Thoracic Outlet Syndrome Rehabilitation Instructions

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed.

It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your shoulder. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Gentle chest stretch with “belly” breathing

1. On the floor, place a half foam roller or a bath towel that is rolled up lengthwise.
2. Lie on your back so your spine—all the way from your head to your tailbone—is on top of the foam roller or towel. Relax. You should feel a gentle stretch across your upper chest.
   1. Keep both feet or heels firmly on the floor.
   1. You may bend your knees for comfort.
   1. Let your arms fall naturally to your sides.
3. Breathe deeply and slowly from your belly. You should feel your belly rise each time you breathe in (inhale). Breathe out (exhale) completely before you inhale again.
4. Stay in this position and continue to inhale and exhale for __________ seconds.
   1. Over time, gradually increase the amount of time that you hold this stretch, as told by your health care provider.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Scalene stretches

There are 3 types of scalene stretches. They vary depending on which direction you are looking while you do the exercise. Your health care provider will tell you which type of scalene stretch to do.

1. Lie on your back. Place the hand from your left / right side under the hip of your left / right side. For example, if your right shoulder is injured, place your right hand under your right hip.
2. Gently and slowly tilt your head toward your healthy shoulder. Follow instructions from your health care provider about which direction you should turn your face while you tilt your head:
   1. Scalenus posterior stretch: Turn your face toward your healthy shoulder, in the same direction that you tilt your head.
   1. Scalenus medius stretch: Turn your face toward the ceiling while you tilt your head toward your healthy shoulder.
   1. Scalenus anterior stretch: Turn your face toward your injured shoulder. This means that you tilt your head one direction (toward your healthy shoulder), but you turn your face to the opposite direction.
3. Hold each stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Chin tuck (axial extension)

1. Using good posture, sit on a stable surface or stand up. If you have trouble keeping good posture, rest your back and head against a stable wall during this exercise.
2. Look straight ahead and slowly move your chin back, toward your neck, until you feel a stretch in the back of your head.
   1. Your head should slide back.
   1. Your chin should be slightly lowered.
3. Hold for __________ seconds.
4. Return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Shoulder rolls

1. Sit in a sturdy chair or stand. Keep good posture during the exercise.
2. Shrug your shoulders up toward your ears and gently move your shoulders around in circles going forward.
3. Reverse the direction of your shoulder rolls so you are moving your shoulders around in circles going backward.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Chest stretch (external rotation and abduction)

1. Stand in a doorway with one of your feet slightly in front of the other. This is called a staggered stance. If you cannot reach your forearms to the door frame, do this exercise in a corner of a room.
2. Choose one of the following positions as told by your health care provider:
   1. Place your hands and forearms on the door frame above your head.
   1. Place your hands and forearms on the door frame at the height of your head.
   1. Place your hands on the door frame at the height of your elbows.
3. Slowly move your weight onto your front foot until you feel a stretch across your chest and in the front of your shoulders. Keep your head and chest upright and keep your abdominal muscles tight.
4. Hold for __________ seconds.
5. To release the stretch, shift your weight to your back foot.

Repeat __________ times. Complete this stretch __________ times a day

Strengthening exercise

This exercise builds strength and endurance in your shoulder. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise F: Scapular retraction

1. Sit in a stable chair without armrests, or stand.
2. Secure an exercise band to a stable object in front of you so the band is at shoulder height.
3. Hold one end of the band in each hand. Your palms should face down.
4. Straighten your elbows and lift your arms up to shoulder height.
5. Step back, away from the secured end of the band, until the band has no slack.
6. Squeeze your shoulder blades together and pull your elbows back behind you.
   1. Your elbows should be at about chest or shoulder height.
   1. Keep your upper arms lifted, away from your sides.
7. Hold for __________ seconds.
8. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Posture and body mechanics

Body mechanics refers to the movements and positions of your body while you do your daily activities. Posture is part of body mechanics. Good posture and healthy body mechanics can help to relieve stress in your body’s tissues and joints. Good posture means that your spine is in its natural S-curve position (your spine is neutral), your shoulders are pulled back slightly, and your head is not tipped forward. The following are general guidelines for applying improved posture and body mechanics to your everyday activities.

Standing

• When standing, keep your spine neutral and your feet about hip-width apart. Keep a slight bend in your knees. Your ears, shoulders, and hips should line up with each other.
• When you do a task in which you stand in one place for a long time, place one foot up on a stable object that is 2–4 inches (5–10 cm) high, such as a footstool. This helps keep your spine neutral.

Sitting

• When sitting, keep your spine neutral and your feet flat on the floor. Use a footrest, if necessary, and keep your thighs parallel to the floor. Avoid rounding your shoulders, and avoid tilting your head forward.
• When working at a desk or a computer, keep your desk at a height where your hands are slightly lower than your elbows. Slide your chair under your desk so you are close enough to maintain good posture.
• When working at a computer, place your monitor at a height and where you are looking straight ahead and you do not have to tilt your head forward or downward to look at the screen.

Resting

• When lying down and resting, avoid positions that are most painful for you.
• If you have pain with activities such as sitting, bending, stooping, or squatting (flexion-based activities), lie in a position in which your body does not bend very much. For example, avoid curling up on your side with your arms and knees near your chest (fetal position).
• If you have pain with activities such as standing for a long time or reaching with your arms (extension-based activities), lie with your spine in a neutral position and bend your knees slightly. Try the following positions:
• Lying on your side with a pillow between your knees.
• Lying on your back with a pillow under your knees.