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Thoracic Outlet Syndrome

Location of  TOS
I have received a few questions from lifters concerned with a tingling/ numb sensation in their fingers and pain in the neck/clavicle region. I myself had some questions, as I experience these sensations as well. After talking to a few physical therapists, the most likely cause of these symptoms is Thoracic Outlet Syndrome (TOS).

Let’s take a look at what TOS is, what some of the causes  are and how it can be treated.

TOS is a somewhat rare condition that is caused by blood vessels and nerves from the spine to be compressed or pinched as they pass through the collarbone and upper ribs. This constriction causes pain in the neck/shoulder region, with tingling and numbness in some of the fingers, sometimes accompanied by a weakened grip. This pain can range from mild to severe, and has been described as tingling, or even a burning sensation.

My TOS appeared about two weeks into my Smolov program. Squatting 4x a week was nothing new to me, but I was recovering from a bruised T-1 vertebrate which probably exacerbated the situation. There are currently many causes for TOS, including the Forward Head Posture position, poor sleeping position, and overworked shoulders (kipping pullups, anyone?)

There is not currently a consensus on the best way to medically diagnose for TOS, but let me just say that if you have it, you will know it. TOS is currently being analyzed as one of the underlying causes for carpal tunnel syndrome and other wrist-related pain.

As far as treatment in concerned, some medical experts agree that the following are some acceptable methods to treat TOS:

When thoracic outlet syndrome affects the nerves, the first treatment is always physical therapy. Physical therapy helps strengthen the shoulder muscles, improve range of motion, and promote better posture. Treatment may also include pain medication.
If there is pressure on the vein, your doctor may give you a blood thinner to dissolve the blood clot. This will help reduce swelling in your arm.
You may need surgery if physical therapy and changes in activity do not improve your symptoms. The surgeon may make a cut either under your armpit or just above your collarbone.
During surgery, the following may be done:
  • An extra rib is removed and certain muscles are cut.
  • A section of the first rib is removed to release pressure in the area.
  • Bypass surgery is done to reroute blood around the compression or remove the area that is causing the symptoms.

While I view the removal of the rib as a drastic step to alleviate the problem, defective rib issues from birth may leave removal as the only solution.

Along with my physical therapist, I have been using the following videos to help treat my TOS at home:

Here he discusses proper sleeping positions. I am currently working on improving mine.

Our man Starrett discusses his methods for alleviating TOS. I did not find success with these, but others have

Give some of these methods a shot to try and alleviate your TOS. Work on keeping your chest big and shoulders back: a constant rounded upper back when sitting, stand, or sleeping can cause TOS. If working with a therapist, expect 6-10 sessions before it is alleviated.



7 thoughts on “Thoracic Outlet Syndrome

  1. Great article! Do you have any suggestions for type of pillow to sleep on? I’ve tried standard feather, down, and even memory foam. The first two seem too soft and the memory foam seems too hard. I need that perfect Goldilocks kind of pillow. Thanks!

  2. Clint, pillows are a big issue for me too. I find that a well-worn medium-firmness down pillow or down alternative works best for me, something that you can have cradle your head and keep your neck neutral with no incline negative or positive. The problem with that is that 1) you have to break the pillow in and 2) once it’s too worn down it’s too worn down.

  3. Chiropractic care can also be a great treatment alternative for T.O.S. Either by itself, or in conjunction with a good physical therapist. Should of been mentioned in the article – which in my opinion jumped a little too quickly to surgical solutions.

    – SAE

  4. I’ve had success with acupuncture and massage therapy to alleviate my pain. If I go at least once a month I am generally pain free.

  5. I have posted a link to your blog on
    Thank you for your contribution to the TOS Community.

  6. Nice article. I may have something similar. I have swelling above my right clavicle and wake up with a numb hand sometimes. I hurt my shoulder last year doing over head presses and I was in a car accident this time last year and that is where the seat belt was. CT scan says I have no masses or legions, so now I am trying to figure this mess out with my chiropractor. I can tell in your pic, but where is the swelling? Oh and I work in fron of a computer all freakin’ day. Thoughts?

  7. Hey Brandon. I’ve most likely caught TOS, but is yet to see a physical therapist. But in the mean time and between sessions, is it okay for to go to the gym? If so, what exercises can I continue to perform? (I am currently doing Wendler’s 5/3/1 routine). Thanks!

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