Thoracic Outlet Syndrome and Yoga

by Baxter

Thoracic Outlet Syndrome (TOS) arises most commonly in people who have been in traumatic accidents, typically in car accidents, or who do repetitive jobs, such as computer work at a non-ergonomic workstation, so that is potentially a lot of people. In addition to the two causes mentioned already, there are other less common causes of Thoracic Outlet Syndrome, like the presence of an extra small rib that can compress nerves and blood vessels near the lower side of the neck. Regardless of the underlying cause, folks who develop Thoracic Outlet Syndrome often complain of a host of symptoms, which can include, but are not limited to, numbness and pain in the affected side of the neck, that is, in the arm, front chest and neck. There can also be weakness in that arm or hand. Symptoms often come and go, and in some situations can be positional in nature, only arising when the affected side arm is lifted and held overhead for a little while. 

What’s happening under the skin, so to speak, is that any of a number of structures could be getting compressed that should not be. More specifically, the cervical nerves that come out of your spine and come together to form the brachial plexus, (a kind of super highway interchange of different nerves from the cervical spine before heading down into the arm) can be pushed on by muscles and/or bones and lead to the symptoms described above. The same fate can befall the subclavian artery, the large blood vessel from the heart that feeds the arms, as it moves through the area of the side neck, under the collar bone, and out into the upper arm. 

A commonly cited aggravator of this condition is poor posture, which we have mentioned in many other contexts as contributing to other body pain conditions, and for which yoga is such a great antidote. In fact, most people diagnosed with Thoracic Outlet Syndrome will first be referred to physical therapy for postural re-alignment and stretches to open up the area of the neck and upper chest in order to create more space around the brachial plexus and arteries and veins to lessen or eliminate the symptoms associated with the condition. One muscle group that is often implicated in compressing the nerves and blood vessels is the scalenes, specifically the anterior and medial bodies of this three-muscle trio.

Muscles of the Neck

It would be worth your while to review an anatomy book if you are interested in understanding these muscles, which movements they normally create, and how one might stretch them to relieve tension on our delicate nerves and arteries.

Yoga could be a great adjunct to this healing process, since many of our sequences and poses address this area of the body nicely. Even simple warm up exercises like shoulder rolls, where you bring your shoulders forward, then up, then back and down, can start to improve this area immensely. I start class with this kind of attention to the upper chest quite often. Basic attention to Mountain pose and supported reclining backbends would be good starting places as well. And there are a few postures that directly affect the scalenes, such as the head positions in Bharadvajrasana seated twist in which you rotate and then side-bend the neck.

Conversely, since folks with Thoracic Outlet Syndrome often get symptoms when their arms are held overhead, some caution must be used when doing yoga poses with the arms ups, like Warrior I pose, for instance, especially if you intend to hold the pose for a while. I would not be surprised that a few people out there may have become aware of their positional symptoms after starting yoga due to the demands of the poses on the arms. (Yoga would not “cause” Thoracic Outlet Syndrome, but could alert you to its presence in such positions as Mountain pose with arms overhead, Urdhva Hastasana.) If such postures do bring on pain or numbness, it might be more prudent to experiment with dynamic versions of such poses, moving the arms up and down with the breath to see if the dynamic action precipitates symptoms. If not, you could continue to practice this way or even add in short holds as long as no symptoms arise. 

By moving and liberating held tension in this area, ultimately you may be able to relieve the compression that is underlying the Thoracic Outlet Syndrome. In fact, most patients with this diagnosis find some improvement with modalities like physical therapy and, I suspect, yoga as well, and very few have to resort to surgical intervention to find relief. 

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