands are aligned.
2. Lift your right hand then gently thread it beneath your left arm, allowing your right hand to graze the floor.
3. Allow your chest and right shoulder to lower towards the ground.
4. Next, slowly bring your right arm back and then reach out toward the ceiling, allowing your chest to rotate outward to the right.
5. Then, bring your right arm back down and repeat the sequence.
6. Continue this for 8–12 reps. Then, switch sides.

Prone snow angel

1. Lie on your stomach with your forehead touching the ground, legs straight, arms at your side (palms facing down).
2. Gently lift your arms a few inches off ground by retracting shoulder blades. This is the starting position.
3. Next, slowly bring your arms out to the sides (perpendicular to your body). If this is comfortable, continue to bring your arms until they’re over your head.
4. Then, slowly return arms to the starting position. As you’ll notice, the movement is similar to doing snow angels.
5. Perform 8–12 reps, or as many as you feel comfortable doing.

Note: If you find it too difficult to move your arms toward your head, you can perform this exercise by lifting your arms by your sides and holding this position. This exercise is fairly advanced and should be attempted later in the recovery process.

Resistance band pull-apart

1. Stand up straight with your elbows bent around 90 degrees. Hold a resistance band taut in front of you with both hands (palms facing up). The band should be parallel to the floor.
2. Keeping elbows bent at sides, slowly pull the band toward your abdomen by moving your arms out to the sides. Focus on squeezing your shoulder blades together to initiate the movement and keep your spine neutral.
3. Slowly return to the starting position and repeat.
4. Perform 1–3 sets of 8–12 reps.

Stretching can play a helpful role in your recovery of neurogenic thoracic outlet syndrome. In particular, it’s important to stretch the scalene muscles (large muscles near the front sides of your neck) and pectoral muscles (chest muscles).

Scalene stretch

1. Sit upright in a chair with your feet flat on the floor.
2. Take your right hand and grab the seat of the chair.
3. Next, tilt your head to the left while keeping your head straight. You should feel a stretch in the right side of your neck. If it’s painful, lighten the stretch or stop.
4. Hold this for 30–60 seconds. Then, switch sides.

Pectoralis stretch

1. Stand at the opening of a door with both hands on each side of the doorframe. Your hands should be slightly above shoulder height.
2. Next, allow your body to lean forward to stretch your chest. For added support, place one foot forward and slightly bend your knee.
3. Hold this position for 20–30 seconds.

Note: If this stretch further exacerbates the symptoms of numbness and tingling in your fingers, discontinue the stretch, or modify it so you do only one arm at a time.

Sitting back extension

1. Sit upright in a chair with your hands on the back of your head and elbows out to the side.
2. Gently lean back until you feel a stretch in your chest.
3. Hold this for 30 seconds.

While no exercises are officially off-limits, you may need to limit certain movements during recovery from neurogenic thoracic outlet syndrome. If you have arterial or venous thoracic outlet syndrome, it’s crucial to consult with a healthcare professional first.

It’s often recommended you limit or avoid overhead movements or exercises that require lifting heavy loads (e.g., dumbbells, barbells, etc.) until you’ve received clearance from your physical therapist or healthcare team.

Often, it may also be a good idea to steer clear of chest exercises (e.g., bench press) until you’re further along in your recovery. Recovering from thoracic outlet syndrome requires focusing on strengthening the back muscles more than the front.

During recovery, it’s important to take it slow and avoid overdoing it, which can exacerbate your condition. Listen to your body and only perform movements that feel comfortable and are not painful.

There are many causes of thoracic outlet syndrome, such as:

• Anatomical defects: People born with an extra cervical rib or those who have an abnormal formation of the first rib, collarbone, or scalene muscle are at an increased risk for thoracic outlet syndrome due to less available space and greater risk of compression in this area.
• Injury/trauma: Whiplash, overuse injuries, repeated overhead motions (e.g., jobs that require working with hands above head), athletic injuries, and other injuries to the upper extremities can increase risk.
• Rounded posture: Forward head positioning, text neck, and the rounded or hunched shoulders that often result from too much screen time can also lead to thoracic outlet syndrome.
• Cancer: Though rare, growth of a tumor in the neck can lead to compression of the thoracic outlet.
• Other: Some other factors, such as overdeveloped muscles (e.g., bodybuilding), weight gain, and poor posture can put additional stress on the nerves and vessels of the thoracic outlet.

Treatment for thoracic outlet syndrome depends on the type and severity of the condition, which is why it is crucial to get a proper diagnosis from a qualified healthcare professional.

Once you have received your diagnosis, your healthcare team may recommend physical therapy as a first step of treatment, especially in those with neurogenic thoracic outlet syndrome. Pain medications or injections may also be used for pain management.

If symptoms do not improve with physical therapy and pain management, then surgery may be required.

Usually, those with venous or arterial thoracic outlet syndrome will require surgery and may also be prescribed anticoagulants.

Maintaining good posture can help reduce pressure on nerves and vessels within the thoracic outlet.

Common signs of poor posture include rounding the shoulders and upper back and pushing the head and neck forward. Over time, these postures can result in tightness and pressure within the thoracic outlet.

When done often, some activities can worsen posture, such as working at a computer, playing a musical instrument that requires bending forward (e.g., string instruments), holding heavy bags or a child, or other activities that bring the shoulders and neck forward.

To avoid this, it’s important to maintain good posture and keep the thoracic outlet “open”. This can be done by holding the shoulders up and back, keeping the neck in a neutral position, and holding your head up (chin parallel to the ground).

Performing exercises that strengthen the upper back and neck extensors can also help support better posture.

What aggravates thoracic outlet syndrome?

Repetitive overhead movements, poor posture, and heavy lifting can worsen thoracic outlet syndrome.

Is massage good for thoracic outlet syndrome?

For some people, massage may help to relieve symptoms of thoracic outlet syndrome and help open up the space in that region. However, it’s best to see a trained professional to avoid worsening the injury.

How do you calm thoracic outlet syndrome?

For many, limiting activities that worsen thoracic outlet syndrome (e.g., overhead movement or heavy lifting) can help reduce pain. Also, working with a physical therapist can help ensure a safe recovery.

Is heat or cold good for thoracic outlet syndrome?

Applying heat to your shoulder and neck can help improve blood circulation, thereby reducing some pain and discomfort in people with neurogenic thoracic outlet syndrome.

What happens if thoracic outlet syndrome is left untreated?

Early treatment is important for relieving symptoms of thoracic outlet syndrome. If left untreated, you may experience increased pain and discomfort.

If you have venous or arterial thoracic outlet syndrome, it’s important to seek medical attention as this can potentially lead to serious issues, such as blood clots.

Thoracic outlet syndrome is a group of conditions involving compression of the nerves and blood vessels in the thoracic outlet — a region just below the clavicle (or collarbone).

Most people experience neurogenic thoracic outlet syndrome, which occurs when the nerves in the thoracic outlet are compressed. It’s often caused by trauma or injury to the area, repetitive movements (especially overhead), or poor posture.

Other types include venous and arterial thoracic outlet syndrome, which occur in less than 5% of cases and often require surgery.

Usually, most people can treat thoracic outlet syndrome with physical therapy and pain management, but may require surgery in rare cases.

To ensure you have the best treatment based on your condition, seek the advice of a qualified healthcare professional.