It wasn't meant as a criticism. It was meant to point out that each of us is different. Where posture may not be your situation, it IS crucial in many TOSers including mine. Hence my harshest point was your advocating "forget posture" Forget "truncal strengthening" For you, perhaps you can forget it. For many others, we can't if we want to get relief. Strengthening certain muscles to overwhelm the pull of others which is creating postural imbalances and then compression is KEY for many. If it is not for you, more power to you. I was already flamed for advocating something when I clearly did not advocate it. I usually, if not always, post MY experiences and MY findings to the extent that they may help another. I would never say "forget posture" or "forget trunctal strengthening"

Gotta defer to you about "soft rib cage." Never heard of the rib cage referred to as hard or soft. My suspicion, based on your description, is that the medication helped you to relax your breathing so that your ribcage did not expand as much (hence your reference to hyperinflated...i.e. larger than normal ribcage). You say hard, I say large..you say soft, I say reduced in size. Probably the same thing. But it helps my point which is that "reduced space" whether by a hard or larger than normal ribcage will impinge on the space for nerves and muscles and other tissue...less space, creates impingement/entrapment/irritation/compression and voila...TOS or the like. That's all I said.

Currently, my PT is having me work on lowering my rib cage for certain things/movements. It surprised me that it was contributing (not necessarily causing) certain sx. But as I get more and more familiar with my own anatomy, it make sense. Of course isolating certain muscles to achieve this is more work. Dang.

The Brachial Plexus (BP), as I understand it from reading and looking at photos, pictures, drawings etc. passes a large territory and beneath and inbetween and over certain other anatomical structures. In some people it varies the "typical route" and sometimes there are issues and sometimes there are no issues. These detours are common with many nerves.

In my situation (which I assume others share to some extent) the BP is compromised/compressed in the vicinity of the first rib/clavicle. This is usually referred to as costoclavicular syndrome. Not only is the BP compromised, but my subclavian artery and vein is compressed there causing some circulation issues as well. Part of the compromise is aggravated by forward head position (which I have from time to time but am correcting) which tightens the scalenes and causes them to pull UP on the first rib (where one or more scalene is attached). The BP also passes in between or around (depending on each of our unique routes for the BP) the scalenes...so having tight scalenes adds to the compression and irritation...again the circular cycle of irritation, tightness compression that never seems to get relieved. Rounded shoulders also adds to this because of the forward/anterior tilt of the upper body and rib cage. It contributes to the creation of tight pecs including the pec minor. Resulting in what I describe as a sort of concave chest vs. the open chest. Now you have compromise of the BP at the coracoid process which is where the pec minor attaches...surprise surprise. Yes, it is well known that compression here will be yet another TOS offshoot...pec minor syndrome which is the other area in MY case of compression and compromise...both areas are helped/relieved when I engage in trunctal strengthening or what I understand as strengthening back muscles to overwhelm the pull of tight pec minors...correcting posture to open the chest and eliminatte the concaveness...correcting head forward to relieve the stress on the neck muscles including but not limited to the scalenes...and finally (or recently) lowering my ribcage to further assist in the decompression on the first rib/clavicle area.

Oooh...lots of good questions. Compromise behind pec minor...typically (not always)..bad posture..rounded shoulders...weak or tight pec minor muscles...concave chest. Look at the anatomy and you will see a rounded shoulder or it rolling forward REDUCES the space of the BP to pass...thus you increase the likelihood it will get pinched/irritated/injured/compressed. Voila...pain. Muscle imbalance is over time...sit or stand or walk etc...with bad posture and you increase the likelihood. Some are predisposed to this. My PT told me that I was predisposed that I want to take too much responsibility for having bad posture. She said it's bad but not as bad as others who have no issues. I also had huge breasts until 17 and had them reduced...this compounded my poor posture which really never got corrected. All that dragging down. One group vulnerable to TOS are women with huge breasts because of the weight pulling down and forward their upper body posture. Check it out. I'm not sure about why the serratus anterior is weak...but probably the same reason that the upper back muscles rhomboids and mid traps are weak too...they give up trying to hold up the body in the correct upright position and thus become weak...the pecs don't become strong but they tighten in response and almost cause the structure to be permanently bent in this bad position. My back muscles were weak...they are stronger now...not strong enough consistently but it takes time and I have to be patient and keep working at it. I am seeing and feeling the difference. It is one reason I am screaming for people to really work at this. I understand that it may not work for everyone, but it may work more often than is being tried.

To each his own I guess. I don't know your situation well enough to comment about the forward head etc. All literature and common sense says that the head should not be held forward. I recognize there are exceptions. Is it possible though that you are comfortable with forward head because your structure has adapted to this? I forget the explanation but ultimately it is still not good. It was and is a bit of a strain for me to correct my head but ultimately it is not painful and I can almost feel the improved circulation. Though in case the forward head doesn't appear to be the biggest culprit ...but over all upper body posture...thus when I correct shoulders and chest the head almost naturally will go back. I would resort to medication only when all other efforts fail. The one thing I picked up in your many posts that I couldn't relate to or comment on its impact was the compromise of your LTN. You seem to have an element that I did not have. Other than that many of your self help remedies seemed similar to mine...i.e. open the chest...get the body/shoulders to go back etc. I'm surprised that you feel that forward head is good for you...but if it works for you...great.