I'm very happy to report considerable success recently since suffering TOS-like symptoms following a ski injury (fractured neck) in 2010.

Following surgery in June this year (insertion of a prosthetic cervical disc), while the cervical nerve-related symptoms improved, general upper back, shoulder and well-being did not improve and even deteriorated. Still it's hard to say definitively what recent improvements have come from surgery and what has come from physio.

Over the past 4 years, I have seen over 12 PTs, all of them with very different approaches. Some brought more success than others, with the most success coming from those focusing on shoulder stability and mechanics. However, even with these improvements, symptoms in the shoulders, upper back and arms was still not satisfactory.

This all changed two months ago when I was referred to a doctor who calls himself a "movement specialist" (Dr Larsen at Spiraldynamik in Zurich, Switzerland). He did a thorough diagnosis of back mobility using a variety of handheld devices and concluded that the thoracic spine had too much curvature (kyphosis; 45 degrees compared with a healthy 30 degrees) and very limited mobility. He has a specific programme addressing this to restore healthy movement, which has resulted in an enormous improvement in two months (now at 38 degrees - half way there!) and much less pain.

The most important things I have learnt:

• Never give up looking for a solution. I didn't always have this pain so something in my body has changed mechanically, which I can fix.
• Most PTs still struggle to diagnose movement disorders, especially of the trunk.
• The underlying problem is generally incorrect recruitment of the deep stabilising (parasympathetic) muscles, which forces the less efficient superficial (sympathetic) muscles to take on this role, leading to trigger points, compression, inefficient stabilisation and restricted mobility.
• Trigger point therapy and stretching can greatly relieve symptoms, but it is temporary and does not help with the cause.
• I was very sceptical at first of Edgelow's TOS programme focusing on breathing, but this turns out to be a large part of restoring thoracic mobility, although it is only part of it.
• Efficient movement is everything. At every opportunity I now try and move, whether it's at my desk or at home.

The best English book I have read on the topic is:
Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction by Evan Osar. He has a very similar philosophy on movement disorders. His website (Fitness Education Seminars) also has excellent videos on thoracic mobility. I was very dissappointed with the Illig et al. TOS book (which I own) as the conservative treatment chapters number less than 5% of the pages.

I would highly recommend that people investigate whether such a disorder could explain their case.