Dr Sanders reports on TOS
And Peter I Edgelow suggests the following 5 points if TOS sufferers are to improve
In the physical examination of these patients, there are consistent findings that must be addressed before adequate progress can be attained:

1. The patient must become aerobically fit. I surmise to help increase circulation which provides nutrients to muscles and nerves. My theory is that TOS somehow curtails or cuts of circulation
2. There is often present asymmetrical weakness of the small muscles that control movement of the thumb. (Flexor and abductor pollicis). This weakness can be reversed by self-traction for 30 seconds (diagram 1) and weakened again by mechanical stress to the neck such as compression.
3. There is a pattern of chest breathing and an inability for the patient to perform relaxed breathing with the diaphragm.
4. There is loss of mobility and increased sensitivity of the nervous system, especially the brachial plexus. (The nerves that pass from the neck to the arm.)
5. There can be coldness of the hand particularly the ring and little finger.

Treatment must be directed to reversing these 5 issues if they exist. The home program is designed to help the patient accomplish this on his or her own.

DR Steven D Feinberg writes
SYMPTOMS
Symptoms can be brought on by overhead activities such as hair combing, or at night when sleeping on one side which can put pressure on the structures within the thoracic outlet. Each of these maneuvers/positions causes a tightening or compression of the thoracic space. Thus the nerves and/or blood vessels may be compromised and produce the associated symptoms. TREATMENT
More commonly and appropriately though, first-line treatment is directed towards a physical rehabilitation program, in which physical therapy plays a large role. Initial treatment emphasis is placed on weight loss, postural re-education, and shoulder girdle exercises along with stretching, strengthening, conditioning and the passage of time. Evaluation of activities of daily living and the workplace environment is a must. Again, IMHO to see how the posture/position of the body and/or anatomy is causing YOUR particular compression. Physical therapy management of TOS requires accurate evaluation of the peripheral nervous system, posture, and the cervico-scapular muscles. Patients should be instructed in postural correction in sitting, standing and sleeping, stretching exercises, and strengthening exercises of the lower scapular stabilizers beginning in gravity-assisted positions to regain normal movement patterns in the cervico-scapular region. Other techniques include evaluation of joint mobility and muscular imbalance. Patient education, compliance to an exercise program, and behavioral and ergonomic modification at home and work are critical to long-term successful conservative management. Selected patients may benefit from trigger point injections or acupuncture treatments.



Physiotherapists told me that I was chest breathing and showed me exercises to correct this problem. I was unable to correct the problem. So medication helped you to breathe properly which reduced the hyperinflation and corrected the compression.Muscle spasms in my upper back were persistent and very painful. Treatment for these spasms would often make them worse to the point where the soreness extended around to the front where my ribs joined my sternum. Sleeping on this ribcage was very uncomfortable. Cause it causes compression. Laying on this ribcage made matters worse. An x-ray in 2006 for an unconnected matter showed that I had hyper-inflated lung fields.Hyperinflated lungs...less space for BP to pass, increased likelihood of compression. Medication to correct my breathing has changed my world around. Reduced his ribcage size which reduced his compression or likelihood for compression. Muscle spasms are significantly less, my mattress feels like a different mattress, I am not exhausted as I used to be, I now have a soft ribcage. A soft ribcage is a much more comfortable thing to have.
I know now that the changed breathing pattern combined with the increased pressure on my diaphragm from being 12 kilograms (26 pounds) heavier, much of it around my waist had contributed to the way that my rib cage affects the nerves, muscles and other structures in my upper body. (the experts say chest breathing and being overweight causes problems, they don’t say why, Because over weight creates more pressure on nearby tissues and structures and more stress on muscles and nerves...weight loads all of these structure...if you have TOS you want to REDUCE the load/stress. Chest breathing causes the ribcage to inflate...rise up into the space where the BP may pass ...first rib and clavicle...causing it to be compressed..belly breathing reduces this "rising up" I believe it is under rated significance of the effect that an immobile ribcage has on TOS) The problems with my rib cage have caused deterioration in my condition and have been a significant hurdle in the quest for improvement. I am now closer to how I used to be preTOS.
Some people have cervical ribs removed, some have non-cervical ribs removed, some have botox in muscles which connect ribs (I was told that I had myofascial pain of the erector spinae muscles, and offered botox), some have muscles which connect to ribs removed (scalenectomy). My suggestion is try strategies which soften the rib cage, it will make nerves and muscles and joints between vertebrae and ribs feel so much better. Try not to lay too much on the ribcage, try not to put too much pressure on the diaphragm which forces the ribcage up.

Forget truncal strengthening. BS flag...sorry
Forget posture,BS flag again
if attempts to improve one’s posture mean increased pressure on tight muscles and nerve bundles this will only make you worse. True pressure will cause compression...but improving posture and structure usually is to DEcompress...OPEN the space.
Neural stretching and nerve glides are much easier over a soft rib cage.

Edits added to a select portion of Towelhouse's earlier post.